A review of musculoskeletal problems in instrumental musicians.

Musculoskeletal problems are common in instrumental musicians. Most of these problems can be classified as musculotendinous overuse, nerve entrapment/thoracic outlet syndrome, or motor dysfunction. Also seen in musicians are problems related to hypermobility and degenerative arthritis. Although these problems are seen in all instrumentalists, their prevalence is highest in professional musicians, with string players most commonly affected by musculotendinous overuse. Keyboard players are the performers most commonly affected by motor dysfunction. History and physical examination performed with an understanding of the problems of musicians are usually adequate to make the correct diagnosis. Electrophysiological studies are often helpful in confirming or excluding a diagnosis of nerve entrapment. With the exception of motor dysfunction, once these problems are recognized, they can be adequately treated. Treatment should begin conservatively with rest, evaluation of technique and practice habits, and possibly nonsteroidal antiinflammatory drugs. Depending on the type and severity of the problem, physical therapy, adaptive devices, steroid injection, or surgery may be indicated. A strong partnership with music educators is important in the management and prevention of these musculoskeletal problems.