Isolated painless manual incoordination in 57 musicians

Focal motor syndromes are reported in 57 instrumental musicians who presented with painless uncoordinated movement of the upper limbs. Three stereotyped afflictions were noted: flexion of the 4th and 5th fingers in pianists, flexion of the 3rd finger in guitarists, and extension of the 3rd finger in clarinetists. Our patients differed from those with generalised dystonia in that their disabilities were focal, activity-specific, and non-progressive. Because these disabilities represent entrained responses to peripheral stimuli, distinct from progressive dystonias, they may provide insights into control of fine limb movement and sensory triggers of abnormal movement.