Overuse Syndrome

Abstract

Objective: Overuse syndrome is a repetitive strain injury or cumulative trauma disorder that affects instrumentalist musicians. It consists of work-related muscle and ligament symptoms associated with weakness, loss of control, or speed, but objective lesions are not found. The aim of this study is to report incidence, predisposing factors, and follow-up of patients with this current entity in our center in Argentina. Materials and Methods: We performed a 15-year prospective study at our medical center in Buenos Aires. During this period, we evaluated 782 instrumentalist musicians with upper limb symptomatology. The inclusion criterion was pain in the upper limb with normal imaging studies. The exclusion criteria were previous trauma, neuromuscular comorbidity, or another pathology confirmed by imaging study or clinical examination. There were 387 patients with related symptoms of overuse syndrome. We used a detailed clinical test consisting of 4 items: personal history, professional background, symptoms description, and medical examination. In the first appointment, routinely, we evaluated the patients with the Fry Scale of Pain and indicated simple Rx and ultrasound of the affected region. We isolated common risk factors, most affected upper limb region, type of instrument, musical performance, and previous consultation to another physician. Outcome data were obtained from follow-up monitoring, every month until the resolution of the symptoms. Results: A summary of the major findings of the case control analysis is as follows: 387 patients, 280 men and 107 women, were included. The average age of presentation was 27.85 years. The range of age was between 13 and 65 years, with a median of 33. The onset of symptoms and the first consultation ranged between 1 week and 2 years. We identified common risk factors: lack of prevention behaviors (warm up, breaks, stretching maneuvers), higher demand for study or work, carrying the instruments, and absence of aerobic physical activity. The most frequent physical finding was pain in forearms (343), followed by pain in trapezium muscle (25) and first interosseous dorsal muscle (19). The prevalence of overuse syndrome in the different instruments was 190 plucked strings (27 bilateral), 79 swinging strings (75 bilateral), 44 percussion (all bilateral), 42 bowed strings (10 bilateral), 26 winds (3 bilateral), 4 wind bellows (all bilateral), and 2 voices. The treatment was based in two mainstays, one focused to prevention habits (strengthening and relaxing muscles and improving their general physical condition) and the other to pain treatment: a protocolized physiotherapy based on myofascial release technique. This showed good results in 98% of our instrumentalist musician patients treated. Conclusion: Overuse syndrome is a condition of pain and loss of function in muscles of musicians as a consequence of their excessive use. It is important to create awareness of the existence of this entity in young musicians to prevent the appearance of symptoms. The challenge consists in combining parallel experiences, that of specialized medicine with that of those who work in relation with the musical culture, thus, merging science with art to enhance the prevention and treatment of injuries suffered by this professional group.