Piper's Palsy: A Focal Dystonia

Richard J. Lederman
From: Medical Problems of Performing Artists: Volume 13 Number 1: Page 14 (March 1998)

Abstract: Focal dystonia is an uncommon but often disabling disorder of instrumental musicians. This report describes four high-level bagpipers, three men and one woman, with focal dystonia involving the left hand. One man had bilateral involvement. Age at onset ranged from 27 to 49 years, after 13-45 years of playing (median = 17). The left middle finger was involved in all four; other fingers including the thumb were affected in three. Onset was insidious, with progression over one to two years to a plateau in three and a more protracted course in one. Contralateral involvement was delayed by 14 years in the piper with bilateral dystonia. Two of the four had a total of three nerve decompression procedures prior to recognition of the correct diagnosis, with no therapeutic benefit realized. Treatment with trihexyphenidyl has been of benefit in two of the four. One has devised splints for the right fingers, which have also been helpful. One patient underwent a series of botulinum toxin injections over two years; these helped temporarily but were ultimately unsatisfactory. Three continue to play (none competitively), one as much as eight hours per day, with variable degrees of impairment

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