The 5-S Metrics that really matter to musicians
Span, Speed, Sensitivity, Strength and Stamina
are quickly noted when they aren’t quite as good as they were. This vlog explains a little more…
The five metrics of things that I think musicians notice much more than other people
1. Span
2. Speed
3. Sensitivity
4. Strength
5. Stamina
So, the five Ss are the things that musicians notice much more - when they're abnormal -than people who aren't musicians.
For example, if you are looking at your span of your hand, a pianist will be aware of the span of their hand is less than 21cm and if they have small hands there really struggle with ninths and tenths and will find workarounds or they may have change their repertoire and will find other techniques. If you've always had a span that's allowed you to be able to reach a 10th then you suddenly notice, say if you have a Dupuytren’s contracture or some osteoarthritis in your hand which is reducing your span, for example you may have osteoarthritis of the base your thumb which is reducing your span, so you can no longer play a tenth (and most people working at a computer keyboard or doing any other job such as a carpenter wouldn't notice that small diminution of their span) the musicians are acutely aware of that and will need that back if they are to reach their previous level performance.
Similarly in speed, a musician is very aware of the ‘need for speed’ when you play music. Any reduction in that speed, for example if you have some slight flexor tendonitis or some stiffness in your joints, that speed will be reduced then your performance will be impaired.
Sensitivity is really important if you're, say, a violinist and you need to be able to feel the strings, and many musicians play their instruments with their eyes closed, they can feel where they are in space - proprioception as it's called - or they can feel the texture of the strings or the frets, and any reduction in that may impair their performance. That’s quite common in early carpal tunnel syndrome or cubital tunnel syndrome or any other sort of neurophysiological abnormality.
Strength is also important: for example if a guitarist has to play barre chords to press really hard with a thumb against the back of the neck to be able to prevent ‘fret buzz’, then they might notice a reduction in their pinch power.
Stamina: of course musicians are aware of whether they can do a 2 hour session or not and forearm fatigue and tendonitis will would be very obvious and any reduction in stamina, say from 2 hours down to 1.5 hours before they start to fail, and will be noticed early.
So, this is a little summary of five words which happen to begin with S which musicians notice much before anybody else - when they are abnormal.
Of course, they will come to us to see if they can have all of those things returned to normal. In many cases the criteria for surgery that we traditionally use would not apply to a musician because the amount of impairment is so subtle that it may not be detectable on imaging such as MRI, ultrasound or xrays, or even on neurophysiology. Even clinical examination may be normal, but it is noticeable to the musician.
The stakes are much higher you're trying to intervene for something which isn't very abnormal in the first place We are trying to get back to a very high level of function and so you have to worry a lot about what are you doing - intervening at all! Of course, if you're taking on anything with a high risk, such as surgery or even a steroid injection then you might want to think much more carefully about doing that to somebody who is very close to normal but not quite perfect.
This is why I say that musicians are so well attuned to these metrics. They can tell you how much better they are if all goes well with treatment. And conversely… if things aren’t getting any better with treatment, a musician will be able to tell you EXACTLY how much worse they are!
I hope this gives you some idea of some of the areas of difficulty with treating musicians hand that might be different to treating a non-musician.
