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content created by Evgeniya Molotkova, BS and David Cyzak, DMA (June 2, 2025)

Tendinitis/De Quervain's Tenosynovitis explained to a musician (2 minutes 45 seconds):

Story of a musician with significant wrist pain associated with playing the Oboe (11 minutes 14 seconds)

The Music Industries Study Program at the University of Iowa ( one minute 48 seconds)

Full session (44 minutes 54 seconds)

Definitions

Oboe: a type of double reed, woodwind instrument (Wikipedia contributors, 2025)

Movement terms (TeachMeAnatomy): 

• Flexion: decreasing the angle between two body parts 
• Extension: increasing the angle between two body parts 
• Opposition: bringing the thumb and little finger of the hand together 
• Reposition: movement that brings the thumb and little fingers apart, back to their neutral position 
• Internal rotation (medial rotation): rotation towards the middle of the body 
• External rotation (lateral rotation): rotation away from the middle of the body 

Posture: relationship of the musicians’ body to itself and its position in space (Chasnov and Clark, 1988) 

 

Background

Many musicians, both at the professional and casual playing levels, may develop playing-related musculoskeletal disorders (PRMD) over time (Macdonald et al, 2022). Previous studies have suggested that PRMDs are associated with instrument choice. Nemoto and Arino found that, in the wind instrument group, flute, oboe, and clarinet players were more likely to report some degree of pain, stiffness, or numbness/tingling (Nemoto and Arino, 2007). Oboe players are regarded as a group that is especially high risk for PRMDs, largely due to the required asymmetrical playing position. The entire weight of the instrument must be supported by the right thumb, which increases the pressure through the joints of the upper extremity (Macdonald et al, 2022). Risks for PRMDs include female gender and longer playing times. These risks generally cannot be mitigated, especially with playing time in professional oboists, so different techniques have been developed to prevent injury in these musicians and help them recover from injuries faster.  

 

Discussion

Common medical conditions 

Carpal tunnel syndrome 

• Entrapment of the median nerve at the wrist, resulting in pain, numbness, and tingling in the forearm. Can be caused by repetitive hand use, especially with extreme flexion and extension at the wrist (Pidgeon, 2022) 

De Quervain’s tenosynovitis 

• Swelling of the tendons that run across the side of the wrist and attach to the base of the thumb causing pain. Commonly caused by increased thumb and wrist movement (Pidgeon, 2022). 

Osteoarthritis of the hand 

• Repetitive movement at the joints of the hand place pressure on opposing, cartilage covered bones. This stress wears down cartilage over time and leads to a joint that is not adequately cushioned, resulting in movements causing pain (Pidgeon, 2023). 

Lateral epicondylitis (aka tennis elbow) 

• An overuse injury to the extensor carpi radialis brevis due to repetitive extension at the wrist and elbow (Witstein and Alaia, 2024) 

 

Hand positions  

Traditionally, the oboe is held at a 45-degree angle away from the body, balanced on the right thumb. The right thumb sits underneath the thumb rest on the bottom joint of the instrument. The weight of the instrument is transmitted upwards through the finger, wrist, elbow, and shoulder joints (Hamilton, 2020). This asymmetric weight distribution, relying almost entirely on the right upper extremity, predisposes oboists to musculoskeletal disorders (Macdonald et al, 2022).  

• One study determined that the force to the tip to the right thumb ranges from 6 to 11 N. Although the force is not considerably large, it must be maintained for long periods of time during practice or performance (Smutz et al, 1995). 

Changing hand positions to reduce right upper extremity musculoskeletal symptoms, such as pain and numbness relies on decreasing the pressure exerted into the right thumb. 

 

Exercises 

Stretching of the upper extremities may be useful in both preventing and mitigating PRMDs. In order to be effective, it is generally recommended that oboists are consistent with their stretches, much like an athlete. Some suggested stretches include: (Horvath, 2010) 

• Fingers 
  • Full extension at the metacarpophalangeal (knuckle) joints 
    • Bending fingers back as far as they can go without pain 
  • Alternating flexion and extension at the middle interphalangeal joint 
    • Bending fingers towards the palm, as if trying to get the pads of the fingers to touch the palm 
  • Thumb flexion, extension, and opposition/reposition 
    • “Thumb war” motions and trying to touch the thumb to the base of the little finger  
• Wrist 
  • Flexion and extension 
    • Can be done with an open hand or hand closed in a fist 
• Elbow 
  • Flexion and extension of the elbows 
• Shoulder 
  • Internal rotation (bringing the arms across the chest in a “hugging” motion) 
  • External rotation (moving the arms back at the shoulder joint as if trying to touch the hands behind the back) 
  • Flexion and extension (moving the arms above the head and back to anatomic/neutral position) 

A study by Garfinkel and colleagues in 1994 showed that once weekly yoga (practiced for a period of 8 weeks) helped in the treatment of hand osteoarthritis (Garfinkel et al, 1994). A similar study in 1998 demonstrated that a yoga-based intervention may also be useful in relieving the symptoms of carpal tunnel syndrome (Garfinkel et al, 1998). In addition to other exercises and stretching programs, yoga may also be a way to specifically relieve wrist pain. 

 

Posture 

Static posture (a fixed position that is held for some length of time) is more strenuous to maintain than a neutral/resting posture. Repetition of static postures (as in holding and playing an oboe) may increase the likelihood of sustaining an injury (Horvath, 2010) 

• Oboists may not be aware of improperly positioned static postures and put themselves at an even greater risk of injury 
  • Watching themselves play in a mirror, having a mentor/colleague watch them, and recording themselves are all techniques to identify poor posture practices in an effort to address them 
    • Stretching, as mentioned previously, may help address poor posture once identified (Horvath, 2010) 

The Alexander Technique is a way to identify and improve movement habits and postures. It is not a set of physical steps or actions, but is more so a re-education of the mind and body to improve overall quality of life (The Complete Guide to the Alexander Technique) 

• Some techniques include 
  • Laying down in a “semi-supine” position 
    • The back is flat on the floor with the knees bent and the soles of the feet planted on the ground. A book is placed underneath the head to gently align the spine. Once this position is assumed, the person “sinks their weight” into the ground. This allows the discs to restore their shock-absorbing qualities (Kleinman and Buckoke, 2013) 
  • Being aware of head and spine alignment. Think of a “head up and forward posture” while playing the oboe and performing daily tasks (Kleinman and Buckoke, 2013) 
  • Using a body map 
    • Making a conscious effort to feel each joint and where it is in space. This helps detect poor posture and allow the oboist to address it (Kleinman and Buckoke, 2013) 
• As with other techniques, Alexander Techniques work best when they are practiced consistently, focusing on quality, rather than quantity 

 

Support devices 

• Key extensions 
  • Key extensions are additional modifications that are added to instrument keys in order to better accommodate oboist anatomy and allow more comfortable playing 
    • Examples include: 
      • Left-F key: applied to elongate the left-F key, which is useful for players with short pinky fingers (Peterson) 
      • Philadelphia key: when applied to the oboe, it allows for adjustment of the D double ring key opening (split ring). It improves the response of the high D (Sandlin, 2009) 
• Thumb rests 
  • Many oboes come with a thumb rest, or one can also be purchased separately and attached (without damaging the instrument). Thumb rests can be adjusted based on the oboist's anatomy and movement during performance. Thumb rests increase the space between the instrument and the thumb, which allows free movement and playing more comfortably. They can also provide support to the weight of the thumb (Dawson, 2008) 
• Neck straps 
  • Neck straps are attached to the instrument thumb rest and worn around the oboist’s neck. The strap is tightened to alleviate some of the weight of the instrument without pushing the instrument reed too far into the oboist’s mouth (Diehl, 2016) 
• Wrist supports/splints 
  • Splints partially immobilize the wrist to prevent painful movements and help an injury heal. However, splints may be less helpful over time, as long-term use of splints may lead to muscle stiffness and atrophy (Diehl, 2016). 

 

Medication considerations (Houglum, 2016) 

Both oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) are first line for musculoskeletal pain and swelling. By reducing inflammation, and therefore pain, these agents allow oboists to participate in exercises aimed at rehabilitation (stretching programs, working with physical/occupational therapy, etc.) These drugs are not curative and will not address the underlying abnormality 

In particularly severe cases of pain that is unresponsive to NSAIDs, injections of corticosteroids may help with pain. This is most commonly seen in the treatment of tendinopathies, such as lateral epicondylitis and de Quervain’s tenosynovitis (Pidgeon, 2022) (Witstein and Alaia, 2024) 

 

References

Wikipedia contributors. (2025, January 11). Oboe. In Wikipedia, The Free Encyclopedia. Retrieved 17:58, January 28, 2025, from https://en.wikipedia.org/w/index.php?title=Oboe&oldid=1268701928 

“Anatomical Terms of Movement.” TeachMeAnatomy, teachmeanatomy.info/the-basics/anatomical-terminology/terms-of-movement/. Accessed 28 Jan. 2025. 

Mark Chasnov, and Steven Clark, Healing Sports Injuries: A Hands-on Guide to Restorative Massage and Exercise (New York: Ballantine Books, 1988), 21-22. 
Banzhoff S, Del Mar Ropero M, Menzel G, Salmen T, Gross M, Caffier PP. Medical Issues in Playing the Oboe: A Literature Review. Med Probl Perform Art. 2017 Dec;32(4):235-246. doi: 10.21091/mppa.2017.4040. PMID: 29231958.

Macdonald HM, Lavigne SK, Reineberg AE and Thaut MH (2022) Playing-Related Musculoskeletal Disorders, Risk Factors, and Treatment Efficacy in a Large Sample of Oboists. Front. Psychol. 12:772357. doi: 10.3389/fpsyg.2021.772357 

Nemoto, Koichi, and Hiroshi Arino. “Hand and upper extremity problems in wind instrument players in military bands.” Medical Problems of Performing Artists, vol. 22, no. 2, 1 June 2007, pp. 67–69, https://doi.org/10.21091/mppa.2007.2014. 

Pidgeon, Tyler Steven. “De Quervain’s Tenosynovitis.” Edited by Thomas Ward Throckmorton, OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/de-quervains-tendinosis. Accessed 28 Jan. 2025. 

Pidgeon, Tyler Steven. “Carpal Tunnel Syndrome.” Edited by Thomas Ward Throckmorton, OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/. Accessed 28 Jan. 2025. 

Pidgeon, Tyler Steven. “Arthritis of the Hand.” Edited by Thomas Ward Throckmorton, OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-hand/. Accessed 28 Jan. 2025. 

Witstein, Jocelyn Ross, and Michael J. Alaia. “Tennis Elbow (Lateral Epicondylitis).” Edited by Mary K. Mulcahey and Stuart J. Fischer, OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/. Accessed 28 Jan. 2025. 

“Body Use.” Oboehelp, 7 Apr. 2020, oboehelp.com/body-use/. 

Smutz, W. Paul, et al. “Load on the Right Thumb of the Oboist.” Medical Problems of Performing Artists, vol. 10, no. 3, 1995, pp. 94–99. JSTOR, http://www.jstor.org/stable/45440533. Accessed 28 Jan. 2025. 

Horvath, Janet. Playing (Less) Hurt: An Injury Prevention Guide for Musicians. New York: Hal Leonard Books, 2010. 

Garfinkel MS, Schumacher HR Jr, Husain A, Levy M, Reshetar RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol. 1994 Dec;21(12):2341-3. PMID: 7699639. 

Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR Jr. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998 Nov 11;280(18):1601-3. doi: 10.1001/jama.280.18.1601. PMID: 9820263. 

Diehl, S. L. (2016). A selected review of prevention and non-surgical treatment options for musculoskeletal performance-related injuries common among oboists (Order No. 10109496). Available from ProQuest Dissertations & Theses Global. (1796237187). 

“What Is the Alexander Technique and What Are Its Benefits?” The Complete Guide to the Alexander Technique, 28 Nov. 2024, alexandertechnique.com/at/. 

Kleinman J, Buckoke P. The Alexander Technique for Musicians. Bloomsbury Publishing; 2013. 

Dawson, William Fit As A Fiddle: The Musician's Guide to Playing Healthy Rowman & Littlefield Education Lanham 2008 

Peterson, John. “Custom Ergonomic Keywork.” John Peterson Woodwind Repair, www.oboedr.com/adaptive-keywork#:~:text=Left%20f%20extension%20Players%2.... Accessed 28 Jan. 2025. 

Sandlin, Amy. “Glossary.” Oboes for Idgets- Home, www.oboesforidgets.com/glossary.htm. Accessed 28 Jan. 2025. 

Houglum PA. Therapeutic Exercise for Musculoskeletal Injuries 4th Edition. Human Kinetics; 2016. 

Banzhoff S, Del Mar Ropero M, Menzel G, Salmen T, Gross M, Caffier PP. Medical Issues in Playing the Oboe: A Literature Review. Med Probl Perform Art. 2017 Dec;32(4):235-246. doi: 10.21091/mppa.2017.4040. PMID: 29231958.