Upper Extremity Difficulties in the Dedicated Amateur Instrumentalisty

There are more than 62 million amateur instrumental musicians in the United States, many of whom can be described as active, dedicated amateurs. This report details a 15-year experience with 258 such patients with upper extremity problems from the author’s hand surgical practice, and compares some epidemiological and etiological parameters of this group with a cohort of 322 professional instrumentalists. The 258 patients’ ages ranged from 10 to 87 years; 137 (53.1%) were males. More than 75% played string or keyboard instruments. Music was the cause of difficulties in only 14% overall, but this rate rose to 47.2% for overuse-related diagnoses. Inflammatory conditions and muscle–tendon strains were equally represented and constituted 85% of all overuse diagnoses. Trauma caused difficulties in 124 patients (48.1%) and resulted from sports participation in one-third of these; it was significantly more common in males under 40. Falls on the upper limb accounted for another third of the injuries. Fractures and joint dislocations were the most common traumatic diagnoses, most often affecting the digits and distal forearm/wrist. A group of 45 “other” conditions included 18 patients with various nerve compressions (13 with carpal tunnel syndrome), 12 with ganglia in the wrist or fingers, and seven with various inflammatory problems. Only 17 patients presented with arthritic conditions, all resulting from degenerative joint disease; eight had involvement of the thumb carpometacarpal joint. This dedicated amateur group was similar to the professional cohort in many epidemiologic, etiologic, and diagnostic parameters, although the professionals were more likely to present on more than one occasion with upper extremity problems, and more of their problems were related to musical practice or performance.