Advances in objective assessment of hand function and outcome assessment of the musician's hand.

Doctors have made great strides in the past 20 years in the analysis of musicians' medical problems; we realize they suffer the same medical conditions as the general population but the manifestations may be different and hence the diagnosis more difficult; we realize that many of the conditions glibly attributed to overuse and repetition are no more common in this group than the general public engaged in much less repetitive activity; we realize that many of musicians' symptoms may not represent inflammation or injury but are a manifestation of misuse or mismatch to the instrument and of fatigue; we realize many of these symptoms may be related to technical problems alone; we realize that as a group musicians respond well to appropriate care and that surgery does not inevitably end a musician's career. To diagnose and treat this group properly requires a complete and full analysis of the musician, the interface, and the instrument from the outset. Anything less produces an incorrect or incomplete analysis and the poor results that have bedeviled musicians' medical care to date. Such analysis requires a basic understanding of musicians' problems, detailed knowledge of many of the specific syndromes they suffer, and time for a complete and thorough assessment. It is this lack of time and the lack of facilities to examine the musician while playing that currently causes the greatest number of mistakes in the medical care of this unique and demanding group of individuals.

Special operative considerations in musicians.

Musicians are a unique group, requiring digital control and skills at the highest levels. Each instrument has its own special needs and the musician must be seen in the context of the instrument played. Surgery also must be seen in this context. The special areas of modification of technique and some of the more commonsurgical situations encountered in musicians are considered in this article.

Controversies surrounding "misuse," "overuse," and "repetition" in musicians.

Medical opinion remains divided on the existence of a specific medical entity of nonspecific arm pain produced by repetition. Controversy also exists in the pathophysiology of certain painful, anatomically defined medical conditions in the hand and arm and the role of repetition, cumulative trauma, and microtrauma in the development of these conditions. The flaws in science and the language are examined in this article, as are the results of a survey of Australian music students in comparison with nonmusic students, questioning accepted wisdom on repetitive strain injuries.