The hand that has forgotten its cunning—Lessons from musicians' hand dystonia

Abstract

Focal task-specific dystonia of the musicians' hand (FTSDmh) is an occupational movement disorder that affects instrumental musicians and often derails careers. There has been speculation on the role of intense practice or the specific technical demands of various instruments as triggers for the development of FTSDmh. In this study, we review the clinical features of all published cases (899 patients) and 61 previously unpublished cases of FTSDmh. Our primary goals were to search for patterns in the clinical phenotype, and to discern if specific instrumental technical demands might be related to the development of dystonia. Symptoms of FTSDmh began at a mean age 35.7 years (SD = 10.6), with an overwhelming male predominance (M:F = 4.1:1). The right hand was preferentially affected in keyboard and plucked string players (77%), and the left hand in bowed string players (68%). Flexion movements were the most common dystonic movement in each instrument class, and fingers 3, 4, and 5, either in isolation or combination, were most frequently involved. The clinical implications of these findings and their possible relationship to the pathophysiology of focal task-specific dystonia are explored.

Robert Schumanns høyre hånd

“…Håndskriften ble mer utydelig senere i livet, men i perioder med mye komponering og skriving klaget han ikke over svikt i hånden på samme måte som når han spilte. Schumann var rammet i høyre hånd, den hånden som oftest blir affisert hos pianospillere (21).…”

“…Slike tilstander forverres betydelig under påvirk-ning av stresshormoner og følelser og kommer ofte til sterkest til uttrykk da. Oppgavespesifikk dystoni har vaert knyttet til musikere med personlighetstrekk som innebaerer høy grad av angst og perfeksjonisme (27), og er vanligst hos menn, gjerne gitarister eller pianister (21,28).…”

Rating scales for musician's dystonia

“…7 MD is usually associated with loss of fine control and coordination, most commonly in heterogeneous subsets of digits 2-5. 5,[8][9][10] The relative amount of excessive finger flexion or extension, 8,11 as well as which hand is affected, depends on the type of instrument. 8 Among the focal dystonias, MD exhibits some of the most exquisite task specificity.…”

“…11,13 Among performance-related medical problems in professional musicians, MD is the most likely to lead to long-term disability, with up to 62% of affected patients unable to continue their performance careers. 14 The clinical management of MD has not improved much over the past 2 decades.…”

“…Most patients are unable to achieve premorbid levels of ability. 8,11 The whole spectrum of research on MD-from basic pathophysiology to clinical management-depends critically on our ability to measure the symptoms. Based on the Dystonia Study Group 23 guidelines tailored for musician's dystonia, 24,25 a clinically useful rating scale for MD should be 1) reliable and valid, 2) sensitive to change, 3) specifically designed to measure MD, and 4) practical in a clinical setting.…”