Other Injuries and Conditions

Below is a glossary of injuries and conditions musicians sometimes face. This list is not exhaustive and only gives an overview of each injury or condition presented. This glossary should only be used for educational purposes and should not be seen as medical advice. If you believe you may have one of these injuries or conditions you should see a doctor right away.

Arthritis

Arthritis is the common term for inflammation in a joint because of damage to the joint cartilage. It can be accompanied by pain, swelling, stiffness or decreased range of motion of the joint. While there are over 100 specific types of arthritis, there are two main and distinct forms of the condition.

Osteoarthritis is a form of arthritis that is caused by wear and tear over time on the joint cartilage, which worsens with age. As the cartilage of a joint is worn away, bone begins to rub against bone, resulting in pain.

Rheumatoid arthritis is an inflammatory form of arthritis that is caused by an autoimmune disease. In this form of arthritis, the body’s immune system begins to attack joints, resulting in inflammation of the joint lining and can progress so far as to eat away at the cartilage and the bone itself.

Anti-inflammatory medicine can be used to treat arthritis. If you think you may have arthritis you should contact your doctor immediately. Arthritis is treated best in its early stages

Bursitis

Bursae are small fluid-filled sacs that cushion bones, tendons and muscles at a joint. These sacs allow our joints to slide smoothly over each other, reducing friction, wear and tear. Bursitis is the inflammation of a bursa. When a bursa becomes inflamed, the bones, muscles and tendons cannot move smoothly and they stretch the tissues of the bursa, causing pain. In musicians, bursitis is most commonly associated with the raising and repetitive motion of the shoulders.

Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway of bone and ligaments in the wrist that nerves and tendons must pass through to reach the hand and fingers. Carpal tunnel syndrome is caused by compression on the median nerve as it passes through the tunnel, resulting in numbness, tingling and sometimes pain, usually in thumb, index or middle fingers. Compression on the median nerve is most likely caused by swelling and inflammation inside the carpal tunnel as the result of repetitive motion, overuse and improper wrist and thumb positions. The presence of carpal tunnel syndrome usually indicates an underlying overuse injury because of the swelling and inflammation.

Be especially careful of computer and keyboard use, as both have a long history of causing overuse injury, most notably carpal tunnel syndrome.

Cubital Tunnel Syndrome

The cubital tunnel is a small, narrow passageway in the elbow that the ulnar nerve must pass through as it travels down the pinky side of the arm to the fingers. Cubital Tunnel syndrome is caused by compression on the ulnar nerve as it passes through the tunnel, resulting in numbness, tingling and sometimes pain (especially when the elbow is bent), radiating down the top or bottom of the pinky side of the arm, hand and finger.

Compression on the ulnar nerve is most likely caused by swelling and inflammation inside the cubital tunnel as the result of repetitive motion, overuse or prolonged bending of the arm at the elbow. Propping your elbows on a desk while sitting or bending your elbows while sleeping can also cause irritation and compression of the ulnar nerve. The presence of cubital tunnel syndrome usually indicates an underlying overuse injury because of the swelling and inflammation.

De Quervain’s Syndrome

De Quervain’s Syndrome is a specific form of tendinitis affecting the tendons at the base of the thumb. It is characterized by pain along the thumb, at the base of the thumb, and along the thumb side of the arm. Pain is often felt when the thumb or wrist is extended or moved. De Quervain’s Syndrome commonly affects flutists, oboists, clarinetists and bassoonists, who grip and support their instruments with a “frozen” thumb position.

Focal Dystonia

Dystonia is a neurological disorder that causes muscles to move involuntarily and uncontrollably. It can also cause cramping, even without the presence of fatigue. Focal dystonia is the most common type of dystonia. In musicians, it manifests itself most commonly in the muscles of the embouchure, in vocal chords, and the hands and arms.

The term Focal describes a dystonia that affects only one part or section of the body, specifically muscles that that have been used and trained for a specific purpose for many years, often relating to a person’s job. Focal Dystonia is usually limited to affecting muscles only for that one specific purpose (for instance, a violinist with Focal Dystonia in his/her hands could still type on a computer, but not play the notes on the finger board).

Symptoms of Focal Dystonia can progress slowly or rapidly. Early symptoms may begin as a feeling of heaviness, resistance and inability to perform technical passages at the musicians’ standard level of playing. Involuntary cramping and spasms in the afflicted muscles are also common. During the onset of Focal Dystonia, it is easy to pass these conditions off as a fluke. However, problems with practice and performance will continue to increase as the condition progresses to the point where a musician can no longer play or even hold their instrument without experiencing debilitating symptoms of Dystonia.

Focal Dystonia is usually a painless condition. Since it is a neurological condition, treatments such as acupuncture and massage therapy, which target muscles, will have little to no effect. Researchers know little about Focal Dystonia and do not understand how it is developed, or why certain people get it and not others.

Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a condition that prevents normal shoulder movements, usually accompanied by stiffness and pain. Frozen shoulder develops when the capsule that encases the muscles and tendons of the shoulder becomes inflamed or torn and restricts the shoulder’s range of motion greatly.

In other cases, recovering from an injury where the shoulder is nearly or completely immobilized may result in extreme loss of motion. It is essential that the shoulder not be immobilized during the recovery of an arm or shoulder injury in order to maintain its complete range of motion. The longer this condition goes unaddressed the longer it takes and the harder it is to heal.

Ganglion Cysts

Ganglion cysts are benign, fluid-filled masses that form on tendons, tendon sheaths or joints, usually of the hand, wrist or arm. As long as these cysts do not affect performance they are not inherently dangerous and usually go away on their own, although they sometimes indicate the presence of an underlying overuse injury. It is possible for ganglion cysts to cause pain, compression of nerves, or limited wrist movement, which can impede performance. In these cases treatment will be necessary. This may involve draining fluid from the cyst. Removing cysts by surgery should be used as a last resort.

Golfers Elbow (medial epicondylitis)

Medial epicondylitis is a specific injury that affects the muscles and tendons that connect to the medial epicondyle, or boney protrusion on the inside of the elbow (if your palm is facing up, the medial epicondyle is the bump on your elbow that faces towards you).

Damage to the muscles and tendons that connect to the medial epicondyle are caused by excessive strain and overuse of the flexor muscles on the underside of the forearm, which are responsible for contracting and curling the wrist and fingers (as opposed to extending or straightening them).

Symptoms include pain, tenderness and swelling on the medial epicondyle and may extend down the pinky side of the forearm or wrist and may affect the pinky and ring fingers.

Hernia

A hernia is a bulge of tissue that protrudes through a weak spot in the abdominal wall. It is usually caused by lifting heavy objects or increased amounts pressure in the abdominal area. Generally, hernias are merely uncomfortable and may be noticeable when bending, lifting, straining or coughing. However, hernias can become painful and dangerous, so if you think you have one you should see a doctor right away. Hernias do not get better or go away on their own, so surgery is almost always necessary to repair them. Hernias are more common in men than women and generally afflict brass and wind players who exert abdominal pressure as they blow into their instrument.

Joint Hypermobility

Joint hypermobility, sometimes referred to as having “loose joints” or being “double jointed,” is a term that describes joints that are excessively flexible and have a larger-than-normal range of motion. The large range of motion of people with joint hypermobility is due to excessively loose and flexible muscles and ligaments that hold their bodies and joints together.

Doctors believe that joint hypermobility is a genetic trait. While sometimes a harmless condition, it can cause problems such as joint pain or dislocated joints. Additionally, during long or intense workouts, the muscles that are being used may need to do double duty to hold hypermobile joints in place and prevent them from over-stretching. Overworking the muscles that support hypermobile joints could result in overuse or misuse injuries.

Since the accompanying symptoms of joint hypermobility are usually negligible or ambiguous, it can sometimes be hard for doctors to diagnose joint hypermobility. Usually, an exercise or physical therapy regimen will be prescribed to help strengthen and stabilize hypermobile joints, and long-term or short-term splints may be prescribed.

Nerve entrapments (ulnar/median)

Nerve entrapment describes a state of pressure or irritation on a nerve. Nerve entrapments happen most commonly at places where the nerve passes over a joint or passes through a narrow pathway (see carpel tunnel, cubital tunnel, thoracic outlet). They are generally caused by static holding of a joint in a bent position or poor posture.

The best way to prevent nerve entrapments is to keep your muscles flexible and free through exercise and proper rest. You can also let you arms and wrists to hang at your sides during rehearsals and concerts, and roll your neck and shoulder muscles to keep them free.

Raynaud’s Disease

Raynaud’s disease is a condition that results in the shrinkage of blood vessels that supply blood to certain parts of the body like the fingers and toes. Raynaud’s causes coldness, numbness and sometimes tingling or lack of sensation in the hands or feet, and there is usually a progression of color change during an episode. Episodes are brought on by cold environments and stress, which triggers the constriction of blood vessels and can last from only seconds to over an hour.

Rotator Cuff Impingement

The rotator cuff is a group of four muscles that connect the arm to the shoulder and allow for the arms’ wide range of motion at the shoulder joint. Irritation, inflammation and pain result when the tendons or bursae in the rotator cuff become pinched, or impinged, and rub up against the shoulder blade and joint. Repetitive arm motions while in raised positions can cause rotator cuff impingements and results in motions-induced pain.

Rotator Cuff Tendinitis

The rotator cuff is a group of four muscles that connect the arm to the shoulder and allow for the arms wide range of motion at the shoulder joint. Rotator cuff tendinitis is an inflammation in one or more of the tendons that connect the rotator cuff muscles to bone. It is caused by repetitive arm motions from the shoulder, usually while in raised positions and results in motion-induced pain in the shoulder.

Temporomandibular Joint Disorders

The temporomandibular joint (TMJ) is the hinge that connects the jaw with the rest of the skull in front of the ears. TMJ disorders cause pain in the jaw, and sometimes result in headaches or pain in other parts of the face, neck, shoulders or back. It is generally caused by muscle and jaw tension, like excessive biting or gripping with the embouchure or chin. Biting or grinding your teeth when you sleep and stress can also cause TMJ problems. TMJ disorders often afflicts wind instrumentalists and the upper stringed instrumentalists.

Tennis Elbow (lateral epicondylitis)

Lateral epicondylitis is a specific injury that affects the muscles and tendons that connect to the later epicondyle, or the boney protrusion on the outside of the elbow (if your palm is facing down, the lateral epicondyle is the bump on your elbow that faces away from you).

Damage to the muscles and tendons that connect to the lateral epicondyle are caused by excessive strain and overuse of the extensor muscles on the top of the forearm, which are responsible for extending or straightening the wrist and fingers (as opposed to contracting and curling them).

Symptoms include pain, tenderness and swelling on the lateral epicondyle, and may extend into the forearm and wrist.

Thoracic Outlet Syndrome

The thoracic outlet is a narrow passageway between the collarbone, first rib and scalene muscles (neck muscles) that blood vessels and the median and ulnar nerves pass through to get from the neck to the arms. Thoracic outlet syndrome describes the compression on these nerves and blood vessels. Symptoms include numbness, tingling, pain, weakness, poor circulation and coldness in the hands or arms. Causes of compression can range from injury, repetitive motions that creates swelling and inflammation in the thoracic outlet, constant elevation of the arms, poor shoulder and chest posture, tightness in the neck or pectoral muscles, or even heavy backpacks and instrument cases. Symptoms of thoracic outlet syndrome are similar to those of carpel and cubital tunnel, so proper diagnosis by a doctor is essential.

Works Referenced

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