Synonyms [for over-use syndrome] more likely to be found in the medical abstracts include cumulative stress disorder, repetitive motion disorder, repetitive stress injury. These all include a wide range of more specific things like various tendon disorders of particular tendons, or entrapment of nerves, or joint problems: de Quervain's is a thumb tendon, carpal tunnel is the tendons and median nerve that controls roughly the thumb and first two fingers, tennis elbow, trigger finger, bursitis, etc. Quite often, if you have any one of these, you'll have several others as well.
There is no simple easy definition, since the symptoms and affected bits of the body vary greatly from person to person, and task to task. Some of the worst things you can do to yourself include not only lots of finger motion, but grasping and squeezing, leaning on a desk edge with your wrists, palms, or elbows, holding a phone with your shoulder, carrying a shoulder bag, bad posture. The initial symptoms often involve the tendons. If it's ignored, scar tissue starts to form around the tendon sheath, causing even more friction and inflamation. If the tendonitis is in the wrong place, such as in the carpal tunnel, a nerve can get squeezed. As it gets squished, it loses its blood supply, and cells start to die, eventually causing permanent disability.
None of this necessarily has anything specific to do with musicians, but many wusicians have a lot of the predisposing factors - lots of finger motion with the hand in awkward positions, stress while doing it, tendency to practice or play for long periods without a break, tendency towards poor upper body posture. And other things you do add to the load: computer use (mice and other pointing devices are often worse than typing), hand tools (especially screwdrivers), gardening, washing dishes by hand, rowing, holding a book.
Some keys to avoiding it: 1) listen to your mom - don't slouch; 2) take frequent breaks; 3) be aware of other activities that put you at risk - e.g., if you spend a lot longer than normal typing one day, spend less time practising that day and do some sight singing instead; 4) use an exercise/muscle stretching routine so that one set of muscles doesn't become inflexible and cramp up, which can compress tendon channels. (This is the problem with slouching - it leads to tendonitis in the shoulder and/or neck, which can then trap one or more nerves.)
A few early symptoms to watch out for: 1) a deep down tickly feeling in the base of your thumbs, especially when you wake up or push a shopping cart over a rough surface (vibration sensitivity in general); 2) numbness or pins and needles in the hands or arm especially at night; 3) twinges in the hand, wrist or arm when you do things such as reach for something or push open a door; 4) reduced touch sensitivity and/or pain in your finger tips; 5) even just noticing too much that your hands or arms exist - thinking about things that you used to take for granted and not notice.
If you notice any symptoms, run, don't walk to a doctor who knows what's going on. If a doctor doesn't ask a lot of questions about shoulders and elbows and neck, and seems stuck on a simple `carpal tunnel, therefore wrist splints at night, ibuprofen, then cortisone injections, then surgery' track, find someone else. De Quervain's tendonitis is much more common than carpal tunnel syndrome - if a doctor doesn't check for it straight off, he doesn't know enough. They should also test for diabetes and thyroid function, which are predisposing factors, and arthritis, which can have some similar symptoms. Insist on going to physical/occupational therapy as soon as possible. Don't allow a non-specialist to give you cortisone injections, and only then if physical therapy has failed, or if nerve conduction tests show impairment. Surgery is absolutely the last resort - it has a high long-term risk of complications.
Early treatment is essential. The longer you ignore it, the more it will affect the rest of your life. Some of the conditions can become permanently painful and disabling. Even early on, it can take months to recover, and you can never go back to business as usual (soft tissue injuries never heal completely; there will probably be at least some reduction of endurance, and in any case, you need to change whatever caused it in the first place). Ten per cent of the population at large is expected to get RSI, more like 25% and more if you are in a high risk group. Women are more at risk than men, and middle age people more so than young people, but young men shouldn't be complacent about it... Prevention is possible, but these days, with so many things demanding hand use, training in or at least awareness of good technique and ergonomics is a good idea. It doesn't come naturally.
There is finally an excellent book out, Repetitive Stress Injury by Pascarelli (may be slightly misspelled). It's aimed at computer users, but his computer users are a side line at a clinic for performing artists in Chicago(?). If I had had this book last fall, I could be playing Dufay trios this summer, instead of just starting physical therapy.
There have been several articles in the newsgroup from people asking about dealing with pain during or after playing their instruments. Here's a brief description of some types of over-use syndrome and a few suggestions on what to do if you have pain.
If you have pain while playing your instrument (or after playing), it might be related to what doctors now call `over-use syndrome.' This is caused by strain on muscles, ligaments and tendons causing swelling, which induces pain. One common type of `over-use syndrome' is tendonitis, caused by a swelling of the blood-vessel sheath surrounding tendons. For performers, this often occurs in your fingers, your hand, or your arm, or your shoulder. Tendonitis is common among musicians, typists, professional phone bank workers and assembly-line workers; the common denominator is work (or play) involving very repetitive motion in the fingers, hands or arms.
Another, more specific, injury is carpal-tunnel syndrome (CTS). The carpal tunnel is a wrist `tunnel' formed on three sides by bone and the 4th side by a strong ligament (the Transverse Carpal Ligament, to be technical). There are nine tendons and the median nerve which travel through this tunnel. Each tendon is surrounded by a lubricating lining, called the synovium. CTS is caused by the compression of these tendons in the carpal tunnel, either by swelling of the synovium, injury to the bone or ligament, or by fluid retention. CTS should be treated by a doctor. There are several types of treatment for CTS, including surgery, but surgery is the last resort and should never be done on a musician without a second or third opinion.
If you think you have tendonitis, there are several things you can do on your own to try to relieve it:
[first line missing] travel through this tunnel. These are the tendons that flex the fingers (toward the palm). The transverse carpal ligament is very strong and has little pliability, so the tunnel can not expand much. Each tendon is surrounded by a lubricating sheath, called the synovium. CTS develops when there is increased pressure in the tunnel that compresses the tendons and nerve. The increased pressure can arise from swelling due to inflammation of the synovial tendon linings caused by an inflammatory disease or simply by overuse, from injury to the bone or ligament, or from fluid buildup in the tissues due to systemic illness (low thyroid or excess growth hormone, for example). Once the synovium becomes inflamed and the pressure increases, the process becomes self perpetuating, as the increased pressure will allow formerly normal and non-injurious levels of use to incite continued inflammation. Pain developing in the wrist is an indication of swelling or inflammation there. The only proper response is a period of several days of enforced rest to allow the swelling and any inflammation to subside completely, followed by a gradual return to a somewhat lower level (or at least a different pattern) of activity, with more frequent intervals of rest. Otherwise, continued insults and the resulting prolonged inflammation may produce scarring that further reduces the room within the tunnel, and the CTS may develop. Proper hand/wrist positioning during activity, avoidance of pressure on the wrists during finger motion, and gentle application of exercises that help stretch the ligament may all help prevent CTS. Pain in the wrist that does not subside with rest or that returns rapidly with resumption of activity after a few days of rest may indicate an evolving CTS, and medical advice should be sought. CTS should be treated by a doctor.
Musicians Injuries Page
The Classical music department of the WWW Virtual Library