Focal peripheral neuropathies in instrumental musicians

A Physiotherapeutic Approach to Musicians' Health - Data From 614 Patients From a Physiotherapy Clinic for Musicians (INAP/O)

Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

Thoracic outlet syndrome (TOS) is a neurovascular condition involving the upper extremity, which is known to occur in individuals who perform chronic repetitive upper extremity activities. We prospectively evaluate the incidence of TOS in high-performance musicians who played bowed string musicians. Sixty-four high-performance string instrument musicians from orchestras and professional musical bands were included in the study. Fifty-two healthy volunteers formed an age-matched control group. Bilateral upper extremity duplex scanning for subclavian vessel compression was performed in all subjects. Provocative maneuvers including Elevated Arm Stress Test (EAST) and Upper Limb Tension Test (ULTT) were performed. Abnormal ultrasound finding is defined by greater than 50% subclavian vessel compression with arm abduction, diminished venous waveforms, or arterial photoplethysmography (PPG) tracing with arm abduction. Bowed string instruments performed by musicians in our study included violin (41%), viola (33%), and cello (27%). Positive EAST or ULTT test in the musician group and control group were 44%, and 3%, respectively (p = 0.03). Abnormal ultrasound scan with vascular compression was detected in 69% of musicians, in contrast to 15% of control subjects (p = 0.03). TOS is a common phenomenon among high-performance bowed string instrumentalists. Musicians who perform bowed string instruments should be aware of this condition and its associated musculoskeletal symptoms.

Thoracic outlet syndrome affecting high-performance musicians playing bowed string instruments

Thoracic outlet syndrome, a condition due to neurovascular compression in the upper shoulder region, can be caused by chronic repetitive activity of the upper extremities. Studies have linked upper extremity musculoskeletal disorders to high-performance musicians who play bowed string instruments such as the violin or viola. We report herein a case series of five elite musicians, including three violinists and two violaists, who developed neurogenic thoracic outlet syndrome following years of intense practice. Successful surgical treatment including first rib resection, scalenectomy, and brachial plexus neurolysis was performed in all patients. All patients were able to resume their musical career following surgical treatment. Our report represents the first description of thoracic outlet syndrome in high-performance bowed string instrumentalists. Clinicians should be aware of thoracic outlet syndrome as a differential diagnosis when treating string instrumentalists with upper extremity musculoskeletal ailments.

Hand disorders in musicians

Like athletes, musicians are vulnerable to musculoskeletal injuries that can be career ending or have a severe negative financial impact. All ages are affected, with a peak incidence in the third and fourth decades. Women are slightly more likely to be affected than men. It is incumbent upon orthopaedic surgeons to be able to complete a thorough physical assessment, be aware of the risk factors associated with musculoskeletal symptoms in musicians, and have a detailed knowledge of the specific syndromes they suffer and their appropriate treatment.

In this paper we review the common hand injuries that afflict musicians and discuss their treatment.

Cite this article: Bone Joint J 2013;95-B:146–50.

Chin force in violin playing

Force generated between the left mandible of violinists and the chinrest of the violin was examined using a force-sensing chinrest developed in this study. A strain-gauge force sensor was built, and it was fixed between the violin's top plate and a chin cup. Fifteen professional/amateur violinists held the violin statically, played musical scales with different sound properties and sounding techniques, as well as an excerpt from a Max Bruch concerto. Peak and mean forces were evaluated for each task. In a separate experiment, lateral movement of the lower teeth due to different levels of voluntary chin force exertion was measured. Static holding forces observed were 15 and 22 N with and without the help of the left hand, respectively. Peak force increased from 16 N at soft dynamics to 20 N at strong dynamics during scales. The force further increased to 29 N with the use of vibrato technique and 35 N during shifts. Tempo and hand position did not affect the force. Playing a Bruch concerto induced a mean peak force of 52 N, ranging from 31 to 82 N among the violinists. The developed force-sensing chinrest could accurately record the generated chin force. Typical chin force to stabilize the violin during ordinary musical performance was less than 30 N, but it could momentarily exceed 50 N when technically demanding musical pieces were performed. The lateral shift of the mandible was fairly small (<0.4 mm) even with high chin-force exertion, possibly due to clenching of the molars.

Left hand finger force in violin playing: tempo, loudness, and finger differences

A three-dimensional force transducer was installed in the neck of a violin under the A string at the D5 position in order to study the force with which the violinist clamps the string against the fingerboard under normal playing conditions. Violinists performed repetitive sequences of open A- and fingered D-tones using the ring finger at tempi of 1, 2, 4, 8, and 16 notes/s at mezzo-forte. At selected tempi, the effects of dynamic level and the use of different fingers were investigated as well. The force profiles were clearly dependent on tempo and dynamic level. At slow tempi, the force profiles were characterized by an initial pulse followed by a level force to the end of the finger contact period. At tempi higher than 2 Hz, only pulsed profiles were observed. The peak force exceeded 4.5 N at 1 and 2 Hz and decreased to 1.7 N at 16 Hz. All force and impulse values were lower at softer dynamic levels, and when using the ring or little finger compared to the index finger.