[Guitarist's cramp: management with sensory re-education]. / Distonía del guitarrista: tratamiento con reeducación sensorial.

INTRODUCTION: Dystonia is defined as a sustained co-contraction of agonistic and antagonistic muscles that can cause twisting, twitching and abnormal postures. Occupational dystonias are included in a special group of pathologies that are secondary to a repeated effort related to the professional activity carried out by the sufferer, as can occur in guitarists, violinists and trumpet players, for example. Its pathophysiology includes descriptions of disorders affecting the peripheral and central nervous systems. Studies conducted in monkeys have shown that, through sensory stimulation, repeated movements can give rise to central anomalies in the somatosensory cortex, with growth of the receptive fields that are stimulated and deformation of the separations between those fields. CASE REPORT: We describe the case of a professional guitarist with a seven-year history of symptoms. A neurological examination revealed a co-contraction in the right hand that triggered the extension of the index and little fingers, which made it difficult for him to play his instrument. The patient was submitted to sensory re-education therapy with the use of a splint and a two-month routine of exercises. The response was evaluated using a subjective scale of the patient's symptoms and measurements of the maximum angles of flexion and extension of the affected fingers. Both methods reduced the patient's discomfort and allowed him to exhibit greater skill when playing the guitar. CONCLUSIONS: Occupational dystonias produced by repeated stimulation present alterations in the sensory region of the cortex, with the involvement of motor performance that improves with sensory re-education therapy.

Distonía del guitarrista: tratamiento con reeducación sensorial / Guitarist´s cramp: treatment with sensory re-education

Introducción. La distonía se define como una cocontracción de músculos agonistas y antagonistas sostenida que puede causar torsión, movimientos involuntarios y posturas anormales. Las distonías ocupacionales corresponden a un grupo especial de patología secundarias a un esfuerzo repetitivo, que se relaciona con la actividad profesional que realiza el afectado, como es el caso de guitarristas, violinistas y trompetistas. En su fisiopatología se describen alteraciones en el sistema nervioso periférico y central. Estudios en monos han demostrado que los movimientos repetitivos mediante una estimulación sensitiva pueden producir anomalías centrales en la corteza somatosensorial, con un crecimiento de los campos receptivos estimulados y deformación de las separaciones entre dichos campos. Caso clínico. Se presenta el caso de un guitarrista profesional con síntomas de siete años de evolución, cuyo examen neurológico evidencia una cocontractura en su mano diestra que provoca la extensión de los dedos índice y meñique, lo que dificulta la ejecución de su instrumento. Se realiza un tratamiento de reeducación sensorial con el uso de una férula y esquemas de ejercicio durante dos meses. Se evalúa la respuesta mediante una escala subjetiva de sus síntomas y mediciones de los ángulos máximos de flexión y extensión de los dedos afectados. Ambos métodos revelan una disminución de sus molestias y mejor destreza al tocar la guitarra. Conclusiones. Las distonías ocupacionales producidas por una estimulación repetitiva presentan alteraciones en la zona sensitiva cortical, con afectación del rendimiento motor, que se benefician con terapia de reeducación sensorial (AU)

Introduction. Dystonia is defined as a sustained co-contraction of agonistic and antagonistic muscles that can cause twisting, twitching and abnormal postures. Occupational dystonias are included in a special group of pathologies that are secondary to a repeated effort related to the professional activity carried out by the sufferer, as can occur in guitarists, violinists and trumpet players, for example. Its pathophysiology includes descriptions of disorders affecting the peripheral and central nervous systems. Studies conducted in monkeys have shown that, through sensory stimulation, repeated movements can give rise to central anomalies in the somatosensory cortex, with growth of the receptive fields that are stimulated and deformation of the separations between those fields. Case report. We describe the case of a professional guitarist with a seven-year history of symptoms. A neurological examination revealed a co-contraction in the right hand that triggered the extension of the index and little fingers, which made it difficult for him to play his instrument. The patient was submitted to sensory re-education therapy with the use of a splint and a two-month routine of exercises. The response was evaluated using a subjective scale of the patient’s symptoms and measurements of the maximum angles of flexion and extension of the affected fingers. Both methods reduced the patient’s discomfort and allowed him to exhibit greater skill when playing the guitar. Conclusions. Occupational dystonias produced by repeated stimulation present alterations in the sensory region of the cortex, with the involvement of motor performance that improves with sensory re-education therapy (AU)