Common Hand & Wrist Problems in Musicians
These are athletic hands and we can expect them to go wrong occasionally. Sports people expect injury. Musicians injure themselves too. And also develop the same problems with their hands as everyone else. These have very significant effects on musicians at the earliest sign of malfunction - reduced power, speed, dexterity, sensitivity, range.
The commonest problems in musicians are generally related to tendons.
Trigger finger and carpal tunnel syndrome are both examples of swollen flexor tendons in the hand. If all the tendons are slightly swollen as they pass through the carpal tunnel they will cause pressure on the Median nerve and cause altered sensation and pain. If individual tendons are too swollen to pass through the tunnels into the digits, they will cause triggering. Other forms of tendonitis around the wrist are also very common and are generally caused by changes in activity which the body is not used to. Ligaments also fail in this way. Examples of this might be a step-change in the amount of practise people are doing, for example when people first go off to a Conservatoire from school. Practising for a very big engagement or changing to an instrument with a heavier action. Once established, an injured tendon or ligament can cause pain and problems for many months and sometimes years. Some of these are more common with certain instruments than with others. There are recognisable patterns.
Loss of sensation in the hand causes very significant problems for musicians particularly with sensitivity is very important. This can sometimes be a peripheral entrapment such as in the carpal tunnel or cubital tunnel, or is sometimes related to adverse neural tension perhaps related to a cervical disc protrusion, or a localised pressure palsy. Some of these can be dealt with by hand therapy or physiotherapy, and some are amenable to postural adaptations and ergonometric adjustments.
There are degenerative conditions such as arthritis in small joints of the hand or Dupuytren’s contracture which may need surgical treatment but before they do there are many more conservative measures that we can pursue.
Another condition that can affect musicians is musicians focal dystonia. Thankfully this is a rare condition and is very difficult to treat. This is a complex condition that requires more discussion and can be covered in this format. In essence it is a condition in which the hand ‘misbehaves’ and cannot be made to do what the musician wants it to do. There are involuntary movements. It seems that this is primarily a problem with the ‘software’ in the brain, but in some cases it may be triggered by a mechanical abnormality in the hand. This can cause a mismatch between the expected behaviour of the hand in response to stimulation from the brain and the actual behaviour of the hand. Treatments involve ‘slow down’ therapy, mirror treatments, sensory distraction and taping or splinting.
Patients may of course have fractures and other injuries and these will need to be dealt with taking the musician specific needs into account.
