Musculoskeletal
Erin Sanzone, MD
Resident
Mount Sinai
New York, New York, United States
Fatimah Mozawalla, MD
Resident
Mount Sinai
New Yor, New York, United States
Michael Harbus, DO
Attending
Mount Sinai
New York, New York, United States
Erin Sanzone, MD
Mount Sinai
New York, New York, United States
DS is a 40-year-old male violinist presented with 2 weeks of left forearm pain, radiating down to his left hand and up toward his axilla. He had a nodule on his left forearm, which recently had increased in size concurrently with the onset of his pain. He described the pain as sensitivity to touch, associated with numbness in forearm and hand. Pain was exacerbated by nerve glides on left arm, causing a popping sensation. Patient reported no recent injury to elbow and denies weakness. On ultrasound, left ulnar nerve was found to sublux on repetitive motion. Pain was reproducible with Tinel’s sign at the cubital tunnel.
Discussions:
Instrumental musicians have intense pressure on their bodies from the repetitive motion of their music playing. Common injuries, though varying with instrument type, include regional muscle pain syndromes, focal dystonia, and peripheral neuropathies such as ulnar neuropathy and carpal tunnel syndrome. A literature review analyzing 1353 instrumental musicians found 311 presented with peripheral nerve disorders, and 64 of these patients were diagnosed with ulnar neuropathy of the elbow. Of the 64 patients with ulnar neuropathy, 24 were bow-string players. A violinist must flex their left arm for extensive periods of time, with repetitive supination and finger motion, contributing to the etiology of ulnar neuropathy. Electrodiagnostic evaluation can be completed for diagnosis, but often it is diagnosed clinically. Treatment is focused on technique of instrument playing and posture adjustment with physical and occupational therapy.
Conclusions:
While sports medicine is a growing field in physiatry, it is important to treat professional instrumentalists as athletes due to the harsh and unique repetitive movements of their profession. Treatment includes exercises with physical and occupational therapy for improving posture while playing, especially therapists who have experience working with musicians.
