Occupational Disorders in Instrumental Musicians

The purpose of the study was to determine the frequency of occupational disorders in instrumental musicians and address questions essential for the performing arts medical professional in dealing with workers compensation and disability insurance. Work-related disorders might be eligible for health and wage-loss benefits through workers compensation and private and state-funded disability insurance. Some unique medical aspects and questions have to be addressed in the care of musicians with playing- related disorders: Is the medical problem directly caused by the playing and can it be considered as an occupational disorder? How long will playing and performance be restricted during recovery and treatment? What is the likelihood that the musician will not return to the previous artistic level and remain unable to continue his or her profession? We reviewed the performing arts medical literature with respect to frequency and risk factors for playing-provoked musculoskeletal and neuromuscular disorders, playing limitations during recovery, and risk for long-term disability. A large percentage of medical problems in instrumental musicians are playing provoked. Focal task-specific dystonia is nearly always an occupational disorder often involving highly skillful and repetitive movements. In about half of the patients with musculoskeletal pain syndromes, the symptoms seem to be directly related to playing. Entrapment neuropathies are a diverse group of disorders, consisting of problems frequently encountered in the general population, such as carpal tunnel syndrome, ulnar neuropathy, or thoracic outlet syndrome, but also including nerve compressions at particular sites more specifically seen in certain instrument groups. A period of relative or, less frequently, absolute rest is often advised in all three conditions, lasting in most cases 1-3 months. Overall, many of the medical problems encountered in instrumental musicians seem to have a good outcome and rarely lead to long-term disability with the exception of focal dystonia. The existing performing arts literature offers important information for the physician to guide musicians with problems involving workers compensation and income replacement insurance. Further epidemiologic studies looking specifically at risk factors for playing-provoked disorders in musicians are needed. Prospective outcome studies would avoid referral bias and provide more accurate data on temporary and long-term disability.