Trauma to the High-level Instrumentalist's Hand and Upper Extremity: An Epidemiologic and Outcome Study

Abstract

Expanding on a pilot study of musician trauma presented several years ago, this paper reports on 276 professional or serious amateur instrumentalists, with 178 followed to a final outcome. The group represents 39.4% of all 701 musicians with trauma and 20.4% of all musicians seen by the author from 1981 to 1996 for hand and upper extremity problems. More than 60% were male, and 75% played strings and keyboards. Performing professionals constituted 38.8% of the total, while dedicated amateurs added 44.9%. Sports (30.1%) and a fall or blow (32.6%) were the most common causes of injury, with sports the most common among musicians aged 10 to 40 yrs. Nearly two-thirds of the sports trauma was due to ball sports, followed by household injuries and motor vehicle accidents. Diagnoses included fractures (32.7%), sprains/strains (24.4%), and open wounds (10.8%). More than one third of the group with open wounds also suffered nerve and/or tendon lacerations. The outcome in 178 patients included complete relief of symptoms in 122 (68.6%) and improvement in 53 (29.8%). Full return to performance occurred in 149 (83.7%) and in modified fashion in 25 (14.1%). Four patients stopped playing because of the injury or its sequelae. Forty-three patients presented with late sequelae from a prior injury, which resulted from sports or a fall/direct blow in 25. Of 27 with a known outcome, 11 returned fully to music, while 14 modified their performance. Division of nerves or tendons were more likely to result in very long-term disability or incomplete recovery, regardless of the accuracy of repair or extent of rehabilitation.