Medical Problems of Musicians

Surveys of performing musicians indicate that almost half of them experience playing-related medical problems, some of which threaten or end their careers. Overuse injuries involving the muscle—tendon unit are the most common problem, with symptoms ranging from mild pain while the musician is playing to pain severe enough to preclude any use of the affected hand. String players are the most commonly affected, and percussionists the least. The most important predisposing characteristic is the use of repetitive movements during long hours of practice, but awkward body positions man-dated by the shape and weight of the instrument, the technical difficulty of the repertoire, and unfamiliar instruments may also play a part. Women are more commonly affected than men. Rest is the cornerstone of therapy. Neural impingement syndromes affecting the median or ulnar nerves or the thoracic outlet affect many musicians. Focal dystonias may involve part or all of a hand or the muscles forming the embouchure (the position of the lips in wind players). These are very resistant to therapy and may terminate or drastically alter a career. Stress, especially performance anxiety, may impede performance. Beta-adrenergic blocking agents prevent the symptoms of performance anxiety and are frequently used by musicians without medical supervision. A recognition of the unique problems of musician-patients has led to the formation of successful specialty clinics in a number of cities. (N Engl J Med 1989; 320:221-7.) MUSIC and medicine have always been closely linked. Apollo the Physician, referred to in early versions of the Hippocratic oath, was an accomplished musician. Shamans, who were perhaps the earliest health care providers, continue to use music and dance as the cornerstone of their therapy. This identity between the performing and healing arts has been blurred as refinements in our understanding of disease processes have transformed medicine. As a consequence, new perspectives on the arts have appeared. Creativity and perception have become the objects of high-technology studies in medical schools, which at the same time have taken deliberate steps to. . .