CASE STUDIES IN THE PERFORMING ARTS DAN BROWN, MD, MPH - - PowerPoint PPT Presentation

CASE STUDIES IN THE PERFORMING ARTS

DAN BROWN, MD, MPH

• Disclosures

–IU School of Medicine – Evansville

–Voluntary Faculty

–Parker-Brown Band –Blind Pig Studios

ME MEDICAL AL P PRO ROBLEMS O MS OF P F PERFO RFORMI RMING ARTI G ARTISTS STS

• the first clinical medical journal devoted

to the etiology, diagnosis, and treatment

• f medical and psychological disorders

related to the performing arts.

• Official journal of the Performing Arts

Medical Association (PAMA), the Dutch Performing Arts Medicine Association (NVDMG), and the Australian Society for Performing Arts Healthcare (ASPAH).

PERFORMING ARTISTS TEND TO BE GROUPED INTO:

• Artists who work

with their hands, mouths, and voice

• Artists who work

with their whole bodies such as dancers and theater performers

HISTORY: THIS IS NOT A NEW PROBLEM!

• Per the Medical Journal of Australia 1986:
• Medical literature regarding overuse syndrome in musicians

from 1830 to 1911 was reviewed including 21 books and 54 articles.

• Two theories:
• Central Theory: the lesion was regarded as being in the central

nervous system.

• Peripheral Theory: the condition as a primary muscle disorder

An Overview of Health Issues for Performing and Visual Arts Students

May 2009 Reprint

Council of Arts Accrediting Associations:

National Association of Schools of Art and Design National Association of Schools of Dance National Association of Schools of Music National Association of Schools of Theatre

OVERUSE SYNDROMES ARE COMMON

• 2013 study of the US Army Medical Command

Band

• 10 of 35 subjects had abnormal EPS studies of

the median nerve at the wrist

• 9 of the 10 had a clinical exam consistent with

carpal tunnel syndrome

A COMMON PROBLEM

• Survey of International Conference of Symphony and Opera Musicians (ICSOM) members:
• 64% had painful oversuse syndromes
• Prevalence from 75% among string players to 32% in

percussionists

• Keyboard players at high risk

FREQUENT PROBLEMS

• Overuse Syndromes
• Neural Impingement
• Focal Dystonias
• Psychological Issues

OVERUSE SYNDROMES

These are symptom complexes of injuries caused by the cumulative effects on tissues of repetitive physical stress that exceeds physiologic limits. Common locations for overuse syndromes include the fingers, wrists, shoulders, neck, and low back.

NEURAL IMPINGEMENT

Common sites are the wrist, forearm, elbow, shoulder, and neck.

(Carpal tunnel, plexopathies, radiculopathies, etc.)

FOCAL DYSTONIAS

• Dystonia is a movement disorder in which a person's muscles

contract uncontrollably. The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures.

• Most cases of dystonia do not have a specific cause. Dystonia

seems to be related to a problem in the basal ganglia, the area of the that is responsible for initiating muscle contractions. The problem involves the way the nerve cells communicate.

VOICE PROBLEMS:

• Voice problems include a multitude of issues including vocal cord

nodules, polyps, and cysts. Infections and allergies affect the voice in

• bvious ways.
• Laryngeal dystonias, also known as spasmodic dysphonia, can be

very problematic for those who are professional singers and speakers

HISTOPATHOLOGY OF COMMON TENDINOPATHIES:

WHY DON’T YOU SEE THESE PEOPLE IN YOUR OCC MED PRACTICE?

• T
• lerating pain is acceptable in the attempt

to overcome technical problems.

• Wash U 2013 Study of 261 musicians:
• 93% had playing-related symptoms in the previous 12
• months. 16% had symptoms that interfered with daily

activities.

• Only 3% filed a work-comp claim in their entire career!

HAND THERAPY CERTIFICATION COMMISSION Certified Hand Therapist (CHT)

CASE 1

Jim Green “The Wandering Endorphin”

JIM GREEN

• Professional guitarist
• Late 40s
• Left upper extremity problems

CASE 2: TOM PLACIDO

• Jazz pianist
• Early 60s
• Pain in right index finger distal phalanx

Tom showing extended wrists in his technique before Taubman.

Neutral position of wrists using the Taubman technique.

OKSANA POKOPENKO

Oksana is an artist whose work includes the creation

• f religious icons in the tradition of the Russian

Orthodox Church. Also known as icon writing. Oksana works in mosaics which involves cutting and placing of pieces of glass, some as small as a few mm. One icon contains thousands of pieces of glass

Tools

TOOL USAGE