Common Peripheral Nerve Injuries for Musiciansby Isabelle Duchesne, physiotherapist
/ November 1, 2011
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According to neurologist
R. Lederman, peripheral nerve injury (neuropathy) accounts for 20% of
all diagnoses in musician patients. The most frequently encountered
neuropathies are listed in Table 1.
Main injuries to
peripheral nerves suffered by musicians (Based on 1353 musician patients
assessed by R. Lederman)
Ulnar neuropathy at the elbow: 21%
Carpal tunnel syndrome: 18%
Cervical radiculopathy: 9%
Nerve injury predictably occurs at a point on the body where a nerve
is subjected to compression, friction, or stretching. Compression may
be caused by a bone, ligament, muscle, tendon, or a thickening of the
fascia. A superficial nerve may also be compressed from outside the
body. According to Lederman, there is no evidence to suggest that instrumental
musicians are more likely than other professionals to develop neuropathy.
However, it can be clearly shown that compression neuropathies are diagnosed
in many instrumentalists.
his instrument for a while, a 24-year old violinist suffers from pain
and paresthesia (numbness, tingling) in the middle of his left forearm
and in his left hand, forcing him to stop playing.
The symptoms described by the musician suggest two possible diagnoses,
either thoracic outlet syndrome or ulnar neuropathy at the elbow. Again
according to Lederman, the most common neuropathy of musicians is
symptomatic thoracic outlet syndrome.
String players (45%
of patients, mainly in the left arm), keyboard players (25%, bilateral
injury), and woodwind instrumentalists (17%) are most often affected
by thoracic outlet syndrome. About half of the patients suffering from
this syndrome have a visible shoulder-girdle depression, which increases
the proximal tension on the brachial plexus at the root of the arms
peripheral nerves (see Photos 1-2). Severe neuropathy with a nerve conduction
deficit, however, rarely occurs in musicians (Lederman).
Summary of symptoms
of thoracic outlet syndrome (No nerve conduction deficit, even in
its symptomatic form)
pain, more often on the ulnar (internal) side than on the radial (external)
Sensitivity, including numbness, paresthesia (tingling), burning,
or a swelling sensation in the same area
Symptoms associated with certain positions or postures, especially
when the upper limb is raised above the shoulder
Summary of symptoms
of ulnar neuropathy at the elbow
at the elbow and usually on the ulnar side of the forearm, hand, and
fourth to fifth fingers
Elbow painful to the touch
Paresthesia (tingling) is less common, but a loss of sensitivity
may occur on the ulnar side of the forearm, hand, and fourth to fifth
The second possible
diagnosis is ulnar neuropathy at the elbow. A common pathogenic
mechanism is intermittent nerve friction, which occurs when the nerve
becomes trapped at one or more points along its pathway, impeding the
sliding motion of the arm. Among string players assessed by Lederman,
90% had injuries to the left arm / left hand. He hypothesizes that keeping
the left elbow bent to hold the instrument creates and maintains a pressure
point on the ulnar nerve. The steady pressure affects the left nerve
more than the right nerve is affected by the repeated flexion-extension
of the right elbow moving the bow.
B.Sc., PT, FCAMT, Bachelor of Music (classical piano) is a physiotherapist
at Kinatex Sports Physio, Rosemount and Downtown Montreal, who has treated
professional musicians for several years. She is a Fellow of the Canadian
Academy of Manipulative Physiotherapy, presently studying for the European
Diploma of Arts Medicine (Paris).
Lederman R. Neuromuscular and musculoskeletal problems in instrumental
musicians. Muscle Nerve 2003; 27:549-561.
Lederman R. Focal peripheral neuropathies in instrumental musicians.
Phys Med Rehabil Clin N Am 2006; 761-779.