Diagnostic Ultrasound Findings and Treatments in Cellists with Performance-Related Musculoskeletal Disorders: A Retrospective Study.

OBJECTIVE

Performance-related musculoskeletal disorders (PRMDs) are common among orchestral musicians, with string players, including cellists, at high risk due to their unique playing posture and forceful movements. Despite frequent reports of pain, especially in the upper back, shoulders, and hands, specific tissue pathologies in cellists remain underexplored. This study investigates ultrasound findings in cellists with PRMDs and their clinical implications.

METHODS

This retrospective case series study, conducted at a musician clinic in a tertiary medical center from January 2019 to September 2023, included cellists diagnosed with PRMDs. Exclusion criteria included traumatic accidents and rheumatological conditions. Data collected according to the CARE guidelines included demographics, PRMD severity, discomfort localization, ultrasound imaging findings, and treatment modalities (e.g., postural training, manual therapy, and injections). The null hypothesis was rejected at a < 0.05. Statistical analysis was performed using SPSS (ver. 27.0).

RESULTS

Fifty-one cellists were included. The majority were students (70.6%), with Stage 4 PRMDs being the most common (60.7%). Common discomfort regions included the left scapulae/shoulder (33.3%), left hand (25.4%), and right scapulae/shoulder (19.6%). Ultrasound revealed the left serratus anterior superior bundle (21.5%) and left levator scapula (15.6%) as the most affected sites. 98% of participants resumed playing within 3 months after the interventions, with reported functional improvement and pain reduction. Treatment included physical therapy, instrument adjustment, ultrasound-guided regenerative injection (hypertonic dextrose and/or platelet-rich plasma), and a postural retraining program.

CONCLUSION

This study provides the first ultrasound-based analysis of PRMDs in cellists. Key lesions were identified in the left serratus anterior superior bundle and levator scapulae. Ultrasound-guided regenerative injections and postural retraining effectively treated cellists, with 98% returning to playing within 3 months.