Embouchure Dystonia - Trombone - "Losing the Lip" - Loss of Lip Control Wind Instruments -- Music and Medicine on MondayClick Here

Cello - Warm-Up, Ergonomics, Dealing with Injury -- Music and Medicine on Monday

see: Music and Medicine on Monday (M+M+M) at the University of Iowa - Schedule of Events and Disclaimer

protocol page initiated Feb 2024 Piper Wenzel BS, Henry Hoffman MD

Sound is Visible Like a Dance with the Cello (60 seconds)

Cello Playing at the University of Iowa (60 seconds)

 

 

Definitions

  • Carpal tunnel: a canal on the palmar/anterior side of the wrist, bordered anteriorly by the flexor retinaculum, "a thick band of connective tissue". Its posterior, lateral, and medial walls consist of carpal bones. The contents of the carpal tunnel include the median nerve and flexor tendons of the forearm (Drake et al. 2020).
  • Carpal tunnel syndrome: the most frequent nerve entrapment syndrome characterized "by compression of the median nerve at the wrist as it passes through a space-limited osteofibrous canal" (Padua et al. 2016)

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons
  • Trigger finger: disorder characterized by "catching or snapping" of one or more flexor tendons in the hand, may also present with pain and dysfunction (Drake et al. 2020)
    • May be related to fibrosis (scarring) and "tightening of the flexor tendon sheath" at the metacarpophalangeal joint (MCP)

Background

"Low String Instrument" musicians (cellists and bassists) require strong proximal shoulder strength and scapular stabilizers to minimize distal tension (Turner-Stokes and Reid 1999 and Yang et al 2021).

Common Injuries

  • Thumb, radial wrist and forearm pain are commonly seen in beginning cellists and thought to be related to excessive tension against the neck of the cello - compensating for weak proximal shoulder strength (Yang et al. 2021)
  • Paresthesia (tingling/numbness) at the tip of the finger may occur due to excessive force against the thick instrument strings (Yang et al. 2021)
  • Strains/sprains
  • Tendinitis
  • Muscle fatigue
  • Ulnar neuropathy at the elbow
    • Occurs commonly in left arm due to elbow flexion (Amadio 2003)
  • Carpal tunnel syndrome

Management

Prevention Strategies

A. Regular exercise

  • Regular weekly aerobic exercise and strengthening exercises to increase shoulder strength (Yang et al. 2021)

B. Warm-ups and Cool-downs

  • Big arm movements prior to playing can increase arm circulation
  • Stretching before and after playing to address muscle tightness (Yang et al. 2021)

C. Posture

  • Although appliances may help address functional problems, interference with a relaxed mobile posture through immobilization has been shown to impair performance negatively impact on motor coordination of the right arm imparing fluency to degrade timbre quality (Rozé et al. 2020)

D. Appliances

  • The thumb in the bow arm can be stabilized by use of a splint to revent it from excessive adduction
  • Lighter weight bows can be used during recovery
  • Digital nerve irritation can be diminished by protective covering such as covering the digit with elastic tape, a gel cap sleeve, or other thin protective material
  • A study evaluating the impact of kinesio tape and/or compression sleeves on "DOMS" (delayed onset muscle soreness) following standardized lower limb muscle exercises (Xue 2023). Through this controlled study the investigators concluded that kinesio tape combined with compression sleeves can accelerate muscle strength recovery, shorten overall recovery, and mitigate DOMS pain. Kinesio tape alone was better than compression sleeve alone in reducing DOMS pain and improving recovery effect.

Treatment

  • Custom orthoses (devices to correct alignment or provide support) may be used to maintain proper arch and posture but still accommodate movements needed to play (Johnson 1992)

References

Amadio PC, Russotti GM. Evaluation and treatment of hand and wrist disorders in musicians. Hand Clin. 1990 Aug;6(3):405-16. PMID: 2211853.

Amadio PC. Management of nerve compression syndrome in musicians. Hand Clin. 2003 May;19(2):279-86, vi-vii. doi: 10.1016/s0749-0712(02)00101-4. PMID: 12852670.

Amadio PC. Surgical assessment of musicians. Hand Clin. 2003 May;19(2):241-5, vi. doi: 10.1016/s0749-0712(02)00125-7. PMID: 12852666.

Ballenberger N, Avermann F, Zalpour C. Musculoskeletal Health Complaints and Associated Risk Factors in Freshmen Music Students. Int J Environ Res Public Health. 2023 Feb 10;20(4):3169. doi: 10.3390/ijerph20043169. PMID: 36833864; PMCID: PMC9964731.

Bravi R, Ioannou CI, Minciacchi D, Altenmüller E. Assessment of the effects of Kinesiotaping on musical motor performance in musicians suffering from focal hand dystonia: a pilot study. Clin Rehabil. 2019 Oct;33(10):1636-1648. doi: 10.1177/0269215519852408. Epub 2019 Jun 4. PMID: 31159569.

Caryl D. Johnson, Splinting the injured musician, Journal of Hand Therapy, Volume 5, Issue 2, 1992, Pages 107-110, ISSN 0894-1130, https://doi.org/10.1016/S0894-1130(12)80266-3. (https://www.sciencedirect.com/science/article/pii/S0894113012802663)

Drake RL, Vogl AW, Mitchell WMA. Gray’s anatomy for students (4th ed.) 2020.

Kelleher LK, Campbell KR, Dickey JP. Biomechanical research on bowed string musicians: a scoping study. Med Probl Perform Art. 2013 Dec;28(4):212-8. PMID: 24337033.

Lee SH, Carey S, Dubey R, Matz R. Intervention program in college instrumental musicians, with kinematics analysis of cello and flute playing: a combined program of yogic breathing and muscle strengthening-flexibility exercises. Med Probl Perform Art. 2012 Jun;27(2):85-94. PMID: 22739821.

Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016 Nov;15(12):1273-1284. doi: 10.1016/S1474-4422(16)30231-9. Epub 2016 Oct 11. PMID: 27751557.

Reneker JC, Latham L, McGlawn R, Reneker MR. Effectiveness of kinesiology tape on sports performance abilities in athletes: A systematic review. Phys Ther Sport. 2018 May;31:83-98. doi: 10.1016/j.ptsp.2017.10.001. Epub 2017 Oct 9. PMID: 29248350.

Rozé J, Aramaki M, Kronland-Martinet R, Ystad S. Cellists' sound quality is shaped by their primary postural behavior. Sci Rep. 2020 Aug 17;10(1):13882. doi: 10.1038/s41598-020-70705-8. PMID: 32807898; PMCID: PMC7431865.

Turner-Stokes L, Reid K. Three-dimensional motion analysis of upper limb movement in the bowing arm of string-playing musicians. Clin Biomech (Bristol, Avon). 1999;14:426–433 doi:. doi:10.1016/S0268-0033(98)00110-7.

Merry SP, O'Grady JS, Boswell CL. Trigger Finger? Just Shoot! J Prim Care Community Health. 2020 Jan-Dec;11:2150132720943345. doi: 10.1177/2150132720943345. PMID: 32686570; PMCID: PMC7372603.

Xue X, Hao Y, Yang X, Zhang C, Xu J, Wu X, Deng Z, Li N. Effect of Kinesio tape and Compression sleeves on delayed onset of muscle soreness: a single-blinded randomized controlled trial. BMC Musculoskelet Disord. 2023 May 17;24(1):392. doi: 10.1186/s12891-023-06499-3. PMID: 37198619; PMCID: PMC10189969.

Yang N, Fufa DT, Wolff AL. A musician-centered approach to management of performance-related upper musculoskeletal injuries. J Hand Ther. 2021 Apr-Jun;34(2):208-216. doi: 10.1016/j.jht.2021.04.006. Epub 2021 Apr 14. PMID: 34158229.