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Intrinsic Muscle Strain in the Instrumentalist

William J. Dawson
From: Medical Problems of Performing Artists: Volume 20 Number 2: Page 66 (June 2005)

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Abstract: The playing of many musical instruments is performed principally by the small intrinsic muscles of the hands. Practice records were reviewed to investigate the epidemiology, etiology, and risk factors for intrinsic muscle strain. Fifty-one instrumentalists were found, out of 129 having strains of all hand and forearm muscles. These 51 comprised 15.5% of all 329 musicians seen for overuse-related conditions. The patients¿ ages ranged from 10 to 72 years; 20 were male. Forty-one of the 51 played keyboard or stringed instruments; 11 of the 19 stringed instruments were bowed. Twentyone patients were professionals or university conservatory music students. Sixty percent of strains were caused by playing music, with slightly more than half being in the professional/collegiate cohort. Pianists were more likely to experience right hand involvement. Seven patients had bilateral intrinsic strains. Thirteen experienced concomitant strains of the extrinsic forearm muscles, either on the same side or bilaterally with bilateral intrinsic strains. Treatment followed standard principles, with hand rest prescribed in 12, musical practice changes in 19, activity modification in 30, and formal exercises/hand therapy in 23. Nonsteroidal medication was prescribed in 17 cases. The data suggest that intrinsic muscle strains related to overuse follow the same etiologic and anatomic patterns as other upper extremity muscle strain and pain syndromes and have the same risk factors. Health care providers should be aware of the role of the hand intrinsic muscles in playing musical instruments and their propensity for overuse-related strain syndromes from both musical and nonmusical activities.

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