Left shoulder pain in a violinist, related to extensor tendon adhesions in a small scar on the back of the wrist

Clin Rheumatol. 2013 Apr;32(4):501-6. doi: 10.1007/s10067-013-2185-7. Epub 2013 Feb 10.


A female professional orchestra violin player, age 54, with an 8-year history of severe left shoulder problems, presented with reproducible, acute, incapacitating left shoulder pain when playing the lowest violin string. This complaint was found caused by compensatory left arm positions for unnoticed finger extensor excursion limitations in a well-healed scar bed from two dorsal wrist ganglion operations 11 and 13 years before. Immediately after extensor tendon mobilization in the scar bed, the patient could assume a normal playing position, which was pain free, and could return to orchestral duties without further major shoulder complaints (follow-up of 10 years). The case study presents finger extensor excursion limitations at the wrist as an unusual extra-regional risk factor for a shoulder complaint and analyses the biomechanics linking these limitations to the complaint. The case illustrates the importance of long-term post-operative hand surgery rehabilitation in musicians.

Publication types

  • Case Reports

MeSH terms

  • Biomechanical Phenomena / physiology
  • Cicatrix / complications*
  • Cicatrix / physiopathology
  • Female
  • Ganglion Cysts / physiopathology
  • Ganglion Cysts / surgery
  • Humans
  • Middle Aged
  • Music*
  • Occupational Diseases / diagnosis
  • Occupational Diseases / etiology*
  • Occupational Diseases / physiopathology
  • Orthopedic Procedures / rehabilitation
  • Shoulder Pain / diagnosis
  • Shoulder Pain / etiology*
  • Shoulder Pain / physiopathology
  • Tendons / physiopathology*
  • Tendons / surgery
  • Tissue Adhesions / complications*
  • Tissue Adhesions / physiopathology
  • Wrist Joint / innervation
  • Wrist Joint / surgery