Modification Of Ergonomics for a World-Class Brass Instrumentalist With a Congenital Limb Difference: Level 3 Case

Authors

O G. Newhouse, Marshall University, Huntington, WV

Keywords

Performing Arts Athletic Trainers’ Society Meeting and Conference 2025

Abstract

Background: A drum and bugle corps is a musical marching organization that consists of approximately 160 brass, percussion, and color guard performers. There are currently twenty-one drum corps organizations at the world-class level that compete. Organizations learn their 8–10-minute show in the late spring and begin traveling the country performing and competing in the early summer until August. Rehearsal days can be up to 10 hours of practice including visual and music. It has been reported that the incidence of upper limb pain is higher in those who have longer practice times, in which is a symptom of overuse. These rehearsal days hone and refine a single show that continues to contribute to the last performance of the season- the championships. Patient: The patient is a high school aged female baritone instrumentalist. She has a congenital limb difference with the left arm ending just below the elbow joint. She was experiencing pain in her right fifth phalange due to the varus force the horn finger ring was placing on it as well as it was starting to cause deformation. Additionally, her right wrist began to experience overuse pain from holding her horn for extended periods of time. Her left limb aided in the holding of the bottom of the horn and contributed to severe and numerous trigger points in her upper and middle trapezius bilaterally with the right side being more severe. Intervention: Modifications were made to her baritone instrument by contacting a brass repair company that re-welded the finger ring closer to the valves of the horn. This took pressure off of the proximal interphalangeal joint of the 5th phalange and decreased the consistent varus position. The weight of the horn was now shifted more proximal to the metacarpal phalangeal joint. Additionally, gauze and half inch power flex were used over phalange collateral tape to provide additional stability. Rehabilitation for her wrist consisted of 4-way wrist strengthening, ice, and transcutaneous electrical nerve stimulation. Her wrist was stabilized during rehearsal with an over-the-hand power flex tape job to provide additional stability while allowing movement for her visual and auditory performance. For the neurological trigger points, trigger point release was performed as well as passive stretching of her shortened limb. Outcomes: By making ergonomic modifications, stabilizing the wrist with tape, wrist strengthening, and neurological trigger point release, the athlete was able to compete through the entire performing season effectively and with minimal pain. Conclusions: This case highlights the need for individualized care in young musicians with physical challenges. Modifying the baritone horn to alleviate pressure on the right fifth phalange was crucial for her comfort and performance. The rehabilitation approach, incorporating wrist stabilization and trigger point release, effectively addressed her overuse injuries. Clinical Bottom Line: Future efforts should focus on adaptive techniques and preventive strategies to ensure that all performers can thrive, regardless of physical limitations.

Recommended Citation

Newhouse, O G. (2025) "Modification Of Ergonomics for a World-Class Brass Instrumentalist With a Congenital Limb Difference: Level 3 Case," Clinical Practice in Athletic Training: Vol. 8: Iss. 1, Article 16.
Available at: https://scholars.indianastate.edu/clinat/vol8/iss1/16