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pianomap: Tendonitis

Most pianists' injuries are injuries to the tendons of the arm and hand--that is, some form of tendonitis. Names and spellings vary. "Tendonitis" and "tendinitis" are equivalent; "tenosynovitis" refers to injuries involving the synovial sheath that surrounds the tendon. "De Quervain's disease" affects tendons of the thumb. "Lateral epicondylitis" or "tennis elbow" affects tendons on the outside of the elbow, "medial epicondylitis" or "golfer's elbow" affects tendons on the inside of the elbow. "Ganglion cysts" are disorders of the tendon sheaths. There are also injuries to the tendons in the shoulder. Shoulder injuries may affect the tendons in the rotator cuff or the bursa which is the cushion underlying the tendon and protecting it. Injuries to the bursa are called "bursitis," injuries to the tendons receive different names depending on the specific structure that is affected. All these problems can occur in pianists, though few pianists suffer from all at once. All of them are use-related--they result from the pianist's way of using the arm and hand. In almost all cases they can be cured if the pianist adopts a better use.

Why should pianists (and other people who use their hands in repetitive tasks) be subject to tendon injuries? The answer is obvious the moment we look at the array of muscles that move the hand and fingers.

Almost all pianists are familiar with exercises designed to "strengthen the fingers." But very few pianists seem to know that the muscles that move the fingers are not in the fingers. There are no muscles in the fingers. The fingers are moved partly by muscles in the hand, but most of the work is done by muscles in the forearm. These muscles do not attach directly to the different joints of the fingers, they attach by means of long tendons. There are separate muscles for the various joints of the different fingers, each with its own tendon. There are some 24 tendons attaching to different parts of hand and fingers--9 extensor tendons to the thumb and fingers, 1 abductor tendon to the thumb, 2 extensor tendons to the hand, 3 flexor tendons to the hand and 9 flexor tendons to the fingers and thumb. In an anatomical drawing the tendons look like strands of spaghetti arranged neatly parallel by a fastidious cook. Tendon problems often arise near joints where the tendons rub on ligaments or bones, and they also result from repeated tensing of the muscle/tendon unit. Every pianist should examine an illustration of the muscles and tendons of the arm and hand. A picture gives a vivid sense of the length of the tendons and their vulnerability to various kinds of mis-use. Looking at an illustration makes clear why awkward positions, excessive force, co-contraction, and static muscular tension (the four principal causes of injury described in the article "Pianist's Injuries") will put extra stress on the tendons. Pianists and teachers with this knowledge will be better able to prevent or recover from injury, and better able to help their students. (Good illustrations can be found in Netter, Atlas of Human Anatomy, or in Gray's Anatomy which is available online.)

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