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Arm pain without physical findings occurring in association with light repetitive work has been with us from the time man developed factories but has become controversial since a number of reported cases in Australia in 1983. It remains a highly contentious and medically confused area. Claims for compensation for the condition against employers have been firmly rejected by courts in Australia and the USA, but large awards continue to be made in UK courts. The reason for this difference lies in recent changes in British Law and court procedure and British courts now seem to recognize this nebulous clinical condition as representing a compensable injury. In this situation, therefore, physicians must be meticulous in their examinations and record keeping. In addition, they must only use specific diagnoses when irrefutable clinical signs or confirmatory special investigation results are present and must be guarded in loose talk or discussion about "causation".

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Care of the painful or injured hand or arm in a musician requires time, great patience, sophisticated knowledge and analysis of both the musician and their instrument, and in most cases a non-surgical approach. This is a tall order for the busy hand surgeon. Close collaboration between interested specialized physicians and the hand surgeon facilitates care of these patients. Additional help from music teachers, specialized instrumentalists, psychologists, arts therapists and family may be vital. Nevertheless, nothing short of a comprehensive approach will be successful and a limited approach may be functionally damaging if not disastrous. If an operation is necessary, provided surgery is performed with careful planning and skill, the results need not be as unsatisfactory as previously believed and indeed can in certain circumstances salvage a musician’s career.