A handy guide for musicians - 3 March 2017

Capable of producing the most sublime sounds, a musician’s hands are also susceptible to a great deal of strain and pain, largely due to the repetitive stress that is placed on certain muscles or tendons depending on the demands of their particular instrument. In 1887, one of Queen Victoria’s preferred physicians, George Vivian Poore published in the British Medical Journal the first major study in to conditions that affect the hands and arms of musicians.

An overuse injury will be experienced as discomfort leading to pain, lack of flexibility, fatigue of the affected hand and, eventually, loss of fine motor control. At first these symptoms may be present only when playing, but eventually they will start to affect the musician at all times. The impact of developing this type of injury extends far beyond the affected limb; just like a top-flight athlete, a professional musician’s career and livelihood can be significantly damaged and they may even be forced to abandon a discipline they love.

Common overuse injuries that affect musicians include:

Tendonitis
A pianist who practices relentlessly, playing for many hours on end, will be prone to developing tendonitis, an inflammation of the tendon that often occurs at a joint such as the wrist. Initially, the musician may start to experience weakness or fatigue after just a short time of playing and there may be pain and swelling.

How can musicians avoid developing tendonitis?

Mr David Hargreaves, Fortius Consultant in hand & wrist, told us that “warming up is key. Strengthening exercises of the hands can also help. Musicians should take frequent breaks when practicing or performing, so the hands and wrists receive adequate rest”. Confirmation of correct technique is essential as incorrect wrist positioning may be the cause. Swollen tendons can be treated with ice to relieve any pain and reduce swelling. Mr Hargreaves added that “ in some cases it may be necessary to splint and brace temporarily to allow the hand to heal. Anti-inflammatory gels can be useful for superficial sites”.

Functional Dystonia
Functional dystonia or musician’s cramp is a hand disorder that affects one to two per cent of all musicians and causes the fingers to move involuntarily. It is particularly common in those that play the violin, guitar, piano and clarinet and can be triggered by an increase in practicing or a change in techniques.

What treatments are available for functional dystonia?

Both diagnosis and treatment of this condition is challenging and it should be approached differently from other conditions affecting the hand. Mr Hargreaves and the hand & wrist team work closely with specialist hand therapists who are experts in this field.

Carpal Tunnel Syndrome
Sufferers commonly experience persistent numbness in the hand accompanied by pain and a burning sensation at the base of the palm. The median nerve that runs through the narrow carpal tunnel becomes compressed – repeated flexing and extending the wrist when playing the drums, for example, can also constrict the carpal tunnel.

Can you prevent Carpal Tunnel Syndrome?

Keep your wrist in a neutral position as much as possible as it reduces the risk of contracting the carpal tunnel. It’s natural for the musician to keep their fingers and hands perpetually flexed during rehearsals, so be aware of this and rest your hand during breaks.

Cubital Tunnel Syndrome
Typically, musicians with Cubital Tunnel Syndrome experience numbness on the inner edge of the elbow, the little finger and the inner half of the ring finger. The ulnar nerve which passes through the inner middle elbow, known as the cubital fossa, becomes compressed. It commonly affects string musicians that regularly flex and extend their muscles. At first, there is usually discomfort and numbness and the sensation of prickling or burning in the fingers and forearm may begin to affect performance.

Is it possible to improve Cubital Tunnel Syndrome non-surgically?

Physical therapy can greatly relieve this syndrome in the early stages, but if it doesn’t improve then surgery for the nerve at the elbow may be required. Surgery either moves the ulnar nerve to a new canal or increases space to restore function.

De Quervain Tenosynovitis
The repetitive strumming of the guitar combined with an ‘over-cocking’ of the hand, can result in this wrist condition which causes intense pain and often crippling swelling at the base of the thumb. Typically, it can be treated with splinting and physical therapy that works on the thumb.

Does De Quervain Tenosynovitis require surgery?

Mr Hargreaves explained, “Steroid injection can resolve this in the early stages. If pain and swelling persists despite other measures being taken, then a hand surgeon may release the flexor tendon to reduce symptoms and allow full mobility of the tendons that are employed when strumming the guitar, for example”.

Stenosing Tenosynovitis
Also known as ‘trigger finger’, this condition can result in the index finger being constantly bent. It’s often experienced by violinists that perform a repetitive gripping action as they rapidly change chords.

Will I be able to continue play with Stenosing Tenosynovitis?

Precision playing of the violin or guitar isn’t compatible with a condition such as Stenosing Tenosynovitis, therefore persistent cases may require intervention; this could be with an injection of a corticosteroid into an inflamed area or releasing the tendon sheath with a needle.

The aim of treatment is to return a musician to play as soon as possible. A violinist holds the bow in a number of different positions, mainly using the middle finger and thumb. Playing the piano puts a great deal of pressure on the thumb as it is continually flexed and rotated. A guitarist’s hands are fully flexed and the fingers perform many small, precision movements. Surgery must be approached with caution, after other measures have failed to work, and the musician’s specific instrument physical demands must be taken into account.

At the Fortius Clinic, our hand and wrist surgeons focus exclusively on treating the upper limbs and are experienced in treating musicians and performing artists at all levels. They fully understand the concern that musicians have when their hands are letting them down. If you wish to contact a member of the hand & wrist team visit their profiles on our website.

Source: www.fortiusclinic.com/news/a-handy-guide-for-musicians