[Guitarist's cramp: management with sensory re-education].
BACKGROUND
Dystonia is defined as a sustained co-contraction of agonistic and antagonistic muscles that can cause twisting, twitching and abnormal postures. Occupational dystonias are included in a special group of pathologies that are secondary to a repeated effort related to the professional activity carried out by the sufferer, as can occur in guitarists, violinists and trumpet players, for example. Its pathophysiology includes descriptions of disorders affecting the peripheral and central nervous systems. Studies conducted in monkeys have shown that, through sensory stimulation, repeated movements can give rise to central anomalies in the somatosensory cortex, with growth of the receptive fields that are stimulated and deformation of the separations between those fields.


METHODS
We describe the case of a professional guitarist with a seven-year history of symptoms. A neurological examination revealed a co-contraction in the right hand that triggered the extension of the index and little fingers, which made it difficult for him to play his instrument. The patient was submitted to sensory re-education therapy with the use of a splint and a two-month routine of exercises. The response was evaluated using a subjective scale of the patient's symptoms and measurements of the maximum angles of flexion and extension of the affected fingers. Both methods reduced the patient's discomfort and allowed him to exhibit greater skill when playing the guitar.


CONCLUSIONS
Occupational dystonias produced by repeated stimulation present alterations in the sensory region of the cortex, with the involvement of motor performance that improves with sensory re-education therapy.
Servicio de Neurología y Neurocirugía, Universidad de Santiago de Chile, Santiago de Chile, Chile. pedrochana@mi.cl
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P
Chaná-Cuevas
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C
Kunstmann-Rioseco
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T
Rodríguez-Riquelme
D000328:Adult; D000818:Animals; D012090:Cumulative Trauma Disorders; D004421:Dystonia / Q000503:physiopathology*; D005385:Fingers / Q000503:physiopathology*; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D009146:Music; D009784:Occupational Diseases / Q000503:physiopathology; D009788:Occupational Therapy; D013003:Somatosensory Cortex / Q000502:physiology*