[Occupational arm ailments in musicians]

We began our specific interest in this subject in 1975 and to date have seen and treated over 600 musicians with functional problems of the upper limb. These are common problems affecting over one third of instrumental musicians. Every instrument may have its own specific repercussions. However certain factors may influence their onset: intensive practice; a technique requiring non-physiological positioning; a change in technique, instrument or habits; pre-existing trauma; psychological predisposition; inappropriate physique. The presentations are varied and the limits imprecise. Muscles, tendons, joints and nerves may be involved. The commonest, and easiest to cure are due to pain resulting from overuse syndromes cover a multitude of sins resulting from marked physical effort in excess of the normal physiological capacity of the body. Joint instability and degenerative disease pose their own specific problems. Peripheral nerve lesions can be related to overuse syndromes or to the adoption of non-physiological or harmful positions. The most difficult problems to deal with are those related to a loss of motor control when performing the same repetitive movement--functional dystonia. Their origin remains obscure with the major discussion revolving around either a neurological or organic aetiology. Our intensive experience of instrumentalists with these problems secondary to bad positioning or posture, has led us to propose a therapeutic regime based on structured re-education and relaxation. The great majority of sufferers overuse syndromes or functional dystonias have been able to resume their professional activities. It is clear that functional dystonias are curable if treatment is instituted early and that the lesions are not too long standing.