Injuries associated with instrumentalists are often referred to as RSIs (repetitive stress injuries) or overuse injuries. This diagnosis is often an all-encompassing generalization for various musculoskeletal disorders and, consequently, may lead to a generic treatment approach to the problem. Overuse syndrome, in particular, is frequently a misdiagnosed form of tendinitis, bursitis, or other inflammation (Hansen & Reed 2006). In accordance with the majority of present research, we will refer to this genre of injury as performance-related musculoskeletal disorders (PRMDs).
PRMD Indicators
Early signs of a possible PRMD can become visible in the form of muscle weakness, cramping, pain, or dystonia (Shafer-Crane, 2006). A very common injury among musicians is tendonitis. This is inflammation of the tendon (usually in the forearm) in response to tissue damage such as small micro-tears and strains (Shafer-Crane, 2006). General tissue damage and inflammation cover a great deal of the injuries experienced by musicians. Perhaps the most common causes are poor posture and technique. According to Maganaris, playing to the point of excessive muscle fatigue is another large concern for injury, potentially leading to ischemia and “tendon creep” (as cited in Shafer-Crane, 2006).
Neurological
If the musician experiences numbness or tingling sensations in the upper extremities, particularly the hands and fingers, it can indicate damage or compression of a nerve. A common PRMD is focal dystonia, which refers to cramping and uncontrollable muscle contractions. This is usually seen in the hands and fingers but, in the case of pianists who often use a system of foot pedals, may include one’s feet (Shafer-Crane, 2006). Early signs of focal dystonia may be seen as a decreased level of control in the fingers, hand, or arm (Guptill & Zaza 2010). Another potential threat to neural function is an adhesion, which may form within the connective tissue as a response to tissue damage or general hypertrophy. If this adhesion is located within the vicinity of a local nerve, it can cause compression and lead to complications in neural function of the affected area. This translates to a possible decrease in muscle strength as well as potential muscle atrophy (Shafer-Crane, 2006). Yet another factor to consider with neuromuscular issues is muscle tone. Some studies have shown that a significant amount of muscle tone can cause interference or even nerve entrapment in peripheral nerves that are located within areas densely packed with muscle and connective tissue. There are many factors that can affect the neuromuscular system in musicians, but posture is perhaps one of the most influential. Awkward and improper postures may place the body out of its natural alignment and elevate the amount of stress in certain areas, leading to possible nerve compression.
Symptoms exhibited in the thumb, index finger, middle finger and radial half of the ring finger may be signs of median nerve compression or entrapment. Those experienced in the ulnar half of the ring finger and the little finger may indicate compression or entrapment within the ulnar nerve. Finally, having sensations of tingling or numbness in the first three digits during sleep can be a sign of carpal tunnel syndrome (Shafer-Crane, 2006). If any of these symptoms are experienced, the individual should be assessed by a physician. The most widely accepted test used to diagnose any of these neurological symptoms with a specific musculoskeletal disorder is the nerve conduction test, which monitors the delay of electrical impulses throughout the affected area.
PRMD Indicators
Early signs of a possible PRMD can become visible in the form of muscle weakness, cramping, pain, or dystonia (Shafer-Crane, 2006). A very common injury among musicians is tendonitis. This is inflammation of the tendon (usually in the forearm) in response to tissue damage such as small micro-tears and strains (Shafer-Crane, 2006). General tissue damage and inflammation cover a great deal of the injuries experienced by musicians. Perhaps the most common causes are poor posture and technique. According to Maganaris, playing to the point of excessive muscle fatigue is another large concern for injury, potentially leading to ischemia and “tendon creep” (as cited in Shafer-Crane, 2006).
Neurological
If the musician experiences numbness or tingling sensations in the upper extremities, particularly the hands and fingers, it can indicate damage or compression of a nerve. A common PRMD is focal dystonia, which refers to cramping and uncontrollable muscle contractions. This is usually seen in the hands and fingers but, in the case of pianists who often use a system of foot pedals, may include one’s feet (Shafer-Crane, 2006). Early signs of focal dystonia may be seen as a decreased level of control in the fingers, hand, or arm (Guptill & Zaza 2010). Another potential threat to neural function is an adhesion, which may form within the connective tissue as a response to tissue damage or general hypertrophy. If this adhesion is located within the vicinity of a local nerve, it can cause compression and lead to complications in neural function of the affected area. This translates to a possible decrease in muscle strength as well as potential muscle atrophy (Shafer-Crane, 2006). Yet another factor to consider with neuromuscular issues is muscle tone. Some studies have shown that a significant amount of muscle tone can cause interference or even nerve entrapment in peripheral nerves that are located within areas densely packed with muscle and connective tissue. There are many factors that can affect the neuromuscular system in musicians, but posture is perhaps one of the most influential. Awkward and improper postures may place the body out of its natural alignment and elevate the amount of stress in certain areas, leading to possible nerve compression.
Symptoms exhibited in the thumb, index finger, middle finger and radial half of the ring finger may be signs of median nerve compression or entrapment. Those experienced in the ulnar half of the ring finger and the little finger may indicate compression or entrapment within the ulnar nerve. Finally, having sensations of tingling or numbness in the first three digits during sleep can be a sign of carpal tunnel syndrome (Shafer-Crane, 2006). If any of these symptoms are experienced, the individual should be assessed by a physician. The most widely accepted test used to diagnose any of these neurological symptoms with a specific musculoskeletal disorder is the nerve conduction test, which monitors the delay of electrical impulses throughout the affected area.