Table of Contents

The Musician’s Hand & wrist

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PART I:
The Musician’s Hand: An Organ of Exquisite Finesse!

          

Introduction

Elements of Hand Function:

   A. Brain and Hands............................................................................................

        1. Conscious Control....................................................................................

        2. Brain Development..................................................................................

        3. Our Brain’s Priorities................................................................................

        4. Unconscious Control..............................................................................

        5. Interconnections........................................................................................

   B. Movement – Motor Function....................................................................

        1. Bones..............................................................................................................
        2. Joints...............................................................................................................

        3. Ligaments.....................................................................................................

        4. Demonstration (Joint Congruence).................................................

        5. Muscles..........................................................................................................
        6. Optimal Muscle Stretch.........................................................................
        7. Extrinsic Muscles / Tendons................................................................

        8. Intrinsic Muscles........................................................................................

   C. Sensation–Feedback.................................................................................
   D. Sensation - The Nature of Pain..............................................................

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PART II:
The Physiology of Hand, Wrist and Forearm Pain in Professional Musicians

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Introduction

Why are High-Level Musicians “Focal Athletes”?

Classifying Upper Extremity Pain in Musicians

   A. Physiological Conditions...........................................................................

   B. Pathological Conditions............................................................................

Muscle Physiology for Musicians

   A. Muscle Training – Adaptive Changes................................................
   B. Muscle Fatigue...............................................................................................
   C. Muscle Pain and Strain..............................................................................
   D. Muscle Healing..............................................................................................
   E. Swelling (“Edema”).......................................................................................

   F. The Role of Rest in Recovery...................................................................

Easier Said than Done! Some Practical Suggestions

If It’s “Normal” Physiology, “Why do We Have Pain”?

Misuse of the Term “Repetitive Strain Injury"

Summary of Take-Home Thoughts for Musicians

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PART III:
Common Pathologies of the Hand, Wrist and Forearm in High-Level Musicians

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Introduction

   (RED = Possible higher incidence in musicians and/or preventable)

Inflammatory Conditions

   A. Localized............................................................................................................
        1. Typical Presentation (all).......................................................................

        2. Wrist.................................................................................................................

            a) DeQuervain’s “Disease”....................................................................

            b) Intersection Syndrome......................................................................

            c) ECU Tenosynovitis................................................................................

        3. Fingers............................................................................................................

            a) Stenosing Tenosynovitis...................................................................

            b) “Trigger” Finger......................................................................................

        4. Causes............................................................................................................

        5. Pathophysiology........................................................................................

        6. Prevention.....................................................................................................

        7. Treatments...................................................................................................

   B. Systemic ("Whole Body")...........................................................................

Neurological Conditions

   A. Peripheral Nerves..........................................................................................

        1. Cervical Radiculopathy.........................................................................

        2. Carpal Tunnel Syndrome......................................................................

        3. Cubital Tunnel Syndrome.....................................................................

        4. Digital Nerve Compression..................................................................

        5. Radial tunnel & Pronator syndrome................................................

   B. Central Nervous System............................................................................
        1. Task Specific Focal Dystonia..............................................................

        2. Multiple Sclerosis......................................................................................

        3. Parkinson’sDisease.................................................................................

Degenerative Diseases

   A. Epicondylitis ("Tennis and Golfer’s Elbow").......................................

   B. Osteoarthritis (Primary = "aging joints")..............................................
   C. Post-Traumatic Arthritis (Secondary = "old injury")......................

Congenital Abnormalities

   A. Ligamentous Hyperlaxity ("double-jointed")....................................
   B. Radioulnar Fibrous Synostosis ("locked forearm").......................

Tips for Finding a Musician-Competent Physician
Take-Home Messages - Musicians with Hand Problems

Appendix I: Anti-InflammatoryDrugs ("NSAIDS")

Appendix II: Steroids
Appendix III: Upper Extremity Surgery in Musicians

Appendix IV: References for Professional Musicians

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