Objective: We describe the clinical characteristics of a large US cohort of musician’s focal dystonia (MFD), including both amateur and professional musicians.

Background: Musician’s focal dystonia (MFD), encompassing focal hand dystonia (FHD) and embouchure dystonia (ED), affects 1-2% of professional musicians, often resulting in significant disability. The etiology is unknown, but soft tissue injury or nerve entrapment may trigger FHD in genetically susceptible individuals. In musicians, ulnar neuropathy at the elbow is of specific importance because the ulnar nerve innervates most of the intrinsic hand muscles, which are essential for good finger coordination.

Method: We reviewed the case records of all patients attending a specialist performing arts clinic from 1989-2015. There were 2653 individual musician patients and we identified 240 cases (9.0%) of MFD. Cases were analysed by subgroup as task-specific FHD and ED.

Results: There were 216 cases of FHD (122 right, 88 left and 6 bilateral) and 24 ED and were generally classical musicians. The MFD group comprised 157 professional players (65.4%), 16 music students (6.7%) and 67 amateurs (27.9%); ED occurred almost exclusively in professionals. The onset of symptoms was at 36.8±12.3 years of age and started playing their principal instrument at 11.2±6.5 years. The majority of patients identified a precipitating factor or trigger, most commonly involving increased practice, a change in technique or new instrument, pain or overuse, and an abrupt return to playing after an absence. In FHD, sign of a concurrent neuropathy were frequently seen and 63 (29.2%) had ulnar entrapment, of which all but 2 were ipsilateral and almost exclusively involving dystonic flexion of the ring or little fingers.

Conclusion: Many patients report the onset of dystonia after precipitating factors. Many had concurrent ipsilateral neuropathy, particularly ulnar neuropathy, suggesting that this is an important risk factor.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/musicians-dystonia-results-from-a-large-us-case-series/