Neuromuscular problems in musicians

BACKGROUND- Musicians are an occupational (or avocational) group that may on occasion have highly specific health care problems apparently caused by or adversely affecting instrumental performance. Neurologists have been intimately involved in the development of a burgeoning interest in these disorders and, because of the nature of the most common symptoms, neurologists can expect to be called upon to evaluate such patients. REVIEW SUMMARY- In this review, the most common playing-related disorders are discussed. These include the regional pain syndromes, primarily involving the neck and upper extremity, the focal neuropathies, again predominantly involving the upper extremity, and the focal dystonias or occupational cramps, which typically affect the hand or the cranial-innervated muscles involved in the embouchure (the relationship of the facial musculature to the mouthpiece of the instrument). Risk factors contributing to the development of these disorders are reviewed, the diagnostic approach is described, and the management of these playing-related problems is summarized. Aspects in which the instrumental musician may differ from other patients commonly seen by the neurologist, particularly with respect to the types of problems seen, methods of evaluation, and therapeutic strategies, are emphasized. CONCLUSIONS- Many unanswered questions remain in each of these areas. Neurologists and neuroscientists are in an excellent position to help fill the voids in our knowledge base. It is hoped that the reader will be stimulated to participate in this effort.