Medical Problems of Performing ArtistsMedical Problems of Performing Artists

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Upper-extremity problems caused by playing specific instruments

William J. Dawson
From: Medical Problems of Performing Artists: Volume 17 Number 3: Page 135 (September 2002)

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Abstract: This study was undertaken to obtain information on the prevalence of music-related upper-extremity problems peculiar to a specific instrument or group of closely-related instruments, and to help determine what problem types are most common or characteristic for players of specific instruments. Music-related problems in 167 performers from a hand surgical practice were reviewed retrospectively. The musicians ranged in age from 9 to 83 years; 41.9% were males. Nearly 90% were professional performers, teachers, collegiate music students, or dedicated amateurs. More than 75% played strings or keyboard instruments. Multiple diagnoses were found in 37.7% of musicians. Data from the six largest instrumental groups revealed that muscle-tendon strain diagnoses were most common, occurring principally among pianists, violinists and violists, guitarists, and reed instrumentalists. Other common diagnoses included inflammatory disorders (tenosynovitis and the like), hypermobility, masses, and arthritic problems. Of the pianists, 54.7% developed strains, 17.4% inflammatory conditions, and 12.8% nerve problems. Violinists and violists as a group had 64.4% strains and 6.7% inflammatory conditions. Guitarists presented with 37.5% strains, 21.9% inflammatory conditions, and 15.6% nerve problems. Flutists had 25% strains and 45% inflammatory conditions. Other woodwind musicians developed 68.2% strains and 13.6% inflammatory conditions. Percussionists had 36.4% strains and 36.4% inflammatory conditions. Only one musician developed an upper-extremity problem that could be considered unique to playing a specific instrument. Statistically significant occurrence rates were found only in pianists under age 30 with strain diagnoses and in those above age 30 with inflammatory problems. These categories seem to be related to repetitive and/or forceful upper-extremity movements, and the resulting specific pathological processesThis paper is driven by the idea that the work of musical performance (possibly together with other forms of fine arts performance such as dance and theater) shares many things with other types of work, but has, as well, a few important factors that set it apart. Just as work on the assembly line is shaped in part by the design of the line equipment and the constraints imposed by the production process (number and order of operations, line pace, etc.), the work of musical performance is shaped in part by the mechanism of sound production associated with the instrument used and the "production process" mandated by the specific music performed. It is my hope that by illuminating the likenesses and differences between these two types of work, especially the constraints associated with music performance, I will prompt performers (and those who treat them) to begin to form a clearer picture of the real demands this work places on them.

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