Lederman Richard J
Department of Neurology and Medical Center for Performing Artists, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Phys Med Rehabil Clin N Am. 2006 Nov;17(4):761-79. doi: 10.1016/j.pmr.2006.06.009.
Instrumental musicians often seek medical consultation for symptoms suggestive of nerve entrapment. About 20% of those seen in the author's performing artists' clinic were diagnosed with a focal neuropathy. In general, neuropathies that are most common in the overall population tend also to be most common among musicians, although some expectations exist, including, for example, localized peri-oral sensory syndromes associated with playing a brass instrument, and, possibly, ulnar neuropathies related to the playing position of bowed string players. The diagnosis is made, as always, by careful clinical assessment, including observation of the instrumentalist playing, with ancillary procedures such as nerve conduction studies and needle electromyography adding to the accuracy of the diagnosis. Treatment is similar to that used in nonmusicians, but certain factors, including the musician's requirement for extraordinary neuromuscular dexterity, may influence the therapeutic decisions. Very limited long-term outcome results are available, and additional studies in musicians would be helpful in determining the most appropriate therapeutic approaches. Virtually no longitudinal studies have been performed to look at methods for preventing these disorders.
器乐演奏者常常因疑似神经卡压的症状而寻求医疗咨询。在作者的表演艺术家诊所就诊的患者中，约20%被诊断为局灶性神经病。一般来说，在普通人群中最常见的神经病在音乐家当中往往也最为常见，不过也有一些例外情况，例如与吹奏铜管乐器相关的局限性口周感觉综合征，以及可能与拉弦乐器演奏者的演奏姿势相关的尺神经病变。一如既往，诊断是通过仔细的临床评估做出的，包括观察演奏者的演奏情况，辅助检查如神经传导研究和针极肌电图可提高诊断的准确性。治疗方法与非音乐家所用的方法类似，但某些因素，包括音乐家对非凡神经肌肉灵活性的要求，可能会影响治疗决策。长期疗效结果非常有限，对音乐家进行更多研究将有助于确定最合适的治疗方法。实际上，尚未进行纵向研究来探讨预防这些疾病的方法。
