Medical problems of musicians.

Surveys of performing musicians indicate that almost half of them experience playing-related medical problems, some of which threaten or end their careers. Overuse injuries involving the muscle--tendon unit are the most common problem, with symptoms ranging from mild pain while the musician is playing to pain severe enough to preclude any use of the affected hand. String players are the most commonly affected, and percussionists the least. The most important predisposing characteristic is the use of repetitive movements during long hours of practice, but awkward body positions mandated by the shape and weight of the instrument, the technical difficulty of the repertoire, and unfamiliar instruments may also play a part. Women are more commonly affected than men. Rest is the cornerstone of therapy. Neural impingement syndromes affecting the median or ulnar nerves or the thoracic outlet affect many musicians. Focal dystonias may involve part or all of a hand or the muscles forming the embouchure (the position of the lips in wind players). These are very resistant to therapy and may terminate or drastically alter a career. Stress, especially performance anxiety, may impede performance. Beta-adrenergic blocking agents prevent the symptoms of performance anxiety and are frequently used by musicians without medical supervision. A recognition of the unique problems of musician-patients has led to the formation of successful specialty clinics in a number of cities.