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Overuse Syndrome of the Hand and Wrist in Musicians: A Systematic Review

 This week's article for Musician's Journal Club was a 2020 article from the Journal of Hand Surgery (European volume) entitled "Overuse syndrome of the hand and wrist in musicians: a systematic review".  I chose this article because hand and wrist pain is an issue that affects many different instrumentalists, and one I have personal experience with. I thought this review article gave a nice balanced view of defining overuse syndrome and symptoms and discussing treatment and prevention strategies.

The lifetime prevalence of musculoskeletal pain in musicians has been reported as 77%, 67%, and 89%

Musculoskeletal pain in musicians is clearly an issue. Even by the lowest number reported in this article, about two out of three musicians experience pain during their career. Overuse syndrome is one of the common diagnoses for musician pain, and some of the most common areas affected by overuse syndrome are the wrist, forearm, fingers, and right hand, especially in wind players. Interestingly, there was no significant gendered-difference in hand and wrist overuse syndrome seen in these studies, even though there has been documentation of higher overuse syndrome prevalence in females than males.

Overuse syndrome risk factors:
  • Intensive repetitive use during practice
  • Increase in playing time
  • Psychological stress
  • Change in instruction
  • Incorrect technique
  • Technically demanding passages
  • Small hand size (especially in pianists)

Symptoms of overuse syndrome include pain present at rest and at night, not only while playing, weakness or stiffness of the affected area, loss of control during or after playing or practicing, swelling or tenderness, muscle fatigue, cramps, or involuntary spasms.  Treatments for overuse syndrome generally consist of rest, stretching, bracing, and physical or occupational therapy. 
About 35% of music students affected by playing-related pain syndrome do not ask for help at all
While experiencing pain is relatively common, there is still stigma around asking for help. One of the main goals of this page is to discuss symptoms and treatments to encourage musicians to seek out additional resources and recognize that these injuries are common and nothing to be ashamed of. With this in mind, some prevention techniques for overuse syndrome are warm up exercises, breaks during practicing, balancing hours of repetitive practice, physical activity and upper body strengthening, and utilizing mental practicing.  

To begin this week's discussion, I utilized Instagram stories to poll my audience on injuries they've experienced and how they are affected by hand and wrist pain.

Survey results from instagram polls showing that 100% of respondents had hand or wrist pain while playing, 88% used self treatment methods, 41% did regular physical warm-ups, 88% took breaks during practice sessions, and 41% had sought out medical advice for hand or wrist pain

Resources

Some of the prevention and self-treatment options for overuse syndrome include stretching and physical warm ups. Try out the videos below to experiment with warm-ups and hand and wrist stretches. Keep in mind that these stretches may not work for you, as each body is different, but here's a place to start.



Reflection

I was pleasantly surprised by the amount of engagement with this week's posts, especially with this being the first week of actual posting for the project. The two main posts for this week, explaining the article, had combined 30 likes and 4 comments (at the time of writing this blog post). The Instagram polls averaged 35 views and 17 responses on each question. My follower count grew from 54% in the last week to 74 followers. I think it is clear that there is a need and an audience for this type of work.

An issue I ran in to is the challenge in finding open-access articles. While I can read most journal articles through the University of Arizona library, my followers may not have the same access. Because of this, I am transitioning my posts to do a more thorough explanation of the article (I did two posts about article content rather than my planned one post) and focus on creating discussing questions inspired by the paper, but that do not depend on having read the paper. I get the sense that the majority of my audience wants to learn and participate, but doesn't have the time or access to read the full article each week. 

Betzl, Julia, Ursula Kraneburg, and Kai Megerle. “Overuse Syndrome of the Hand and Wrist in Musicians: A Systematic Review.” Journal of Hand Surgery (European Volume) 45, no. 6 (July 2020): 636–42. https://doi.org/10.1177/1753193420912644.

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