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Biomedical subjects

H J Fry

Publications and source records attributed to H J Fry.

At least 19 recordsLinked to original sources

Incoordination in pianists with overuse syndrome.

To investigate claims that painful musculoligamentous overuse in the arms and hands of pianists is accompanied by loss of motor control, we studied 18 pianists with overuse syndrome of one or both arms and hands and 22 skill-matched pianists with no history of overuse. All of the pianists performed continuous repetitions of a five-finger exercise on a piano keyboard at metronome-paced tempos. The main outcome measures were quantitative analysis of four measurements of performance (duration of key presses, interval between key presses, velocity of key presses [loudness], and time off the metronome beat [difference between actual and expected time of key press]); comparison of the errors in the two groups; and comparison of the performances by a listening panel. The two groups had significant differences in performance, and a classification tree had a sensitivity of 0.886 and a specificity of 0.862 in identifying the affected hands. The pianists with overuse syndrome made more skill-based errors. The listening panel could distinguish between the affected and unaffected hands. We conclude that pianists with overuse syndrome have a coordination disturbance.

Adult↗

The treatment of overuse injury syndrome.

The emphasis on performance injury has shifted from epidemiology to prevention. Rest treatment, modified or radical, followed by rehabilitation, remains the cornerstone of treatment. The basic features, details of management, and side effects of these treatment phases are discussed at length, followed by a detailed description of the author's experience with 176 musicians seen for overuse injury syndrome. Forty-one patients were not prescribed rest treatment, refused rest treatment, or quit rest treatment early; 45 patients were prescribed a modified rest treatment program, of whom 87% were cured of symptoms; and 90 patients were prescribed radical rest treatment, with a final success rate of 87% also.

Arm Injuries↗

Music related upper limb pain in schoolchildren.

Two British secondary schools (one a specialist music school) were surveyed to assess the prevalence of upper limb pain among specialist music students compared with students in a regular school setting. Female students tended to report pain more often than male students, but for both significantly higher prevalence was found in the music school. Pain in the regular school was most often attributed to writing, whereas in the music school it was associated with the playing of all instruments, but most particularly with cello, clarinet, and flute. Music students reported long hours of practice, but it appeared that the intensity of practice may be more important as a determinant of pain than the total hours spent practising. The results of the study are in substantial agreement with those previously published from Australia and North America. On the balance of probabilities the pain is due to overuse syndrome, which is very common in musicians and well known in writers.

Adolescent↗

Overuse syndrome: a muscle biopsy study.

Biopsy specimens were taken from the affected first dorsal interosseous muscle in 29 women with painful chronic overuse syndrome and from 8 volunteer controls. Structural differences in samples from the women with overuse syndrome included increased type 1 fibres with type grouping, decreased type 2 fibres, type 2 fibre hypertrophy, increased internal nuclear count, mitochondrial changes, and various ultrastructural abnormalities. These changes were related to clinical severity, and point to an organic cause for the syndrome.

Adult↗

The treatment of overuse syndrome in musicians. Results in 175 patients.

Overuse syndrome, a condition of pain and loss of function in muscle groups and ligaments through excessive use, is common in musicians. In this series, the less serious cases of the disorder have been successfully treated by a modification of physical activity while allowing the musician to continue to play. The more serious cases were treated by a radical rest programme, first described last century, usually up to 12 months, until the patient is pain free and the muscles and ligaments are no longer tender. Performance is then very gradually resumed. The criterion for total success is a return to music performance free of pain with sustainable practice habits.

Adolescent↗

Tenosynovitis.

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Humans↗

Prevalence of overuse (injury) syndrome in Australian music schools.

Overuse (injury) syndrome, common in musicians, is characterised by persisting pain and tenderness in the muscles and joint ligaments of the upper limb due to excessive use and in more advanced instances by weakness and loss of response and control in the affected muscle groups. This occurs typically in tertiary music students when their practice load is raised. In seven Australian performing music schools the minimum prevalence of the condition was found to be 9.3%. In two music schools where the study was more controlled the incidences were 13% and 21%. The factors leading to overuse (injury) syndrome may be identified as follows: the genetic factor of vulnerability which cannot be altered; the student's technique which may be influenced by teaching and application so that it is more "energy efficient"; and the time X intensity of practice which is totally within the student's control. Prevention involves education of staff and students about the overuse process, rationalisation of practice habits and repertoire, abolition or reduction of static loading of the weight of the instruments, and earlier reporting when the problem is most easily corrected. Psychological problems arising in this syndrome appeared to occur as a reaction to the condition rather than as a causal factor.

Arm Injuries↗

Tenosynovitis.

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Cumulative Trauma Disorders↗

Overuse syndrome of the upper limb in musicians.

A series of 379 musicians with painful overuse syndrome ("RSI") were examined and studied. The commonly used diagnosis for the condition of "tenosynovitis" or "tendinitis" could not be substantiated as it appeared to be a distinct clinical entity rather than a collection of unrelated disorders. The patients in this series showed muscular and joint capsule overuse. Those with painful hands and wrists showed persisting tenderness in the intrinsic muscles and joint ligaments, notable in the carpometacarpal joints of the thumb and the radial side of the wrist. Tenderness of more proximal muscle groups was also usually present. Pain generally started in a particular area, then spread both proximally and distally. The patients felt depressed. The treatment that evolved from the study was radical rest of the tender structures by the total avoidance of pain-inducing activities. The condition did not appear to be inflammatory in nature. The prevention of overuse lies in the control of use.

Adolescent↗