Playing percussion leads to unusual injury: Report

You've heard of tennis elbow and runner's knee, but how about "percussionist's wrist"? A case of overuse injury of the wrist occurring in a professional percussionist is presented in a report in the August issue of JCR: Journal of Clinical Rheumatology. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Drs. Naoto Yokogawa and H. Ralph Schumacher, Jr., rheumatologists at the University of Pennsylvania, Philadelphia, describe and illustrate this unusual occupational injury.

Playing Percussion Leads to Unusual Injury
The patient was a 70-year-old man with a growing but painless mass on his left wrist. He had previously had a similar growth on the right wrist, which cleared up without treatment. The patient had no obvious recent injuries to the wrists or hands. However, he had been a professional percussionist for more than 30 years.

Both hands were stiff, with limited movement of the wrists. A sample of fluid drained from the mass on the left wrist showed no signs of infection. However, x-rays revealed a specific type of wrist deformity called scapholunate advanced collapse (SLAC), in which there is "collapse" of certain bones of the wrist joint. An MRI scan showed that the mass on the patient's hand was caused by tenosynovitis—inflammation of the tissues surrounding the wrist tendons.

Tenosynovitis and arthritis of the hands are common problems in percussionists. The SLAC wrist is a common form of arthritis in the wrist, caused by trauma, manual labor, or other causes. When painful, surgery may be needed to correct the wrist deformity.

However, as in the reported patient, the SLAC wrist deformity may be painless, in which case surgery is usually unnecessary. Drs. Yokogawa and Schumacher believe this case of "percussionist's wrist" was an overuse injury—similar to elbow tendinitis occurring in tennis players or knee or other leg problems developing in runners. They think that repeated "microtrauma," caused damage to the wrist ligaments over time, eventually leading to the SLAC wrist deformity.