'Musician's hand': 5 common problems

Written by: Mr Mark Phillips
Published: | Updated: 18/06/2019
Edited by: Top Doctors®

Musicians are deeply dedicated to what they do and cannot imagine life without their vocation. However, as well as suffering the same conditions as everyone else they also face problems specific to their art. Ergonometric solutions, adaptations and steroid injections are common solutions. Surgery, although sometimes an option, needs to be adapted to specific needs. Most musicians are effectively on a ‘zero-hours contract’ – no play, no pay. So working with performers requires an understanding of this.

 

Trigger finger

The finger may lock in flexion, most commonly in the morning. During the day there may be an annoying and painful click as the finger flexes and extends. Steroid injection is a very effective primary treatment and may be curative in 70-80% of cases. Occasionally a 2nd injection is required, and if the condition persists a surgical release under local anaesthetic will usually cure the condition. Some patients are unfortunately afflicted by this condition on more than one digit.

Learn more about trigger finger here!

Dupuytrens Contracture

This condition is characterised by nodules in the palm which pull the fingers down into a contracted position. Pianists and string instrumentalists are most significantly affected by the lack of range of movement. It is not painful, but restricts function. There is a strong genetic predisposition to this condition. It is a very slowly progressive condition and there is rarely any urgency to treat it. The problems may not be generic but may be specific unique to that musician and their own instrument. Surgery has been the mainstay of treatment until the last few years. We now have injectable medication which can dissolve the cords that cause the contracture.

Learn more about "the Viking disease"!

Thumb base arthritis

Arthritis in the thumb is the most common form of arthritis affecting the function of the hands. Guitarists suffer particularly with pain in the left thumb where good power is required for good performance. Arthritis results from the breakdown of joint cartilage exposing the underlying bone. It tends to affect the basal joint, which is the joint near the wrist and the fleshy part of the thumb. This joint normally allows you to pinch, pivot, and swivel your thumb The pain it causes can make playing an instrument extremely difficult. A combination of hand exercises and various medications can help relieve symptoms. Surgery is a last resort but works well when required.

 

Focal dystonia

Focal dystonia is a neurological condition that affects a muscle or group of muscles in a specific part of the body, causing involuntary muscular contractions and abnormal postures. For example, in focal and hand dystonia, the fingers either curl into the palm or extend outward without control. It is a terrible curse for musicians as it is very difficult to treat It can strike at the peak of a musician’s career and needs a super-specialist approach.

 

Carpal tunnel syndrome

Because of overuse, you get repetitive strain injuries. It makes that area swell from inflammation because of the extra work. The result is pain and numbness. There is a ligament at the wrist crease called the transverse carpal ligament and when the tendons that share the tunnel with the median nerve it presses down on the nerve and patients experience symptoms. It is fortunately a very treatable condition.

Adaptation

Django Reinhardt is regarded as one of the greatest musicians of the twentieth century. Despite being unable to use two of his fingers after they were burnt in a fire, he overcame the handicap and went on to forge an entirely new style of jazz guitar technique known as 'hot' jazz guitar. He is a testament to the positivity and drive that many musicians demonstrate when faced with problems with their hands which threaten their career.

If you are suffering from one of these conditions or want further expert advice you should see an expert in orthopaedics.

By Mr Mark Phillips
Orthopaedic surgery

Mr Mark Phillips is a highly-respected and experienced orthopaedic surgeon based in London. He now practises privately at a number of reputable hospitals in London including the London Bridge Hospital, Blackheath and Hendon specialising in hand and wrist conditions, with a particular interest in trauma. He was a consultant in the NHS for 14 years, mainly at King's College Hospital where he had an interest in trauma and ortho-plastic reconstruction for complex injuries. 

Mr Phillips is an enthusiastic teacher at all levels and is a frequent speaker at conferences and meetings. Mr Phillips has also recently taken over a practice treating musician's hand pathologies, which requires a holistic approach. He provides consultations for patients via the British Association for Performing Arts Medicine (BAPAM) every four weeks in Camden.

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