Musicians and others with high-demand occupations may suffer from a host of repetitive strain injuries, including tennis elbow, golfer’s elbow, wrist tendonitis, rotator cuff impingement or trigger finger. They also are susceptible to nerve entrapments, such as carpal tunnel syndrome or ulnar neuropathy at the elbow.
“Musicians are at risk for repetitive strain injuries when there is a sudden increase in playing time or intensity,” says Scott Homer, MD, a nonsurgical hand specialist and clinical instructor in physical medicine and rehabilitation, who often treats musicians and others suffering from hand and arm injuries caused by repetitive use. “It may happen when preparing for a recital or performance, or in the transition from summer break back to the demands of music school.”
Homer, along with colleagues Kevin Chung, MD, chief of hand surgery and professor of plastic surgery and orthopaedic surgery, and Jeffrey Lawton, MD, service chief of hand and upper extremity surgery, is part of the University of Michigan Hand Program, which includes non-operative hand specialists, orthopaedic and hand plastic surgeons, physician assistants and hand therapists who treat University of Michigan Comprehensive Musculoskeletal Center patients.
Homer and his team will sit down with a patient and solicit details regarding occupation, changes in physical activity and ergonomics, as well as pain, numbness or weakness. They will then perform a physical examination, which includes assessment for tenderness or pain with stress of the associated areas. Additional testing may include ultrasounds for nerve or tendon issues and electromyography testing for nerve damage.
When it comes to treatment of the hand injury, hand physiatrists and surgeons aim not only to relieve the pain, but also to resolve the underlying condition causing the injury.
“If a performer’s posture or technique is suboptimal, there may be an increased susceptibility to muscle fatigue and tension, predisposing him or her to injury,” Homer says. “It’s very important to fix issues with posture and technique for a sustainable outcome.”
Lawton adds, “Often, many musicians are not interested in cutting their two- to four-hour practice sessions shorter, but they can do the same total time in 45-minute increments, which tends to be less stressful on the injury.”
Additionally, hand specialists often encourage relative rest with associated intermittent splinting of the injured area, ice, anti-inflammatories and a trial of topical nitroglycerin patches for tendonitis. Homer adds that steroid injections can be appropriate in certain cases, but discouraged in others, such as for treating tennis elbow.
Chung adds that hand problems in the musician patient group should not be equated to surgery.
“Musicians do not have structural problems with their hands,” Chung says. “They have overuse problems, including muscle soreness and perhaps developing incorrect posture. We don’t want to operate on this patient group when we instead can understand their motivations for playing and intensity levels, and help them adjust their schedule. This, in turn, allows treatment of their injury to be more effective.”
The various members of the U-M Hand Program frequently confer on overlapping cases, such as carpal tunnel syndrome, ulnar neuropathy, thumb arthritis, trigger finger, and tendon and ligament injuries. In addition to musicians, they treat a wide variety of hand and upper extremity conditions in various patient groups.
“We have an excellent team and infrastructure here at the U-M Hand Program to treat complex and major trauma injuries, such as farming accidents, motorcycle injuries and industrial injuries,” Chung says.
“Our program strives to help patients along the hand and upper extremity injury spectrum, from rehabilitation treatments with musicians to reconstructive surgery for trauma patients.”