title: Task-Specific Dystonia in Professional Musicians. A Systematic Review of the Importance of Intensive Playing as a Risk Factor.
abstract: BACKGROUND
  Focal dystonia in professional musicians is a movement disorder that manifests itself during playing. It is a multifactorial condition in which a genetic predisposition and exogenous factors both play a role. Evidence suggests that intensive playing is a risk factor for the development of task-specific dystonia in professional musicians.
  
  
  METHODS
  This review is based on pertinent publications (1950-2013) retrieved by a systematic search in medical and musicological databases. The references of the retrieved publications were also considered in the search.
  
  
  RESULTS
  16 articles with clinical information on a total of 1144 affected musicians were reviewed systematically. Their overall quality was intermediate to poor, and a meta-analysis was therefore not possible. The Bradford Hill criteria were applied to study a possible causative link between intensive playing and musician's dystonia. Musician's dystonia generally arises after at least ten years of intensive playing (corresponding to roughly 10 000 hours of practice). An association was found between the affected limb and the type of instrument: the limb that is subject to the greatest fine motor demands is the one most commonly affected. The average age of onset is 28 to 44 years.
  
  
  CONCLUSIONS
  The Bradford Hill causality criteria indicate that intensive playing is related to the development of musician's dystonia. In particular, the association of the type of instrument with the site of dystonia supports this thesis. The findings imply that task-specific dystonia in professional musicians should be included in the list of occupational diseases in Germany.
authors.affiliation: Neurological Clinic and Policlinic, Großhadern Hospital, Ludwig-Maximilians-Universität Müünchen, Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München.
authors.forename: Verena Eveline
authors.initials: VE
authors.lastname: Rozanski
authors.forename: Eva
authors.initials: E
authors.lastname: Rehfuess
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
authors.forename: Dennis
authors.initials: D
authors.lastname: Nowak
mesh_terms: D000328:Adult; D017677:Age Distribution; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009146:Music; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data*; D011597:Psychomotor Performance; D012307:Risk Factors; D017678:Sex Distribution