Skip to main content

Advertisement

Log in

Focal hand dystonia in musicians: a synopsis

  • ORIGINAL ARTICLE
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Focal hand dystonia in musicians (FHDM), also known as ‘musicians’ cramp’, is a relatively rare, task-specific, pain-free disorder of control, causing unintentional, abnormal movements and/or positions in a part of the body directly involved in playing a musical instrument. Few physicians are familiar with the diagnosis, yet the exact cause of the disorder remains unknown and there is no generally effective therapy. In this synopsis, the authors present their experience with the diagnosis and treatment of FHDM and their aetiology hypothesis that musicians’ cramp is caused by a loss of central motor control initiated by a failure of coping mechanisms, which (try to) compensate for the effects of peripheral local movement disturbing factors in the hand. Recent publications focus on the role of the central nervous system and on motor pattern relearning. We recommend further (prospective) research of the results of operative (peripheral) therapy, followed by (central) motor pattern relearning, and of neuropsychological contributions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Altenmüller E, Jabusch HC (2010) Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art 25(1):3–9

    PubMed  Google Scholar 

  2. Tubiana R (2003) Musician’s focal dystonia. Hand Clin 19(2):303–308, vii. PMID: 12852672

    Article  PubMed  Google Scholar 

  3. Rosset-Llobet J, Candia V, Fàbregas i Molas S, Dolors Rosinés i Cubells D, Pascual-Leone A (2009) The challenge of diagnosing focal hand dystonia in musicians. Eur J Neurol 16(7):864–869, Epub 2009 Mar 31. PMID: 19473363

    Article  PubMed  CAS  Google Scholar 

  4. Potter P (2012) Task specific focal hand dystonia: understanding the enigma and current concepts. Work 41(1):61–68

    PubMed  Google Scholar 

  5. Moll LCM, Rietveld ABM (2000) Dystonieën bij musici. Ned Tijdschr Neurol 3:86–92

    Google Scholar 

  6. Joensuu A, Vastamäki M (2010) Musicians consulting a hand surgeon having special competence in musician’s medicine. A survey of 148 patients. Duodecim 126(24):2865–2870, PMID: 21268909

    PubMed  Google Scholar 

  7. Macfarlane JD, Rietveld ABM (2009) A rheumatologist let loose in a performing arts clinic: the spectrum of musicians’ complaints and their treatment. Med Probl Perform Art 24(4):185–187

    Google Scholar 

  8. Conti AM, Pullman S, Frucht SJ (2008) The hand that has forgotten its cunning—lessons from musicians’ hand dystonia. Mov Disord 23(10):1398–1406

    Article  PubMed  Google Scholar 

  9. Rosset-Llobet J, Fàbregas i Molas S, Rosinés i Cubells D, Narberhaus Donner B, Montero i Homs J (2005) Clinical analysis of musicians’ focal hand dystonia. Review of 86 cases. Neurologia 20(3):108–115, PMID: 15815945

    PubMed  CAS  Google Scholar 

  10. Altenmüller E, Baur V, Hofmann A, Lim VK, Jabusch HC (2012) Musician’s cramp as manifestation of maladaptive brain plasticity: arguments from instrumental differences. Ann N Y Acad Sci 1252:259–265

    Article  PubMed  Google Scholar 

  11. Leijnse JNAL, Hallett M (2007) Etiological musculo-skeletal factor in focal dystonia in a musician’s hand: a case study of the right hand of a guitarist. Mov Disord 22(12):1803–1808

    Article  PubMed  Google Scholar 

  12. Rietveld ABM (2013) Postureel bepaalde cerviocobrachialgie bij musici. Quintesse 1:29–34

    Google Scholar 

  13. Rietveld ABM (2008) Dans-en muziekletsels. In: Verhaar JAN, van Mourik J (eds) Nederlands leerboek voor orthopedie, 2nd edn. BSL, Houten, pp 111–118

    Google Scholar 

  14. Charness ME, Ross MH, Shefner JM (1996) Ulnar neuropathy and dystonic flexion of the fourth and fifth digits: clinical correlation in musicians. Muscle Nerve 19:431–437

    Article  PubMed  CAS  Google Scholar 

  15. Ross MH, Charness ME, Lee D, Logigian EL (1995) Does ulnar neuropathy predispose to focal dystonia? Muscle Nerve 18(6):606–611

    Article  PubMed  CAS  Google Scholar 

  16. Leijnse JNAL (1995) Finger exercises with anatomical constraints. Thesis, Erasmus Universiteit Rotterdam

  17. Leijnse JNAL (1997) A generic morphological model of the anatomic variability in the m. flexor digitorum profundus, m. flexor pollicis longus and mm. lumbricales complex. Acta Anat (Basel) 160:62–74

    Article  CAS  Google Scholar 

  18. Leijnse JNAL, Walbeehm ET, Sonneveld GJ, Hovius SER, Kauer JMG (1997) Connections between the tendons of the musculus flexor digitorum profundus formed by the synovial sheaths in the carpal tunnel. Acta Anat (Basel) 160:112–122

    Article  CAS  Google Scholar 

  19. Leijnse JNAL, Bonte JE, Landsmeer JMF, Kalker JJ, van der Meulen JC, Snijders CJ (1992) Biomechanics of the finger with anatomical restrictions—the significance for the exercising hand of the musician. J Biomech 25:1253–1264

    Article  PubMed  CAS  Google Scholar 

  20. Leijnse JNAL, Snijders CJ, Landsmeer JMF, Bonte JE, van der Meulen JC, Sonneveld GJ, Hovius SER (1993) The hand of the musician—the biomechanics of the bidigital finger system with anatomical restrictions. J Biomech 26:1169–1179

    Article  PubMed  CAS  Google Scholar 

  21. Leijnse JNAL (1997) Anatomical factors predisposing to focal dystonia in the musician’s hand: principles, theoretical examples, clinical significance. J Biomech 30(7):659–669

    Article  PubMed  CAS  Google Scholar 

  22. Chamagne P (1986) Functional cramps or functional dystonias in writers and musicians. Ann Chir Main 5(2):148–152

    Article  PubMed  CAS  Google Scholar 

  23. Chamagne P (2003) Functional dystonia in musicians: rehabilitation. Hand Clin 19(2):309–316

    Article  PubMed  Google Scholar 

  24. Leijnse JNAL (1997) Measuring force transfers in the deep flexors of the musician’s hand: theoretical analysis, clinical examples. J Biomech 30:873–882

    Article  PubMed  CAS  Google Scholar 

  25. Leijnse JNAL (1998) A method and device for measuring force transfers between the deep flexors of the musician’s hand. J Biomech 31:773–779

    Article  PubMed  CAS  Google Scholar 

  26. Elbert T, Candia V, Altenmüller E, Rau H, Sterr A, Rockstroh B, Pantev C, Taub E (1998) Alteration of digital representations in somatosensory cortex in focal hand dystonia. Neuroreport 9(16):3571–3575

    Article  PubMed  CAS  Google Scholar 

  27. Charness ME, Schlaug G (2004) Brain mapping in musicians with focal task-specific dystonia. Adv Neurol 94:231–238

    PubMed  Google Scholar 

  28. Walter U, Buttkus F, Benecke R, Grossmann A, Dressler D, Altenmüller E (2012) Sonographic alteration of lenticular nucleus in focal task-specific dystonia of musicians. Neurodegener Dis 9(2):99–103, Epub 2011 Sep 10. PMID: 21912095

    Article  PubMed  Google Scholar 

  29. Granert O, Peller M, Jabusch HC, Altenmüller E, Siebner HR (2011) Sensorimotor skills and focal dystonia are linked to putaminal grey-matter volume in pianists. J Neurol Neurosurg Psychiatry 82(11):1225–1231, Epub 2011 Jun 24. PMID: 21705464

    Article  PubMed  Google Scholar 

  30. Kadota H, Nakajima Y, Miyazaki M, Sekiguchi H, Kohno Y, Amako M, Arino H, Nemoto K, Sakai N (2010) An fMRI study of musicians with focal dystonia during tapping tasks. J Neurol 257(7):1092–1098, Epub 2010 Feb 9. PMID: 20143109

    Article  PubMed  Google Scholar 

  31. Schmidt A, Jabusch HC, Altenmüller E, Hagenah J, Brüggemann N, Hedrich K, Saunders-Pullman R, Bressman SB, Kramer PL, Klein C (2006) Dominantly transmitted focal dystonia in families of patients with musician’s cramp. Neurology 67(4):691–693

    Article  PubMed  CAS  Google Scholar 

  32. Schmidt A, Jabusch HC, Altenmüller E, Hagenah J, Brüggemann N, Lohmann K, Enders L, Kramer PL, Saunders-Pullman R, Bressman SB, Münchau A, Klein C (2009) Etiology of musician’s dystonia: familial or environmental? Neurology 72(14):1248–1254

    Article  PubMed  CAS  Google Scholar 

  33. Pujol J, Roset-Llobet J, Rosinés-Cubells D, Deus J, Narberhaus B, Valls-Solé J, Capdevila A, Pascual-Leone A (2000) Brain cortical activation during guitar-induced hand dystonia studied by functional MRI. NeuroImage 12(3):257–267

    Article  PubMed  CAS  Google Scholar 

  34. Jabusch HC, Vauth H, Altenmüller E (2004) Quantification of focal dystonia in pianists using scale analysis. Mov Disord 19(2):171–180

    Article  PubMed  Google Scholar 

  35. Aránguiz R, Chana-Cuevas P, Alburquerque D, León M (2011) Focal dystonia in musicians. Neurologia 26(1):45–52, Epub 2010 Nov 18. PMID: 21163218

    Article  PubMed  Google Scholar 

  36. Koelman JHTM, Struys MA, Ongerboer de Visser BW, Speelman JD (1998) Schrijfkramp behandeld met botuline injecties. Ned Tijdschr Geneeskd 142(31):1768–1771

    PubMed  CAS  Google Scholar 

  37. Lungu C, Karp BI, Alter K, Zolbrod R, Hallett M (2011) Long-term follow-up of botulinum toxin therapy for focal hand dystonia: outcome at 10 years or more. Mov Disord 26(4):750–753. doi:10.1002/mds.23504, Epub 2011 Feb 1

    Article  PubMed  Google Scholar 

  38. Schuele S, Jabusch HC, Lederman RJ, Altenmüller E (2005) Botulinum toxin injections in the treatment of musician’s dystonia. Neurology 64(2):341–343

    Article  PubMed  CAS  Google Scholar 

  39. Taub E, Uswatte G, Pidikiti R (1999) Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation—a clinical. J Rehabil Res Dev 36(3):237–251

    PubMed  CAS  Google Scholar 

  40. Candia V, Elbert T, Altenmüller E, Rau H, Schäfer T, Taub E (1999) Constraint induced movement therapy for focal hand dystonia in musicians. Lancet 42(9146), PMID: 10023959

    Google Scholar 

  41. Buttkus F, Baur V, Jabusch HC, de la Cruz Gomez-Pellin M, Paulus W, Nitsche MA, Altenmüller E (2011) Single-session tDCS-supported retraining does not improve fine motor control in musician’s dystonia. Restor Neurol Neurosci 29(2):85–90. doi:10.3233/RNN-2011-0582.PMID:21701060

    PubMed  Google Scholar 

  42. Berque P, Gray H, Harkness C, McFadyen A (2010) A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med Probl Perform Art 25(4):149–161

    PubMed  Google Scholar 

  43. Candia V, Wienbruch C, Elbert T, Rockstroh B, Ray W (2003) Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization. Proc Natl Acad Sci U S A 100(13):7942–7946, Epub 2003 May 27. PMID: 12771383

    Article  PubMed  CAS  Google Scholar 

  44. Rosset-Llobet J, Fàbregas-Molas S (2011) Long-term treatment effects of sensory motor retuning in a pianist with focal dystonia. Med Probl Perform Art 26(2):106–107

    PubMed  Google Scholar 

  45. Chaná-Cuevas P, Kunstmann-Rioseco C, Rodríguez-Riquelme T (2003) Guitarist’s cramp: management with sensory re-education. Rev Neurol 37(7):637–640, PMID: 14582020

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank G.J.F. de Haas, neuropsychologist and musician, MCDM, The Hague, The Netherlands and Dr. John Macfarlane for his English textual corrections.

Disclosures

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. B. M. Rietveld.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rietveld, A.B.M., Leijnse, J.N.A.L. Focal hand dystonia in musicians: a synopsis. Clin Rheumatol 32, 481–486 (2013). https://doi.org/10.1007/s10067-013-2196-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-013-2196-4

Keywords

Navigation