[Reasons why musicians consult hand surgeons].

PURPOSE OF THE STUDY: Musicians occasionally consult orthopedic surgeons, particularly upper limb specialists. We wanted to learn more about the reasons why musicians attend orthopedic clinics. MATERIAL AND METHODS: We analyzed retrospectively 227 case files of musicians who consulted our center between 1994 and 2001. We noted patient related factors (age, gender, musical experience, level of performance, daily practice schedule) and their reasons for consulting (pain, discomfort, advice). We studied the medical history of the patients and searched for predisposing or triggering elements. We also recorded therapeutic options proposed. RESULTS: Our series included 119 men (52%) and 108 women, mean age 35 years with 27 years of musical experience on the average. Instruments played were mainly the piano (41%), the violin (19%), and the guitar (15%). Patients playing wind instruments, who consult more often for ENT problems, were exceptional. On the average, the patients played their instrument 4 hours daily. One-third of the patients were high-level amateurs, one-third were professionals, and one-quarter were lower-level amateurs. There was a small proportion of soloists or professors. Two-thirds of the musicians presented disorders of the musculoskeletal system, particularly trauma sequelae. Signs of overuse were present in 18% of the patients, mainly women, signs of misuse due to inappropriate or defective technique in 8.8%, and dystonia in 5.7%. Psychological problems were noted in 4 patients. More than one half of the patients had obtained medical advice prior to consulting an orthopedic surgeon and the very large majority had been referred by specialized physical therapists. A surgical procedure was proposed for only 19% of the patients presenting an orthopedic disorder. DISCUSSION: This study presents a diversified panel of musicians consulting orthopedic surgery clinics. Practicing schedules varied in the study population from one to five hours daily. More than half the patients complained of pain but 18% consulted because they perceived a problem when playing and 17% consulted simply for advice. Our findings recall that musicians comprise a sensitive population requiring careful overall management. Unlike series published to date, we had a majority of men. Problems involving an orthopedic disorder or trauma and trauma sequelae predominated. In the literature, diagnosis has been oriented by the specialty of the consulting physician. We found that our patients who suffered from overuse had often recently changed their habitual practicing methods or conditions. The diagnosis of misuse was facilitated when the patient was examined with his/her instrument. The low rate of dystonic disorders was probably related to the fact that nearly half of our patients were followed regularly by a physical therapist. We did not observe any case of excessive laxity or Linburg Comstock syndrome which exceptionally have functional impact. The very large majority of our patients were referred by physical therapists and when surgery was necessary, the procedure was performed in accordance with accepted rules concerning the therapeutic management of musicians.

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