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Cello

PREFACE

     This document was originally created as a “handout” for lectures given at The Collaborative Piano Summer Institute and Bravo! Summer Music Academy in June 2017 in Faribault, MN, USA. The project began only as a collection of anecdotal information about the hand and wrist that I thought might be of interest to young professional musicians and high-level pre-conservatory students destined to make music into a career.

     As I became more involved in the project however and began to research specific topics, I found that the information easily available to professional musicians on the Internet regarding upper extremity problems consists largely of prevailing assumptions and opinions that date back several decades and often come from people with no medical background or experience in diagnosing and treating hand problems. Few authors even make the critical distinction between physiological and pathological conditions and well-established but more recent scientific data are largely ignored or misinterpreted in order to make them fit into the existing treatment algorithms, particularly when it comes to pain, rest, swelling and immobilization. 

     As professional musicians, you represent such a small percentage of the population that your unique and specific needs are rarely identified and addressed and some of the “standard” treatments used uneventfully in others may actually hasten the end of your careers. For a professional musician who would like to understand our current knowledge from a physiological standpoint, this is a dismal situation. It was in this context that I began to gradually add material and transform this document into something that could now legitimately be entitled “More than Professional Musicians Would Ever Want to Know About Their Hands and Wrists”!

     In my 30 years of practice as a hand and wrist surgeon and as a clinical professor, I have always felt that understanding why a problem occurs leads to much better results, not only for the resident surgeons I taught but also for the patients I treated. People are much more motivated to give and follow treatment advice when they understand why it may be beneficial. Physiology is the study of why our bodies function as they do and that knowledge can reduce our fears, allow us to better understand our needs and ultimately take better control of our own lives. The topic can be daunting but we can understand general concepts and principles without possessing a scientific background or having to learn a new vocabulary.

     This document is labeled “A Reference Manual” because it isn’t something that most musicians will want to sit down and read as they would a novel (unless it is as a sleep-aid before bed). Instead, you should leaf through it once to see how it is organized and what material it covers, reading some of the introductory comments at the beginning of each section, then look specifically at those topics that may be of particular interest to you. The loose “outline” format has been purposely maintained so that you can easily see what you are skipping over and what you may wish to look at more closely. You can then return at a later date if a new topic comes of interest to you.

I strongly recommend that anyone interested in any of the topics in this document take the time to read “Optimal muscle stretch” and “Sensation: The Nature of Pain” in Part I, “Classifying upper extremity pain in musicians”, “Swelling (Edema)”, "The Role of Rest in Recovery”, and “Summary of some take-home thoughts for musicians” in Part II. I also strongly suggest reading “Tips for Finding a Musician-Competent Physician” and “Take home messages for musicians with hand problems” in Part III. These sections all contain crucial and practical information for professional musicians. If you are a professor or teacher, the information provided under "Congenital Abnormalities" in Part III is crucial to helping younger students avoid problems later in their careers and in orienting certain students in their choice of instruments.

     I have chosen to keep this as a free document open to all who are interested and I continue to revise and add to it periodically. The beauty of science is that our knowledge is NEVER complete and we must continue to learn and to grow as new information becomes available. Remember that we once thought the Earth was flat and at the center of the universe and even killed heretics who thought otherwise. As physicians, we used to bleed patients to allow the “bad humors” to escape. We went on to completely immobilize polio patients to “rest” their muscles, allowing what little function that remained to waste away. We must try to learn from our mistakes and previous misconceptions knowing that the beliefs we cling to are sometimes wrong. If you find mistakes in this material or see new and better ways of describing the underlying processes, please share your ideas. I am always willing to change my mind and my credence levels when faced with compelling arguments and/or evidence.

     While I have tried to avoid using scientific or medical terms without parenthetical explanations and clarifications, my goal is to provide you with an accurate and scholarly resource so I have deliberately avoided trying to oversimplify the content. Learning the medical terms is not at all necessary but they are there for those who are interested. Also, since many concepts overlap different aspects of physiology, you will find some of the document repetitive. I have done this purposely because I foresee many people reading only certain sections and not the whole document and without repetition, they would miss important points. It has been my experience that professional musicians are generally intelligent and well educated and it is out of respect that I have chosen to use a nuanced vocabulary and a relatively formal presentation. If I have inadvertently made assumptions about preexisting medical knowledge I will be happy to clarify any segments that may be unclear and I sincerely invite you to leave comments and suggestions.

     Finally, please take the disclaimer at the end of the last pages of this document VERY seriously. Some of the material that I will present and discuss here does not sit well with classical concepts nor with standard clinical practice especially as it relates to pain, swelling, rest and immobilization. While I strongly believe that it is time for us to carefully reconsider these concepts in light of our current understanding and to openly discuss them, I also strongly believe that only a provider you trust that has evaluated and examined you personally can provide you with the best possible care. This document is not about teaching you to diagnose and treat hand pathologies, for that requires years of study and practice. It’s about helping you to understand the underlying processes that govern these organs of exquisite finesse.

     I hope you find the information provided here to be insightful and helpful in your career. I have written this document because I have tremendous respect for what you do!

D.A.G.

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