This article reviews the neuroanatomic and neurophysiologic foundations of music performance and learning. Music performance is regarded as complex voluntary sensorimotor behavior that becomes automated during extensive practice with auditory feedback. It involves all motor, somatosensory, and auditory areas of the brain. Because of the life-long plasticity of neuronal connections, practicing a musical instrument results first in a temporary and later in a stable increase in the amount of nerve tissue devoted to various component tasks. Motor and somatosensory brain regions corresponding to specific subtasks of music performance are larger in musicians starting younger than age 10 years than in the general population. In rare cases, overuse of movement patterns may induce a degradation of motor memory that results in a loss of voluntary control of movements, called musician's cramp. Specific therapeutic options for this condition are reviewed.