Hand therapy for the musician: instrument-focused rehabilitation

Resumen: La distonía focal de mano es un síndrome clínico neurológico caracterizado por la existencia de contracciones musculares involuntarias, sostenidas y persistentes, que provocan movimientos y posturas anormales. Su etiología, aunque controvertida, parece estar desencadenada por la actividad repetitiva, permanente y constante de la misma. Su diagnóstico es difícil, pues no existe ningún "test" o "pruebas diagnósticas" que la confirmen. De hecho, el diagnóstico de certeza de una distonía de mano puede demorarse entre 5 y 8 años, no siendo extraño que estos pacientes hayan pasado por varias cirugías previas innecesarias antes de su diagnóstico definitivo, el cual es básicamente clínico. Es por ello, que consideramos fundamental llegar a un diagnóstico precoz, con el fin evitar pérdidas innecesarias de tiempo y dinero, e iniciar el tratamiento más adecuado. En este sentido, la interacción entre cirujanos de mano, neurólogos y fisioterapeutas se hace imprescindible.Palabras claves: Distonía Ocupacional, músico, escribiente, terapia ocupacional. Focal hand dystoniaAbstract: Focal hand dystonia is a neurological clinical syndrome characterized by the existence of involuntary muscle contractions, sustained and persistent, causing abnormal movements and postures. Its etiology, although controversial, seems triggered by repetitive, continuous and constant activity of the hand. Its diagnosis is difficult because there is no "test" or "diagnostic tests" to confirm it. In fact, the true diagnosis of hand dystonia can take between 5 and 8 years. Sometimes these patients have undergone several previous surgeries before the diagnosis is established, which is mainly clinical. An early diagnosis, in order to avoid unnecessary loss of time and money, and starting the most appropriate treatment as soon as possible is considered fundamental when dealing with such an ilness. In this sense, the interaction between hand surgeons, neurologists and physiotherapists is essential. Key words:Occupational dystonia, musician, clerk, occupational therapy. Artículo de actualización Rev ibeRameR ciR mano 2014. 42 (2) : 172-182Con el término genérico de distonía, se define un "síndrome clínico neurológico caracterizado por la existencia de contracciones musculares involuntarias, sostenidas y persistentes, que provocan movimientos y posturas anormales 1 .No es nuestro propósito realizar una extensa revisión general sobre las distonías, pues escapa completamente del objetivo de este artículo, sino que la intención del presente trabajo es la de llamar la atención sobre un tipo en particular de distonía que afecta exclusivamente a la mano y cuya etiología, aunque controvertida, parece estar desencadenada por la actividad repetitiva, permanente y constante de la misma. La profundización en su estudio, es lo que nos ha llevado a escribir dicho artículo, pues estamos convencidos de que muchos cirujanos de mano, han tenido o tienen pacientes cuya sintomatología y clínica muy bien podrían corresponder a una distonía, cuyo diagnóstico es difícil, pu...

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“…De forma similar, dicho método y otros, se han utilizado en el calambre del escritor, con resultados variables 38,39 .…”

Section: Rehabilitaciónunclassified

Distonía focal de mano

Proubasta

Pagonabarraga

Lamas

et al. 2014

Rev Iberoam Cir Mano

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“…Avoiding prolonged periods of immobility is thus critical towards rehabilitating injured regions, as well as maintaining function in uninjured tissues. 6 Along with improving physical rehabilitation, an early return to playing is also a key factor in protecting the mental state of injured musicians, who are at risk of becoming depressed if unable to play. 7 In circumstances requiring the shortest possible post-operative immobilization period, open reduction and internal fixation procedures should be used even when external fixation would provide successful repair in the average patient.…”

Section: Rehabilitationmentioning

confidence: 99%

“…7 In circumstances requiring the shortest possible post-operative immobilization period, open reduction and internal fixation procedures should be used even when external fixation would provide successful repair in the average patient. 6 This treatment also better enables the surgeon to preclude rotational deformities, which are intolerable even at deviations as minute as 5° in string pressing fingers. 8 Recognizing the significance of the patient's career, her post-operative hand therapy was focused towards enabling her to resume playing the violin promptly.…”

Section: Rehabilitationmentioning

confidence: 99%

“…Utilizing the violin in early rehabilitation stages not only strengthens injured tissues, but also assists in sensory re-education. 6 The patient initially reported a sensory deficit in the distal portion of her finger, and hypersensitivity of the skin surrounding the incision site. She experienced pain each time the hypersensitive region made contact with the violin, and especially when it became caught between the strings.…”

Section: Rehabilitationmentioning

confidence: 99%

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Fractured phalanx in a violinist’s finger: Special considerations in treating musician patients

Gibson

Williams²

2009

DMJ

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Post-traumatic reconstructive surgery on musician patients is uniquely challenging in that sustained motor deficits imperceptible to the average person can be debilitating for this population.1 Instrument manipulation is extremely physically demanding; even without trauma musicians are at risk of developing a musculoskeletal disorder from mere overuse of the muscles involved in their craft.2 Furthermore, the link between physical and emotional well-being is exaggerated in musicians, as their livelihood revolves around the physical expression of emotion.3 Analyzing medical treatment from a musician's perspective provides a useful demonstration of the increased efficacy in utilizing a whole person approach as opposed to one that is strictly biomedical.4 Heightened sensitivity to motor deficits and the economic and emotional implications thereof are significant factors pertaining to the lifestyle of these patients, and treatment should be tailored accordingly. 5 RESEARCH Case PresentationI n February 2007, a 52-year-old violinist and music teacher opened a steel-framed classroom window, which then fell and crushed her left index finger. Being her string-pressing hand, the impact of this injury was potentially devastating. Unfortunately, she did sustain an oblique fracture of her proximal phalanx, which was near the proximal interphalangeal (PIP) joint but was not interarticular (Figure 1). Additionally, there was a laceration on the volar aspect of the same finger.Three days following her injury, she was brought to the operating room for definitive repair. Previously placed sutures were removed, and the incision was extended by 1 cm on the radial aspect in line with the PIP joint. Careful dissection revealed the tendon sheath and digital nerve on the radial aspect to be intact, though the latter appeared to have sustained some damage. The location of the fracture between opposing flexor and extensor tendons caused displacement of the bone fragments rendering the injury inherently unstable. However, once the fracture planes were exposed, reduction was easily achieved and held using termite forceps. Fixation was then attained using two percutaneous 0.035 inch K-wires. These traversed the fracture from the distal portion of the proximal phalanx into the proximal cortex dorsoventrally. The result, as visualized on a portable x-ray machine (Figure 2), was an excellent reduction, and the wires were trimmed near skin level. The skin edges, which were somewhat macerated, were then debrided and closed using 5-0 Prolene sutures. The final step of the procedure was application of Jelonet, gauze and a volar splint.

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“…This repeated exposure to They do not know that the muscles in the forearm are largely responsible for controlling movements in the hand. A contributing factor is that there is fierce competition for work, musicians may therefore be hesitant to complain about an injury or impairment [2]. One of the most common problems in musicians as quoted by Lederman RJ ,in his paper on Neuromuscular problems in musicians, is overuse which is poorly defined but represents the culmination of playing past the point of muscle fatigue.…”

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confidence: 99%

Prevalence of Cumulative Hand Trauma Disorders in Pianists

Tahilram¹,

Nagrate²,

Shaym³

et al. 2018

IJPR

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Background: The professional musician is required to practice daily for an average of about six to eight hours. Practice sessions would typically require the artist to use the same muscles repeatedly. Factors such as poor playing postures and inadequate rest periods predispose artists to repetitive stress injuries over a period of time.Context and purpose of study: The profession of piano playing involves the meticulous use of the various intrinsic muscles of the hand. Repeated exposure to micro trauma over a period of time has a direct effect on performance as a level of speed and precision has to be maintained at all times. Therefore this study was aimed at finding out the effect of the prevalence of cumulative hand trauma disorders faced by pianists.Results: The result of the study carried out showed that 68% of subjects experienced pain in the hand. A majority of 20% of the subjects experienced pain at the site of their wrist. Finkelsteins test was positive in 34% of subjects with pain. The average grip strength taken for males was 37.67 kg's and 20.18 kgs in females. Beighton's scale for hypermobility was taken and 76% of subjects tested positive. Conclusion:In conclusion this study reveals that pianists are predisposed to cumulative hand trauma disorders. With the help of the outcome measure's discussed in the results we are able observe that grip strength is significantly reduced, DeQuervain's is positive and hypermobility does occur in a particularly large amount of the subject population. Using Hoppmann's (1998) pain outcome measure we can conclude that pain does affect the professional performance in a negative way.

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Hand therapy for the musician: instrument-focused rehabilitation

Cited by 26 publications

References 7 publications

Distonía focal de mano

Distonía focal de mano

Fractured phalanx in a violinist’s finger: Special considerations in treating musician patients

Prevalence of Cumulative Hand Trauma Disorders in Pianists

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