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The musician’s hand
  1. P McCrory
  1. PO Box 93, Shoreham, Melbourne, Victoria, Australia; pmccrory{at}compuserve.com

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    Ian Winspur, Christopher Wynn Parry. Martin Dunitz Publishers, 1998, £49.95. ISBN 1 85317 492 0

    This sounds an intriguing title for a book to be reviewed in this journal. In clinical sports medicine practice, it is not uncommon to be consulted by musicians with a variety of soft tissue or other problems. This is partly because of the lack of specific medical care available for this group of people.

    There is also an overlap between the problems of sports men and women and musicians that suggests that each group has much to offer the other. This book by two hand surgeons from London is a fascinating addition to the literature but ultimately disappoints both the sports physician and the performing arts physician.

    Clearly the strength of two surgeons as authors is their diagnostic approach to musician’s hand problems and their obvious surgical skills in this region. Where they stray into topics outside their own expertise, there is both a lack of understanding and a lack of perspective of the injuries discussed. For example, the discussion of “tendinitis” and “tennis elbow” would send shivers down the spine of any reader of the British Journal of Sports Medicine. The terminology in these areas and the pathological basis of the conditions has been extensively reviewed in recent times. This is again reflected in the chapters on nerve compression syndromes and focal or task specific dystonias where a neurological input would have given far more perspective into the current thinking in this interesting and stimulating field.

    There are also far too many examples of “cross referencing” of the co-author’s work rather than a true review of the published literature, which would have added so much more to this book. A prime example of this is in the nerve chapter again, where the electrodiagnostic techniques are references to a 1981 publication of the co-author rather than any of the wide range of neurological reference books on this subject.

    This book has many strengths however. It has a “chatty” style which reads well and contains many anecdotal observations by leading musicians and conductors on performance technique that give a fascinating insight into the minds of these gifted individuals. There is, however, a lack of critical appraisal of their comments and how the experience of leading concert performers may be extrapolated into assisting the problems of “non-elite” instrumentalists. The surgical discussions are concise and elaborate many of the critical issues in planning surgical intervention in this group. Any surgeon contemplating operating on the hand of a musician at any level would certainly benefit by reviewing this important information.

    One of the problems of any book with multiple contributors is editing the various sections to achieve balance and avoid repetition. This is not well achieved and the repeated reference throughout the text to a “Joan Dixon, the doyenne of cello pedagogues” is enough to drive the reader barmy. It is never explained who this person is. Ms Dixon is not listed in the contributors nor in the chapter references. From the frequent mention of her name, I could have assumed that she could have written the chapter on cello technique by herself!

    As I said, there are some real strengths in this book that makes it a useful addition for hand surgery practice, but it could have been so much more. If the authors had utilised expertise from outside the small world of “musician’s medicine”, a far deeper understanding of the problems could have resulted. There are so many overlaps with sports medicine that it is scary.

    For the clinician who wants a better overview of this whole area (rather than just hand problems), then the book Performing arts medicine (2nd ed) by Sataloff, Brandfonbrenner, and Lederman (Singular Publishing Group, San Diego, 1998, ISBN 1 56593 982 4) is a much better option as a starting point. There is also a US based performing arts medicine society, which publishes a regular newsletter in this field, as well as the British Association of Performing Arts Medicine.

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