Fiddler's Neck Research Articles

Musicians’ medicine – potential health problems among violinists and violists caused by playing the string instrument – the review of the literature

Introduction and purpose
 Musicians' medicine has received increasing attention recently. It is known that listening to music or playing an instrument has beneficial effects on cognitive and neural functions. Playing the string instrument demands repetitive precise movements of fingers and arms in a non-ergonomic posture that might give rise to health problems.
 The study aims to present the current state of knowledge regarding different potential health problems among violinists and violists. The article reviews the 24 newest scientific publications available on PubMed and Google Scholar.
 A brief description of the state of knowledge
 The literature review indicated several potential health consequences of excessive playing the violin or viola, as follows: Fiddler's neck and skin allergy, Garrod’s pads, temporomandibular disorders, carpal tunnel syndrome, cubital tunnel syndrome, tennis elbow, compression of the right ulnar nerve in the ulnar (Guyon's) canal, rotator cuff tendonitis, tenosynovitis, bursitis, focal dystonia, thoracic outlet syndrome, bone asymmetry, pain in the neck, cheeks, fingers, wrist, forearm, shoulder, waist, and the back.
 Conclusions 
 Musicians should be aware of potential health problems that occur during prolonged playing the violin or the viola. An important issue is maintaining the accurate proportions between the amount of time spent playing the instrument and resting. The first signs of neurological or musculoskeletal changes should prompt the musician to seek professional medical help to prevent the disorder's progression.

Ultrasound in Sports and Occupational Dermatology.

Chronic exposure to trauma, friction, or extreme conditions can generate cutaneous or ungual lesions in sports and certain occupations. Although some of these dermatologic conditions are diagnosed with a naked-eye examination, there are cases in which the provision of the underlying anatomic alterations can be helpful for the diagnosis and management. In comparison with computed tomography or magnetic resonance imaging, ultrasound has the highest axial resolution, which is critical for the observation of anatomic changes in the skin and nail. We review the ultrasound characteristics of frequent cutaneous and ungual lesions related to sports and occupations with a clinical correlation. The ultrasound features in some particular conditions such as "biker's and surfer's panniculitis," "fiddler's neck," piezogenic papules, and lipoatrophy semicircularis, among others, are discussed.

Skin diseases in musicians.

Instrumental musicians are a risk group for skin diseases. A systematic review was performed on Pubmed database and in the musical literature. Most publications on dermatoses in musicians are case reports. The exact prevalence of skin diseases in musicians is unknown but high rates have been reported. The most at-risk musicians are percussionists, string and wind instrumentalists. Repeated physical trauma is a frequent cause of skin conditions in musicians (callosities, fiddler's neck syndrome…). The allergens most often reported in musicians' allergic contact dermatitis are metals (nickel, dichromate), exotic woods and cane reed components, colophony and propolis. The key preventive measures are early management of the skin disease, specific tests and avoidance of the causative allergens, together with better adjustment of playing techniques to reduce trauma.

Geigerknoten

The fiddler's neck is an uncommon variant of acne mechanica in violinists and violists. It is a single firm red-brown dermal nodule usually on the left side of neck. This special form of acne mechanica represents a therapeutic challenge since the triggering mechanical factors persist, unless they can be corrected by changes in positioning or modifications of the chin pad. A 72-year-old woman who had played the violin since childhood presented with a red-brown nodule on her neck for 18 months. Cushioning provided no relief. Excision of the affected area with primary closure represented one therapeutic option. Further supportive measures include improved posture to reduce the pressure between skin and instrument and interposing a neck cloth.

Fiddler’s neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player

Fiddler's neck refers to an irritant contact dermatitis on the submandibular neck of violin and viola players and an allergic contact dermatitis to nickel from the bracket attaching the violin to the chin rest on the violinist's supraclavicular neck. A 26-year-old woman developed submandibular and supraclavicular left neck lesions corresponding to the locations of the chin rest and bracket that was attached to her violin that held it against her neck when she played. Substitution of a composite chin rest, which did not contain nickel, and the short-term application of a low potency topical corticosteroid cream, resulted in complete resolution of the allergic contact dermatitis supraclavicular neck lesion. The irritant contact dermatitis submandibular neck lesion persisted. In conclusion, violin players are predisposed to developing irritant contact dermatitis or allergic contact dermatitis from the chin rest. We respectfully suggest that the submandibular neck lesions from contact with the chin rest be referred to as 'fiddler's neck - type 1,' whereas the supraclavicular neck lesions resulting from contact of the bracket holding the chin rest in place be called 'fiddler's neck - type 2.' A composite chin rest should be considered in patients with a preceding history of allergic contact dermatitis to nickel.

1131 CELLO SCROTUM, 1974-2009

You have accessJournal of UrologyHistory of Urology1 Apr 20101131 CELLO SCROTUM, 1974-2009 Lawrence Wyner Lawrence WynerLawrence Wyner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2328AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In his seminal 1713 treatise, De Morbis Artificum Diatriba (Diseases of Tradesmen), Bernardino Ramazzini (1633-1714), the father of occupational medicine, included musicians as one of 52 occupations he described with various medical ailments peculiar to their work. Likewise, in 1887, the British Medical Journal (BMJ) became the first scientific periodical to publish an analysis of a musician's malady, “pianist's breakdown,” a study by G.V. Poore of muscle cramps caused by playing the piano. These endeavors spawned the field of performance medicine, which has grown to encompass multiple textbooks and journals dedicated to this topic, as well as a plethora of purported physical ailments ascribed to the challenges of playing various musical instruments. These conditions range from the serious (e.g. fiddler's neck, clarinetist's cheilitis) to the fanciful (e.g. Satchmo's Syndrome, guitar nipple). Perhaps the most bizarre of these was cello scrotum, first described by chemist John Murphy in a letter to the editor of the BMJ in 1974. Murphy and his wife, psychiatrist Elaine Murphy, had read a letter to the editor in a previous BMJ issue identifying guitar nipple, a condition supposedly consisting of areolar irritation in adolescent girls learning to play classical guitar. The Murphys, convinced that guitar nipple was bogus, wrote their own letter to the BMJ as a follow-up, claiming to have seen a cellist patient with scrotal dermatitis caused by long hours of scrotal contact with the vibrating body of his instrument. To their surprise, the letter was published in the BMJ, and began to be reported across the globe. Musicians unions in both the United Kingdom and the Soviet Union lobbied to have the condition listed as an industrial disease. Cello scrotum was referenced a dozen times in the peer-reviewed medical literature over the next 35 years, although skeptics questioned how the body of the cello could contact the scrotum if the instrument were properly played, and one wag commented that the affected cellists might be supplementing their meager incomes by sweeping chimneys! In any case, by Christmas 2008, the Murphys decided it was time to “come clean,” and sent the BMJ a letter of retraction which was published in January 2009, admitting that cello scrotum was indeed a high-brow hoax. The BMJ took the matter in stride, commenting that no one was harmed by the light-hearted deception, especially the Murphys (she sits on the board overseeing the British National Health Service and is a member of the House of Lords, and he is chairman of a brewery), and that the BMJ will continue its pioneering efforts on behalf of musicians' health. METHODS N/A RESULTS N/A CONCLUSIONS N/A Huntington, WV© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e437-e438 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lawrence Wyner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fiddler's Neck Accompanied by Allergic Contact Dermatitis to Nickel in a Viola Player

"Fiddler's neck" is an irritant contact dermatitis that frequently affects violin and viola players. The etiology of the skin changes associated with this condition are probably attributable to a combination of factors--including increased pressure, friction, poor hygiene, and excessive perspiration. Clinically, the lesions generally consist of a localized area of lichenification on the left side of the neck just below the angle of the jaw. Herein, we report a case of fiddler's neck in a viola player, attended by allergic contact dermatitis to the nickel in the metal fixtures of a viola. We hope that our case report draws the attention of dermatologists toward this, and many other skin problems that affect musicians.

Skin conditions in instrumental musicians: a self‐reported survey

Instrumental musicians are a risk group for a variety of skin conditions. To determine the frequency and risk factors of instrument-related skin disorders in musicians. We mailed an 11-item survey to 19 German universities of music and performing arts. 412 musicians returned the completed questionnaire, of whom 21.6% (89/412) had an instrument-related skin disorder including callosities (52/89; 58.4%), contact dermatitis (CD; 17/89; 19.1%), fiddler's neck (17/89; 19.1%), and erosion (3/89; 3.4%). Allergic CD (13/17; 76.5%) was most frequently reported in violinists and violists. Of 116 violinists and violists, 17 (14.7%) suffered from fiddler's neck. String and plucking instrumentalists most frequently reported callosities (61/89; 68.5%) and skin problems (32/37; 86.5%). Instrument-related skin disorders were significantly associated with high practice frequencies (P = 0.022) and a professional status (P = 0.001). Callosities and CD were the most commonly reported skin changes in the respondents. Both callosities and skin problems such as CD and fiddler's neck are significantly associated with high practice frequencies and professional status. Our data indicate that among those returning the questionnaires, string players and plucking instrumentalists seem to be at highest risk of developing skin problems when compared with players of other musical instruments.

Contact dermatitis in guitar players.

Conflict of interest: none declared. Musicians are susceptible to an unusual variety of dermatoses specific to their occupation. Violin and viola players may develop ‘fiddler's neck', a lichenified plaque below the angle of the mandible on the left, corresponding to the site where the chin rests on the instrument while playing.1 Cello playing has similar hazards. Cases of ‘cello knee’, caused by the pressure applied to the instrument by the medial aspects of the knee, resulting in skin calluses, hyperpigmentation or lesions similar to fiddler's neck have been reported.2‘Cellist's chest'2 is a tender, hyperpigmented plaque with erythema, oedema, and inflammatory papules and cysts on the presternal skin, caused by the back of the instrument pressing on the chest when the bow is drawn across the strings. Harp enthusiasts can develop paronychia, onycholysis, subungual haemorrhages or calluses on the fingers as a result of playing their instrument.2 Musicians who develop an irritant contact dermatitis are thought to be relatively rare;2 however, it has been reported in horn players who use cleansers or silver polish containing solvents on their instruments.3 It is well known that colophony is present in the resin used by players of stringed instruments to wax the strings to increase the attrition between the bow and strings.4 The constituent of the instrument (especially hardwoods) may also produce a contact allergic reaction.5 We report a new ‘musician's dermatitis' affecting the hand, which was the result of nickel contact from guitar strings.

Contact dermatitis and other skin conditions in instrumental musicians.

BackgroundThe skin is important in the positioning and playing of a musical instrument. During practicing and performing there is a permanent more or less intense contact between the instrument and the musician's skin. Apart from aggravation of predisposed skin diseases (e.g., atopic eczema or psoriasis) due to music-making, specific dermatologic conditions may develop that are directly caused by playing a musical instrument.MethodsTo perform a systematic review on instrument-related skin diseases in musicians we searched the PubMed database without time limits. Furthermore we studied the online bibliography "Occupational diseases of performing artist. A performing arts medicine bibliography. October, 2003" and checked references of all selected articles for relevant papers.ResultsThe most prevalent skin disorders of instrumental musicians, in particular string instrumentalists (e.g., violinists, cellists, guitarists), woodwind players (e.g., flautists, clarinetists), and brass instrumentalists (e.g., trumpeters), include a variety of allergic contact sensitizations (e.g., colophony, nickel, and exotic woods) and irritant (physical-chemical noxae) skin conditions whose clinical presentation and localization are usually specific for the instrument used (e.g., "fiddler's neck", "cellist's chest", "guitar nipple", "flautist's chin"). Apart from common callosities and "occupational marks" (e.g., "Garrod's pads") more or less severe skin injuries may occur in musical instrumentalists, in particular acute and chronic wounds including their complications. Skin infections such as herpes labialis seem to be a more common skin problem in woodwind and brass instrumentalists.ConclusionsSkin conditions may be a significant problem not only in professional instrumentalists, but also in musicians of all ages and ability. Although not life threatening they may lead to impaired performance and occupational hazard. Unfortunately, epidemiological investigations have exclusively been performed on orchestra musicians, though the prevalence of instrument-related skin conditions in other musician groups (e.g., jazz and rock musicians) is also of interest. The practicing clinician should be aware of the special dermatologic problems unique to the musical instrumentalist. Moreover awareness among musicians needs to be raised, as proper technique and conditioning may help to prevent affection of performance and occupational impairment.

Fiddler's neck

The dermatologic pathological condition of musicians is a rare medical problem. We would like to draw attention to what is called “Fiddler's neck,” a process that is peculiar to violin, viola, or cello players and that may be caused by two different mechanisms: contact allergic reaction or a mechanical action.

Fiddlerʼs Neck

The dermatologic pathological condition of musicians is a rare medical problem. We would like to draw attention to what is called “Fiddler's neck,” a process that is peculiar to violin, viola, or cello players and that may be caused by two different mechanisms: contact allergic reaction or a mechanical action.

The edema of fiddler's neck

Fiddler's neck is a dermatosis of violinists and violists. It characteristically presents as focal lichenification and pigmentation on the left side of the neck. Edema may also occur in the same area and lead to cosmetic concern or fear of malignancy. The edema apparently results from pressure on the patient's neck by the base of the violin or viola and is worsened by holding the instrument in a drooping position.

'Fiddler's neck'.

'Fiddler's neck' is a condition affecting violin and viola players. Although well known to musicians it is not well recognized by dermatologists. Clinically the lesions usually consist of a localized area of lichenification of the left side of the neck--just below the angle of the jaw. Pigmentation, erythema and inflammatory papules or pustules are frequently present, while severe inflammatory induration, cyst formation and scarring occur in more severely affected subjects. The aetiology of the skin changes is probably due to a combination of factors; friction giving rise to lichenification, while local pressure, shearing stress and occlusion may play a part in producing the acne-like changes and cyst formation. In addition, poor hygiene may predispose to local sepsis.

'Fiddler's neck'

British Journal of DermatologyVolume 97, Issue s15 p. 10-10 ‘Fiddler's neck’ R.D.G. Peachey, R.D.G. Peachey Department of Dermatology, Bristol Royal InfirmarySearch for more papers by this authorC.N.A. Matthews, C.N.A. Matthews Department of Dermatology, Bristol Royal InfirmarySearch for more papers by this author R.D.G. Peachey, R.D.G. Peachey Department of Dermatology, Bristol Royal InfirmarySearch for more papers by this authorC.N.A. Matthews, C.N.A. Matthews Department of Dermatology, Bristol Royal InfirmarySearch for more papers by this author First published: December 1977 https://doi.org/10.1111/j.1365-2133.1977.tb14289.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume97, Issues15December 1977Pages 10-10 RelatedInformation