Focal peripheral neuropathies in instrumental musicians.

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.