Posted by Brigham and Women's Hospital April 12, 2016
Nearly 35 years ago, Dr. Michael Charness, a neurologist and Director of the Brigham and Women’s Hospital (BWH) Performing Arts Clinic, was playing in a piano trio in San Francisco when he noticed that he was having trouble controlling his hand. He eventually discovered that excessive playing had resulted in cubital tunnel syndrome, a condition in which the ulnar nerve in the elbow becomes pinched – leading to pain, hand weakness, numbness, and tingling.
Cubital and carpal tunnel syndromes are common among musicians, and sprains and strains from repetitive use can lead to more serious issues, like tendonitis. While surgery enabled him to return to the piano bench, Dr. Charness realized that there weren’t many resources available to musicians to help them avoid or treat injuries.
“When I started seeing musicians as patients, a survey showed that about 75 percent of symphony orchestra musicians had to take time off because of an injury,” says Dr. Charness. “That was a wake-up call to me that this was a prevalent problem.”
Dr. Charness established the Performing Arts Clinic in the BWH Department of Neurology in 1989. The clinic, which meets on Saturdays, provides highly specialized evaluation and care for musicians with performance-related injuries and disorders. Dr. Charness primarily treats pianists, string players, wind players, and guitarists, but he has seen a wide variety of other types of musicians, ranging from bagpipe players to someone who plays the charango, a tiny guitar made from an armadillo shell. Most of his patients have the same symptoms – pain, weakness, numbness, and tingling of the hands, wrists, shoulders, or neck – most often resulting from overuse.
“Many musicians aren’t as mindful about taking breaks as athletes, sometimes playing two or three hours straight without resting,” says Dr. Charness. “Taking a five-minute break every 20 to 25 minutes can make a big difference.”
In the clinic, Dr. Charness observes patients’ techniques, seeing the instruments in action. Patients either use a piano near the clinic or bring their instruments to their appointments. Dr. Charness then looks for changes that can be made to the instruments to prevent the injury from recurring. If time off from playing is the best option, Dr. Charness develops a therapy schedule, including a time frame for patients to begin practicing again. In some cases, surgery is recommended to treat injuries.
Dr. Charness serves on the editorial board of Medical Problems of Performing Artists and has lectured internationally on the subject of performing arts medicine and injury prevention. He presents frequent seminars on injury prevention at conservatories, such as the New England Conservatory of Music and the Juilliard School. Dr. Charness and his wife, a professional musician, regularly perform together, and their children all play instruments. The Charness family once played between 15 and 20 concerts each year, including his daughter, who is now a professional violinist.
“When those who treat musicians are musicians themselves, they not only understand the mechanics of playing and the demands that are placed on musicians, but they also understand the loss that musicians experience when they can’t play,” says Dr. Charness “The risk is not only losing their livelihood, but also what enriches their lives.”
– Michaela K.