Focal Dystonia in Musicians

Focal dystonia is an important neurological disorder that can impact the lives and careers of instrumental musicians. Also known as musicians’ cramp, patients with this condition may complain of a loss of voluntary con-trol in the hands or embouchure (oral musculature) when playing their instrument. Symptoms generally do not manifest during other activities. The disorder may progress over a period of time and then stabilize. Focal dystonia never resolves spontaneously. Rest usually does not alter the con-dition. If the disease progresses, involuntary movements such as extension of the fifth digit or flexion of digits two and three may occur whenever the musician plays the instrument. Later, symptoms may carry over into other activities such as typing or writing. The diagnosis of focal dystonia is clinical, based on history and observa-tion of the musician playing. Instrumental musicians typically present with complaints of incoordination in the fingers or hand. Pain is generally not a feature of the condition. Any pain that is present is likely secondary to movements made in attempt to compensate for the dystonia. In woodwind or brass musicians, symptoms such as stiffness, cramping, or fatigue may be seen in the muscles of the tongue, lips, or jaw. Frucht and colleagues de-scribed embouchure dystonia in 26 professional brass and woodwind players [1]. Patterns of abnormal movements included embouchure tremor, involuntary lip movements, and jaw closure. Unlike in focal hand dystonia, the embouchure dystonia occasionally spreads to other oral tasks. Physical and neurological examinations are almost always normal. On observation of the musician playing, findings can be subtle and only may been seen in certain passages. In each affected musician, the hand behave