Louis Armstrong's Lip Problems: Satchmo's Syndrome Reviewed.

Rupture of the orbicularis muscle of the lips in wind musicians is known as Satchmo's syndrome because it is assumed that Louis Armstrong (nicknamed Satchmo) suffered this condition. But whether Louis Armstrong really had this problem or not has never been documented. AIMS: This study is a biographical review and an analysis of the existing photographs of Armstrong's lip with the aim of better understanding the origin and progression of his disorder. METHODS: A review was made of the most important biographies, newspapers, and magazines referring to Louis Armstrong and medical reports about Satchmo's syndrome. Major archives related to Louis Armstrong were searched for documents, photographs, articles, videos, letters, and other items, using the terms "lip," "embouchure," "mouth," and "problem." Information was sought on Armstrong's playing technique, playing schedule, lip changes, lip problems, and other related health issues. RESULTS: It was found that Louis Armstrong suffered dermatological lip problems due to his intense playing schedule and the way he played from the very beginning of his career. This first created swelling and superficial erosions that later became cracks and fissures. These lesions finally produced ulcers which evolved into scar tissue after healing. This made the mucosa thicker and stiffer, making it more difficult for the lip to vibrate and forcing him to increase the tension and pressure in the area in order to play the trumpet. This created a vicious cycle with the scar tissue leading to further problems. These injuries even bled several times while he was playing and, on some occasions, left his mouth and clothes bloodied in the middle of concerts. His biography does not make any reference to difficulties or symptoms that could indicate that he had orbicularis oris muscle rupture, except for the fact that he had trouble playing, a symptom common to any injury to the lips in a wind instrument player. CONCLUSION: Analysis of the existing data indicates that Louis Armstrong's lip problems were most likely due to mucosa fibromatous hyperplasia resulting from chronic microtrauma rather than a rupture of the orbicularis oris muscle. Therefore, we propose that this disorder should no longer be referred to as Satchmo's syndrome.

A motor control model of task-specific dystonia and its rehabilitation.

Task-specific dystonia is a painless deficit of motor control specific to a particular motor skill. In this article we present a motor control model which integrates risk factors for the disorder with the neuroscientific literature of skill learning in health. We particularly focus on the idea that the amount and type of movement variability is critical and show how retraining therapies such as Differential Learning which reintroduces variability into practice can restore motor performance.

Musculoskeletal Problems in Pianists and Their Influence on Professional Activity.

BACKGROUND: Professional musical performance requires static postures and repetitive movements that may cause musculoskeletal problems in performers. Elite pianists are especially at risk for these disorders, which may cause discomfort but also affect their work. The objective of this study was to describe the most frequent musculoskeletal problems observed in pianists, and to explore the influence of these disorders on their professional activities from the perspective of the pianists themselves. METHODS: Musculoskeletal problems were defined in accordance with the International Classification of Diseases (ICD-10), and an analysis was conducted of medical records of 183 professional pianists held by a performing arts clinic (Terrassa, Spain). In addition, in-depth interviews were conducted with 20 pianists (6 students, 12 teachers, and 2 performers), followed by content analysis of the transcripts to explore musicians' perceptions. RESULTS: We identified a total of 20 different problems, which principally involved the upper body (arms and back). Regardless of occupation or age, all respondents reported having musculoskeletal problems and that these impacted on their professional activity. Interviewees also identified a lack of support or advice on how to prevent these problems. CONCLUSION: Musculoskeletal problems, principally those involving the upper body, are very common among pianists and affect their professional activity. It is necessary to include risk prevention information starting in the early stages of musicians' training programs.

Effect of Transcranial Direct Current Stimulation on Neurorehabilitation of Task-Specific Dystonia: A Double-Blind, Randomized Clinical Trial.

UNLABELLED: Task-specific focal hand dystonia can disable affected individuals. Although neurorehabilitation techniques such as sensory motor retuning can result in complete recovery in some patients, it requires many months of treatment. Combining transcranial direct current stimulation (tDCS) with neurorehabilitation is a new and promising approach that can help these patients. However, the results in different studies are contradictory. OBJECTIVE: Analyze whether delivering tDCS (cathode over left and anode over right parietal region) during the neurorehabilitation process for musicians with dystonia can increase the effectiveness of therapy. METHOD: A parallel double-blind randomized design was used to study 30 musicians with right-hand primary focal dystonia. All patients underwent a 2-week course of neurorehabilitation based on sensory motor retuning therapy coupled with either real or sham tDCS for the first 30 minutes of each daily 1-hour therapy session (total 10 sessions). The therapist and patient were blind to the tDCS condition. A dystonia severity score was obtained before and after the 2-week protocol. The therapist also rated the evolution of each patient. RESULTS: Both groups significantly improved their dystonia severity score during the 2 weeks. Score differences were 88.23 (±40.51) and 63.36 (±30.57) for the active and sham groups, respectively. The active group showed a statistically significant greater improvement. CONCLUSIONS: Biparietal tDCS with left-sided cathode is a safe technique that does not interfere with the neurorehabilitation procedure and can increase therapy effectiveness in rehabilitation patients with right-hand task-specific focal dystonia.

Transcranial direct current stimulation improves neurorehabilitation of task-specific dystonia: a pilot study.

Sensory-motor returning (SMR) can help the symptoms of task-specific focal hand dystonia. However, effects vary across patients and take many sessions. Here, we present proof of principle evidence that transcranial direct current stimulation (tDCS) can enhance these effects. We compared the effects of a combined tDCS-SMR protocol (n=4 patients) with the efficacy of SMR alone (n=30 patients). All 4 patients treated with the combined protocol showed greater improvement than those undergoing SMR alone. Results encourage a larger, parallel-group clinical trial with sham tDCS control.

Role of female reproductive hormones in musicians' dystonia.

UNLABELLED: Musicians' dystonia is an occupational focal dystonia affecting men more often than women. METHODS: We identified all patients presenting with musicians' dystonia and prospectively collected data on reproductive and menstrual history from the women with musician's dystonia and female musicians without dystonia. RESULTS: 149 men and 23 women (13.37%) with musician's dystonia where identified. We did not identify any effect of contraceptive hormones, pregnancy, or menstrual phases on dystonia symptoms, but as compared with women without dystonia, those with musician's dystonia reported oligomenorrhea and menometrorrhagia significantly less frequently. CONCLUSIONS: Our data reinforce the relation between sex hormones variations and musicians' dystonia. This link should be further explored to identify mechanisms and assess whether certain hormonal interventions might protect from the manifestation of dystonia.

Safety of subcutaneous microinjections (mesotherapy) in musicians.

OBJECTIVE: Determine the safety and tolerance of mesotherapy as a technique for the treatment of musculoskeletal complaints in musicians. METHOD: 67 patients (55.2% women) were subjected to a total of 267 mesotherapy sessions. A mesotherapy needle or normal needle was used randomly. The drugs employed were thiocolchicoside and diazepam as muscular relaxants, pentoxifylline or buflomedil as vasodilators, and piroxicam as an anti-inflammatory, as directed. A visual analogue scale was used to quantify the pain produced by the microinjections as well as the degree of immediate and midterm side effects as reported on a standard questionnaire. RESULTS: A mean of 155.5 microinjections were performed per session, of which 45.6% were perceived as painful by the patient with a mean severity of 4.3 out of 10. The pain reduced to 0.5 out of 10 after 24 hours. The most sensitive areas were the levator scapulae and splenius muscles. Systemic symptoms were reported by 5.99% of the musicians after the mesotherapy sessions (muscular weakness 1.5%, rash 1.5%, drowsiness 1.1% and itching 1.1%, being the most frequent). The mean severity of these symptoms was 2.77 out of 10. In all cases the symptoms had completely disappeared after 24 hours. No patient referred to signs of local or systemic infection. CONCLUSIONS: The application of drugs by means of subcutaneous injections (mesotherapy) in musicians is a technique that is safe, well tolerated, and without any severe complications.

Long-term treatment effects of sensory motor retuning in a pianist with focal dystonia.

Here we present the case of a pianist suffering from unilateral focal hand dystonia for 10 yrs which affected his piano playing as well as other activities of daily life. The treatment applied was sensory motor retuning (SMR), a behavioral treatment for focal hand dystonia. Improvement was clearly achieved from the beginning of therapy. After 10 mos of treatment, performance levels were comparable to those before illness onset. The patient returned to high-level piano playing, and after 8 yrs of follow-up, performance remains normal.

Work-related pain in extrinsic finger extensor musculature of instrumentalists is associated with intracellular pH compartmentation during exercise.

BACKGROUND: Although non-specific pain in the upper limb muscles of workers engaged in mild repetitive tasks is a common occupational health problem, much is unknown about the associated structural and biochemical changes. In this study, we compared the muscle energy metabolism of the extrinsic finger extensor musculature in instrumentalists suffering from work-related pain with that of healthy control instrumentalists using non-invasive phosphorus magnetic resonance spectroscopy ((31)P-MRS). We hypothesize that the affected muscles will show alterations related with an impaired energy metabolism. METHODOLOGY/PRINCIPAL FINDINGS: We studied 19 volunteer instrumentalists (11 subjects with work-related pain affecting the extrinsic finger extensor musculature and 8 healthy controls). We used (31)P-MRS to find deviations from the expected metabolic response to exercise in phosphocreatine (PCr), inorganic phosphate (Pi), Pi/PCr ratio and intracellular pH kinetics. We observed a reduced finger extensor exercise tolerance in instrumentalists with myalgia, an intracellular pH compartmentation in the form of neutral and acid compartments, as detected by Pi peak splitting in (31)P-MRS spectra, predominantly in myalgic muscles, and a strong association of this pattern with the condition. CONCLUSIONS/SIGNIFICANCE: Work-related pain in the finger extrinsic extensor muscles is associated with intracellular pH compartmentation during exercise, non-invasively detectable by (31)P-MRS and consistent with the simultaneous energy production by oxidative metabolism and glycolysis. We speculate that a deficit in energy production by oxidative pathways may exist in the affected muscles. Two possible explanations for this would be the partial and/or local reduction of blood supply and the reduction of the muscle oxidative capacity itself.

Secondary motor disturbances in 101 patients with musician's dystonia.

OBJECTIVE: Musician's focal dystonia is usually considered to be task specific but secondary motor disturbances have been reported also. We carried out a detailed evaluation of the incidence of these secondary motor problems in 101 patients. METHOD: Symptoms were assessed using clinical histories, neurological examinations and observation of instrumental manoeuvres. RESULTS: 53.5% of patients reported secondary motor disturbances in activities other than playing their main instrument, with the onset delayed in some cases by up to 12 years from the awareness of dystonic symptoms. 46.5% suffered from simple, 19.8% from complex and 33.7% from progressive cramps. Plucked string players (guitarists) mainly suffered from simple cramps while keyboardists more frequently displayed the progressive form. In all patients, symptoms were focal, and the type of cramp was unrelated to the severity of the perceived symptoms. Those patients playing a second instrument similar to their main instrument showed symptoms which worsened to a higher degree than those playing either only one instrument or whose second instrument was different. CONCLUSIONS: Longer follow-up assessments may reveal secondary motor symptoms that are not visible over shorter examination periods. Therefore, a thorough evaluation of everyday life motor activities should be considered in any clinical and treatment protocol. We speculate that the avoidance of movements that are similar to the main affected task may be of help in limiting symptoms. Consequently, focal dystonia may be considered more movement than task specific.

Changing the brain through therapy for musicians' hand dystonia.

Focal hand dystonia is a disorder in which sensory and motor anomalies emerge that appear to be grounded in maladaptive routes of cortical plasticity. Remodeling cortical networks through sensory-motor retuning (SMR), we achieved long-term reduction in the symptoms of focal hand dystonia. Magnetoencephalography confirmed that SMR modified the representational cortex of the fingers, whereby the representation of the affected hand was reorganized so that it resembled more the organization of the non-affected side. Furthermore, we observed differences in abnormal tactile acuity between patients with musician's cramp and those with writer's cramp: Using two-point finger discrimination, dystonic musicians showed perceptual asymmetry between hands, while writer's cramp patients did not. To further evaluate the occurrence of collateral disturbances in focal dystonia, we assessed the clinical histories of 101 affected musicians. An important finding from this study was that dystonic musicians who play a similar first and second instrument reported a continuous worsening of their symptoms. In addition, collateral disturbances appeared with a shorter delay when more than one instrument was played. Taken together, these studies suggest that (1) neurological dysfunction can be reversed by context-specific training protocols, (2) specific symptomatic and etiological differences among various forms of focal hand dystonia might result from different behavioral experiences and their central representation, and (3) the spread of symptoms might be prevented by avoiding training that implies movement patterns similar to the main affected task, and by reducing the amount of task-associated movement behavior.