Clinical Assessment of Shoulder Impingement Factors in Violin and Viola Players

Abstract

Objective: To describe several clinical tests and predisposing factors for shoulder impingement syndrome in violin and viola players. Subjects: Ten musicians (7 females, 3 males) and 18 controls (8 females, 10 males), all college-aged. Methods: Subjects were interviewed about their music-playing history and shoulder pain. Four clinical assessment tests were performed on both shoulders: Neer impingement text (maximal flexion +/- pain), shoulder internal rotation with over-pressure (end-feel and +/- pain), lower trapezius muscle strength (ft-lbs of torque from manual dynamometer), and forward shoulder posture (height of acromion from plinth with subject supine). Analysis: Descriptive analysis of questionnaire data, plus two-sample t-tests for manual shoulder assessment tests in musicians versus controls. Also comparisons of music-playing history in musicians with and without shoulder impingement. Results: Seventy percent of musicians reported pain somewhere in the upper limb, with 50% in the left shoulder and 30% in the right shoulder. Thirty percent of musicians had a positive Neer impingement test, while 0% of controls did. There was a significant phi (Φ) correlation between being a musician and having a higher incidence of shoulder impingement (p<0.01 for bowing arm, p<0.05 for left arm). Those musicians with a positive impingement test also had pain with over-pressure in internal rotation, indicating a chronic condition. Musicians' mean playing time was 9.8 hr/wk, with 14 min/hr of rest. Musicians with impingement tended to play more hours per week, but differences in playing time and rest were not significant. t-Tests showed no significant difference in lower trapezius strength or degree of forward shoulder between musicians and controls. Conclusions: Upper string players are at increased risk for shoulder impingement.