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Musician Related Skin Conditions:
Fiddler's neck, Cellist's chest, Guitar nipple, Flautist's chin,
Clarinetist's cheilitis, Garrod's pads, Drummer's digit, Pianist Paronychia,
Harpist Subungual Haemorrhage, etc.
| 'Fiddler's neck' is a condition affecting violin and viola players. Although well known to musicians it is not well recognized by dermatologists. Clinically the lesions usually consist of a localized area of lichenification of the left side of the neck--just below the angle of the jaw. Pigmentation, erythema and inflammatory papules or pustules are frequently present, while severe inflammatory induration, cyst formation and scarring occur in more severely affected subjects. The aetiology of the skin changes is probably due to a combination of factors; friction giving rise to lichenification, while local pressure, shearing stress and occlusion may play a part in producing the acne-like changes and cyst formation.In addition, poor hygiene may predispose to local sepsis. Viola players are believed to be more prone to develop "fiddler's neck" than violinists because the instrument itself is larger and heavier. |
Typical Fiddler's Neck |
Similar irritant skin disorders such as "cellist's chest" and "cellist's knee" have also been described in cello players. Even a "cello scrotum" has been described in a brief letter. However this last term has been questioned since the contact of the cello's body with the scrotum would require an extremely awkward playing position. In regards to “Guitar nipple”, reports exist of three girls with traumatic mastitis of one breast. The condition consisted of a slightly inflamed cystic swelling at the base of the nipple. All three patients were learning to play classic guitar on a full-sized guitar – the edge of the sound-box pressed against the nipple. Consequently the two right-handed patients had a right-sided mastitis and the left-handed patient a left-sided mastitis. This condition, also known can easily be prevented by positioning an adequate sized instrument properly in order to reduce the amount of pressure placed on the nipple.
In analogy to string players, woodwind and brass instrumentalists appear to be prone to develop irritant contact dermatitis on her lips and/or chin. "Flautist's chin" has been described in a 32-year-old amateur flautist She presented with an eruption of acne-like lesions and hyperpigmentation confined to the central mid-portion of her chin, where she was in contact with her flute. Wetting of the chin with saliva or breath condensate was suspected as a predisposing factor, as this slipperiness could cause the player to increase the pressure of the flute against the skin. Two separate reports of "clarinetist's cheilitis" have appeared in the literature. Hindson, for example, reported three cases of an irritant contact dermatitis confined to the median area of the lower lip exactly underneath the reed of the clarinet. Results of extensive patch testing were negative. Friedman and Connolly described the case of a 15-year-old clarinetist in whom erythema and scaling of the median portion of the lower lip developed. Again, results of extensive patch testing were negative. Both reports suggest that "clarinetist's cheilitis" may be caused by a combination of factors, including friction, local pressure, shearing forces, and occlusion. It has to be stressed, however, that atopic diathesis is a commonly overlooked cause of cheilitis.
A common and welcome skin condition experienced by almost all musicians at both amateur and professional level is the development of callosities on sites where the skin is repetitively irritated due to intense contact to certain parts of the instrument such as the strings of a guitar. Thickening of the stratum corneum as well as the epidermis covers and protects the more vulnerable layers underneath from repeated stress and trauma. Therefore, building and maintaining calluses is the aim of most instrumentalists, in particular string players. Certain callosities may be considered as "occupational mark". Using the "thumb position", cellist's may develop calluses on their left thumbs. In contrast violinists usually develop calluses ("Garrod's pads") on the dorsal left second and third fingers over the proximal interphalangeal joints. Depending on the technique callosities ("drummer's digit") are frequently observed in drummers on the lateral phalanx of the left ring finger. Moreover calluses are also observed in wind instrumentalists such as clarinetists or oboe players. The affected characteristic area includes the mid portion of the upper lip. Callosities of musicians only require treatment, if they are excessive or symptomatic. Excessive rhagadiform hyperkeratoses (thickening and cracking of the outer layer of the skin) may occur in predisposed individuals, in particular in instrumentalists with psoriatic or atopic diathesis.
| Frequently beginning string instrumentalists are plagued by eternally sore fingertips and traumatic blister formation. In sitar players, repeated stretching of strings with pressure may produce transverse depressions and scars on the pulp spaces of the fingers. More severe skin trauma including erosions, blistering, and ulcerations may be observed in percussionists as well. Paronychia (tender infection or inflammation around the base of the nail fold) are important occupational hazards of instrumentalists such as pianists and harpists. Harpists are also prone to develop onycholysis and subungual haemorrhages. In horn players, a circumscribed atrophy of the upper lip as well as ischaemia of the lips and oral mucosa may occur. Subcorneal bleeding analogous to the "talon noir" seen on the feet of runners can be observed under the calluses of musicians. Apart from skin related trauma a variety of soft tissue and bony changes have been described in instrumentalists, for instance, acro-osteolysis in guitar players and "Satchmo's syndrome" – rupture of the orbicularis oris in trumpet players. |
Paronychia Infection
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Semple proposed the term "guitar groin" in a 24-year-old classic guitarist who was admitted to the hospital with a deep vein thrombosis of the left calf and thigh. On examination, marked varicose veins were present in the left leg only. This patient practiced classic guitar four to six hours a day as he sat with the left leg fully flexed and with the guitar's belly compressing the medial aspect of the thigh. Varicosities and phlebothrombosis were thought to be due to prolonged compression of the long saphenous vein.
 Carpal Tunnel Syndrome
- Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist.
- Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome.
- Symptoms of carpal tunnel syndrome include numbness and tingling of the hand.
- Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing.
- Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.
What is Carpal Tunnel Syndrome
Carpus is a word derived from the Greek word "karpos" which means "wrist." The wrist is surrounded by a band of fibrous tissue which normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."
How does a patient with Carpal Tunnel Syndrome feel?
Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.
How is carpal tunnel syndrome treated?
The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and any underlying disease which might be causing the symptoms.
Initial treatment usually includes rest, immobilization of the wrist in a splint, and occasionally ice application. Patients whose occupations are aggravating the symptoms should modify their activities. For example, computer keyboards and chair height may need to be adjusted to optimize comfort. These measures, as well as periodic resting and range of motion stretching exercise of the wrists can actually prevent the symptoms of carpal tunnel syndrome that are caused by repetitive overuse. Underlying conditions or diseases are treated individually. Fractures can require orthopedic management. Obese individuals will be advised regarding weight reduction. Rheumatoid disease is treated with measures directed against the underlying arthritis. Wrist swelling that can be associated with pregnancy resolves in time after delivery of the baby!
Several types of medications have been used in the treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has been reported to relieve some symptoms of carpal tunnel syndrome, although it is not known how this medication works. Nonsteroidal anti-inflammatory drugs can also be helpful in decreasing inflammation and reducing pain. Side effects include gastrointestinal upset and even ulceration of the stomach. These medications should be taken with food and abdominal symptoms should be reported to the doctor. Corticosteroids can be given by mouth or injected directly into the involved wrist joint. They can bring rapid relief of the persistent symptoms of carpal tunnel syndrome. Side effects of these medications when given in short courses for carpal tunnel syndrome are minimal. However, corticosteroids can aggravate diabetes and should be avoided in the presence of infections.
Most patients with carpal tunnel syndrome improve with conservative measures and medications. Occasionally, chronic pressure on the median nerve can result in persistent numbness and weakness. In order to avoid serious and permanent nerve and muscle consequences of carpal tunnel syndrome, surgical treatment is considered. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. This surgical procedure is called "carpal tunnel release." It can now be performed with a small diameter viewing tube, called an arthroscope, or by open wrist procedure. After carpal tunnel release, patients often undergo exercise rehabilitation. Though it is uncommon, symptoms can recur.
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