title: From embouchure problems to embouchure dystonia? A survey of self-reported embouchure disorders in 585 professional orchestra brass players.
abstract: OBJECTIVE
  Data concerning embouchure problems in professional brass players are scarce. Embouchure problems can potentially lead to focal dystonia. The aim of this study was to investigate the frequency of distinct embouchure problems in professional brass players. Furthermore, the frequency of "cramping", a distinct symptom of embouchure dystonia, was evaluated in the context of established embouchure dystonia risk factors.
  
  
  METHODS
  Five hundred and eighty-five professional brass players participated in a cross-sectional study concerning embouchure problems. A self-administered questionnaire was developed to evaluate embouchure fatigue, embouchure disorders and their consequences. To study the association between risk factors and cramping (a symptom of embouchure dystonia), a log-binomial regression analysis was conducted, enabling estimation of prevalence ratios (PR) and 95 % confidence intervals (95 % CI).
  
  
  RESULTS
  Thirty percent (95 % CI 25.9-33.3) reported embouchure fatigue. The relative frequency of embouchure disorders was 59 % (95 % CI 54.6-63.6), with 26 % (95 % CI 22.4-29.5) reporting embouchure cramping. Embouchure disorders resulted in sick leave in 16 % (95 % CI 12.7-20.6). Female brass players (PR 2.0, 95 % CI 0.98-3.98) and musicians with a prior change in their embouchure (PR 2.4, 95 % CI 1.38-4.05) or breathing technique (PR 2.2, 95 % CI 1.25-3.72) and musicians with embouchure fatigue (PR 1.9, 95 % CI 1.18-2.93) presented more frequently with embouchure cramping than musicians with other or without risk factors.
  
  
  CONCLUSIONS
  This study shows a high relative frequency of embouchure problems in professional brass players. Given that embouchure dystonia is often preceded by embouchure problems, these findings may assist in gaining further insight into the characteristics of embouchure dystonia and the development of preventive strategies.
authors: Department of Orthopaedics, Traumatology and Physical Medicine, University of Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany, anke.steinmetz@uk-halle.de.
authors: Anke
authors: A
authors: Steinmetz
authors: Andreas
authors: A
authors: Stang
authors: Malte
authors: M
authors: Kornhuber
authors: Marc
authors: M
authors: Röllinghoff
authors: Karl-Stefan
authors: KS
authors: Delank
authors: Eckart
authors: E
authors: Altenmüller
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D020821:Dystonic Disorders / Q000453:epidemiology* / Q000503:physiopathology; D005145:Face; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009120:Muscle Cramp / Q000453:epidemiology / Q000503:physiopathology; D018763:Muscle Fatigue; D009146:Music; D009784:Occupational Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors