Upper extremity disorders in performing artists

Upper extremity disorders in performing artists Leo M. Rozmaryn, M.D.
Dr. Rozmaryn is an orthopaedic and hand surgeon in Rockville, Maryland, and a member of the Med Chi Committee on Medicine and the Performing Arts.	ABSTRACT: Studies in the past decade have shown that a significant proportion of instrumentalists report musculoskeletal problems severely affecting their musical performance. Musicians endure daily intensive use of their upper extremities, frequently placing them in bizarre positions. Their training schedules are rigorous and long term Predisposingfactors to, and treatmentfor, overuse syndromes, tendinitis, and tendon trauma commonly encountered by musical performers are discussed at length. Nerve entrapment has also surfaced as a major problem in musicians, and the means of evaluation and treatment and the role of surgery are put forth. T echniques for studying and analyzing the difficultiesfaced by instrumentalists are summarized. Performing arts medicine is a distinct subset of occupational medicine. Its direct applications to upper extremity disorders of performing artists stem from approximately two decades of experience in dealing with special problems of athletes in sports medicine. Musicians, due to the nature of their vocation, present with an array of specialized problems. As a result of developing and maintaining a musical career, performers endure daily intensive use of their upper extremities, often placing them in bizarre positions. Performers frequently bear the weight of instruments on both hands with intense repetitive use of fingers, wrists, elbows, and shoulders. Speed and accuracy are of the essence. There is a strong element of competitiveness andan extraordinarily high demand on them. While many sports careers end when athletes are in their late thirties or early forties, a musical career usually spans a lifetime of70 or 80 years. Historically, musicians have been extremely misunderstood; for the most part, this is still true, but it is changing. Musicians frequently present to the uninitiated health care provider with a "mild injury .' These mild injuries, however, may be potentially career-ending to the performer. A performer's skills are rarely transferrable to other fields, which may result in anxiety and depression. As opposed to many other occupational injuries, there is no secondarY gain and these patients are fiercely driven to return to work. Litigation, workers' compensation, and malingering are rare in this group. Training schedules are rigorous and long-term, and there is a continuously increasing neuromuscular learning curve in this
Maryland Medical Journal March 1993	255
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