Gong Hyun Sik, Cho Hoyune Esther, Rhee Seung Hwan, Kim Jihyeong, Lee Young Ho, Baek Goo Hyun
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea; Albert Einstein College of Medicine, Bronx, NY.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea; Albert Einstein College of Medicine, Bronx, NY.
J Hand Surg Am. 2014 Aug;39(8):1535-9. doi: 10.1016/j.jhsa.2014.04.039. Epub 2014 Jun 6.
To report the features of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players.
Between 2005 and 2012, we treated 6 cases of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players at a single referral center. We conducted a retrospective review of charts and radiographs and telephone-interviewed all patients at a mean follow-up of 33 months (range, 12-66 mo) to evaluate features of this injury.
All patients were girls with a mean age of 10 years (range, 8-12 y), and all had injuries in their right hands. Patients had been playing piano for a mean 3.8 years (range, 3-5 y) and practicing for a mean 1.8 hours per day (range, 1-3 h). Pain was commonly aggravated when they played octaves or advanced pieces requiring extensive finger movements. All patients were playing on standard-size piano keyboards and had generalized hypermobility with a mean Beighton and Horan score of 6.3 (range, 5-9). Two patients had an ulnar deviation deformity of 10° and 15° each at the proximal interphalangeal joint whereas the others had no fixed joint deformity. Five patients showed improvement with conservative treatment, but 1 patient underwent surgery.
In our practice, all piano-related radial collateral ligament injuries were in female preadolescents with evidence of generalized hypermobility; patients had been playing piano extensively, suggesting that the injury could have resulted from stress on the joint during piano playing. Future studies should further evaluate the efficacy of modifying keyboard size, techniques, and repertoires for piano lessons and of patient education for this type of injury.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
报告年轻钢琴演奏者小指近端指间关节桡侧副韧带损伤的特点。
2005年至2012年期间，我们在一家转诊中心治疗了6例年轻钢琴演奏者的小指近端指间关节桡侧副韧带损伤。我们对病历和X线片进行了回顾性分析，并对所有患者进行了电话随访，平均随访时间为33个月（范围12 - 66个月），以评估该损伤的特点。
所有患者均为女孩，平均年龄10岁（范围8 - 12岁），且均为右手受伤。患者平均弹琴3.8年（范围3 - 5年），平均每天练习1.8小时（范围1 - 3小时）。弹奏八度音或需要大量手指运动的进阶曲目时，疼痛通常会加重。所有患者均使用标准尺寸的钢琴键盘，且普遍存在关节活动过度，平均Beighton和Horan评分为6.3（范围5 - 9）。2例患者近端指间关节分别有10°和15°的尺侧偏斜畸形，而其他患者无固定关节畸形。5例患者经保守治疗后病情改善，但1例患者接受了手术。
在我们的实践中，所有与钢琴相关的桡侧副韧带损伤均发生在有全身关节活动过度证据的青春期前女性；患者长期大量弹奏钢琴，提示损伤可能是由于弹奏钢琴时关节受力所致。未来的研究应进一步评估调整钢琴键盘尺寸、技巧和曲目以及对这类损伤患者进行教育的效果。
研究类型/证据水平：治疗性IV级。
