Written by the Phoenix Rehab hand therapy team. Clinically reviewed by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z; neck and back sections by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H. Last reviewed 6 October 2026.
The injuries we see most in musicians sit in the hand, wrist and forearm: tendon pain, trigger finger, thumb-base pain, and irritated nerves at the wrist and elbow. Most of them start the same way. Practice hours go up before a recital or an exam, and the tendons get no time to catch up.
Musicians seldom come in with an injury they can put a date on. They come in with a bar of music. The left-hand stretch you now fake in the Chopin. The barre chord that buzzes because your first finger will not press flat any more. The bow arm that aches by the second hour of an orchestra rehearsal, and the right thumb that throbs after a long clarinet part.
The load on any one note is small. The count is what adds up: thousands of repetitions an hour, positions held for a whole movement, and a practice schedule that doubles in the weeks before an ABRSM exam, a church concert or a gig. A 1998 review of the research found playing-related pain and injury common among instrumental musicians.1
Most of what follows is a load problem in a tendon or a nerve, and a hand therapist can measure it. One condition, focal hand dystonia, is neurological and starts with a doctor. It sits under “When to see a doctor first”, further down.
The instruments, and what they load
| Instrument | What it loads | What it most often irritates |
|---|---|---|
| Piano and keyboard | Fingers, the thumb passing under, the wrist moving side to side, octave stretches | Thumb-side wrist tendons on octaves, the tendon on the little-finger side of the wrist, forearm tendons |
| Guitar and bass, fretting hand | Fingertip pressure on the strings, the thumb behind the neck, the wrist bent forward | Trigger finger, numb fingers from the carpal tunnel, thumb-base pain |
| Guitar and bass, picking hand | Wrist and forearm, hour after hour | Wrist tendons, outer elbow |
| Violin and viola | Left elbow held bent, chin and shoulder holding the instrument, the bow arm raised | Ulnar nerve at the elbow, neck and the top of the shoulder, jaw, rotator cuff of the bow arm |
| Drums and percussion | Grip on the sticks, wrists, shoulders raised to the cymbals, the back on the throne | Wrist tendons, outer elbow, rotator cuff, lower back |
| Wind and brass | The right thumb carrying a clarinet or oboe, arms held up for the flute, the jaw and lips | Thumb-base joint, jaw, neck and shoulders |
| Carrying the instrument | Lower back and one shoulder, with a keyboard, a cello case or a hardware bag | Lower back strain |
Every musician injury, by body part
Start from where it hurts. Each linked row goes to the page that covers that injury in full.
| Where | Injury | How playing usually causes it |
|---|---|---|
| Hand and finger | Musician’s cramp (focal hand dystonia) | Fingers that curl or lift on their own in a practiced passage, without pain. A neurologist sees this first |
| Hand and finger | Trigger finger (flexor tenosynovitis) | Fretting pressure on the strings, and a tight grip on drumsticks |
| Hand and finger | Thumb-base pain or arthritis (CMC joint) | The right thumb carrying a clarinet or oboe, the left thumb pressing against a violin neck |
| Wrist | Pain on the thumb side of the wrist (De Quervain’s) | Octaves and thumb-under passages on the piano, the guitar thumb hooked over the neck |
| Wrist | Carpal tunnel syndrome | The fretting wrist held bent forward for long stretches |
| Wrist | Wrist ganglion | Repeated wrist loading at the keyboard or on the sticks |
| Wrist | Wrist tendon pain (flexor or extensor tendinopathy) | A jump in practice hours before an exam or a concert |
| Wrist | Little-finger side wrist tendon (ECU tendinopathy or subluxation) | A pianist’s wrist drifting outward to reach the top of the keyboard |
| Elbow | Outer elbow pain (tennis elbow) | Practice volume, with the wrist held up |
| Elbow | Ulnar nerve at the elbow (cubital tunnel syndrome) | The elbow held bent for long periods on the violin or the guitar neck |
| Shoulder | Rotator cuff tendon pain | The bow arm held up, drummers reaching to the cymbals |
| Shoulder | Thoracic outlet syndrome | The violin or viola posture, with the left shoulder raised and the arm up |
| Neck | Postural neck pain | The chin holding a violin or viola for a whole rehearsal |
| Neck | Levator scapulae strain | The shoulder hitched up to the instrument |
| Jaw | Jaw pain (TMJ) | Clamping a violin under the jaw, and the embouchure in wind and brass players |
| Lower back | Lower back strain | Hours on a bench or stool, and carrying cases and hardware |
Not on the list, or not sure which row is yours? That is what the first visit is for.
The injuries we see most in musicians
Wrist and forearm tendon pain
What it feels like. An ache along the top or the underside of the forearm that starts partway through practice and builds. Pianists sometimes feel a click or a sharp catch on the little-finger side of the wrist as the hand travels up the keyboard.
What is usually going on. The tendons that move the wrist and fingers are taking more than they were prepared for. The usual trigger is a change: more hours before an exam, a new piece full of fast passages, a drum kit set at a new height. On the little-finger side, the ECU tendon gets irritated when the wrist sits bent outward for long stretches.
What we measure. Grip strength in kilograms on both hands, wrist range in degrees, which resisted movements bring on the pain, and how many minutes of playing it takes to start. That last number is the one we track week to week.
This week. Split practice into blocks of 20 to 30 minutes with a 5-minute break, and play the hardest passages early, while the forearm is fresh. Check that your forearm sits about level with the keys or the snare. Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist. More on wrist tendonitis.
Pain on the thumb side of the wrist (De Quervain’s)
What it feels like. Sharp pain at the base of the thumb, on the wrist side, when the thumb passes under in a scale, when you stretch for an octave, or when your thumb hooks over a guitar neck. Lifting a kettle can hurt as much as playing.
What is usually going on. Two thumb tendons share a tight tunnel at the wrist. Repeated thumb movement with the wrist tilted irritates the tendons and their sheath.
What we measure. Pinch strength in kilograms against the other hand, the thumb and wrist positions that reproduce the pain, and the same positions on your instrument.
This week. Find the passages with the widest thumb stretch and play them in short blocks for now. Our hand therapists make custom splints that rest the thumb overnight and between blocks. More on De Quervain’s tenosynovitis.
A finger that catches or locks (trigger finger)
What it feels like. A finger, often the ring or middle finger of the fretting hand, that clicks as it straightens, or stays bent and then snaps open. It is often worst first thing in the morning, with a tender lump in the palm at the base of the finger.
What is usually going on. The tendon that bends the finger has thickened where it runs under a band of tissue at the base of the finger, so it catches on the way through. String pressure, a tight grip on sticks and long practice hours all add to it.
What we measure. Which fingers catch, how often through the day, whether each finger straightens all the way, and grip strength.
This week. Ease your grip and pressure. String gauge and action height are a conversation for your guitar technician. A splint that holds the finger straight overnight is one of the options our hand therapists use. If a finger locks bent and you cannot straighten it, see a doctor. More on trigger finger.
Numb or tingling fingers (carpal tunnel and cubital tunnel)
What it feels like. Pins and needles in the thumb, index and middle fingers points to the carpal tunnel at the wrist. Pins and needles in the ring and little fingers points to the ulnar nerve at the elbow. Both tend to come on in a held position, or at night.
What is usually going on. A wrist held bent forward, as on a fretting hand, raises the pressure on the nerve inside the carpal tunnel. An elbow held bent, as in a violinist’s left arm, stretches and presses on the ulnar nerve where it runs behind the elbow.
What we measure. Exactly where the tingling is, sensation in each fingertip, pinch and grip strength, the muscle bulk at the base of the thumb and between the thumb and index finger, and how long your playing position takes to bring the symptoms on.
This week. Let the arm drop and straighten between movements and between songs. A night splint that keeps the wrist straight, or keeps the elbow from bending all the way, is common. Weakness or thinning muscles in the hand need a doctor. See carpal tunnel syndrome and the Cubital Tunnel Recovery Program.
Thumb-base pain on clarinet, oboe and violin
What it feels like. A deep ache where the thumb meets the wrist, worse when you pinch, open a jar, or hold the instrument up for a long passage.
What is usually going on. A clarinet or oboe rests its weight on the right thumb. A violinist presses the left thumb against the neck. The joint at the base of the thumb takes that load, and in some players it already has early arthritis.
What we measure. Key pinch and tip pinch in kilograms on both hands, thumb range, and how stable the base joint is under load.
This week. A neck strap moves the clarinet’s or oboe’s weight off the thumb. Ask your teacher to watch your thumb pressure on the violin neck. More on thumb joint pain.
Neck, shoulder and jaw on violin and viola
What it feels like. An ache on the left side of the neck and across the top of the shoulder, a jaw that clicks or aches after rehearsal, and sometimes tingling down the arm while the instrument is up.
What is usually going on. The chin and shoulder hold the instrument, the left shoulder hitches up, and the bow arm stays raised. The muscle from the neck to the shoulder blade (levator scapulae) and the jaw joint take a share of it. Tingling with the arm up can come from the nerves at the neck or around the collarbone, which needs a careful look.
What we measure. Neck rotation each way, how the shoulder blade moves, jaw opening, and how many minutes you can hold the playing position before symptoms start.
This week. Take the instrument down between movements. Ask your teacher or luthier to check the chin rest and shoulder rest against the length of your neck. More on neck pain.
Back to full practice on tests, not dates
A concert date tells you when you have to play. It says nothing about whether the tendon is ready. Before full practice hours come back, we look for these:
- Grip and pinch strength within 10% of the other hand, or of your own baseline.
- The hardest passage in your current program played at performance tempo, with no pain that day or the next morning.
- Practice built back in steps, adding 10 to 15 minutes every two or three days, and only when the morning after is quiet.
- For tingling, your playing position held for the length of your longest piece without symptoms.
- For trigger finger, a finger that straightens all the way without catching through a full practice.
Run the full program once at tempo at least a week before the performance, so the performance is not the first test. Pain is the first thing to leave. Strength is the last to train and recover.
Is this normal?
Usually expected: tired forearm muscles after a long rehearsal, in both arms, gone by the next morning. A new piece with an unfamiliar stretch can leave the hand sore for a day or two.
What our patients say
Google reviews from our clinics in Singapore.
Worth getting checked: pain at one spot that starts earlier in practice each week, pain the next morning, a finger that clicks or catches, tingling or numbness, or less control in a passage you used to play cleanly.
When to see a doctor first
- Call 995 for sudden weakness or numbness down one side of the body, a face that droops, slurred speech, or chest pain.
- Go to the emergency department now for a cut to a finger or the palm after which the finger is numb or will not bend on its own, or a hand that turns cold, pale or blue. Cut tendons and nerves need a surgeon. After repair, see the Flexor Tendon Repair Recovery Program and the Digital Nerve Repair Recovery Program.
- See a doctor the same day for a finger, hand or wrist that is hot, red and swollen, especially with a fever, or a finger locked bent that you cannot straighten.
- See a doctor soon if a finger curls, lifts or freezes on its own in one passage, without pain, and only when you play. That pattern can be focal hand dystonia, a neurological condition. Ask your GP to refer you to a neurologist, who confirms the diagnosis and talks you through the options. The same applies to numbness that stays all day, weakness, thinning of the muscles in the hand, or a lump at the wrist that grows or hurts.
Questions people ask
Why does my wrist hurt when I play piano or guitar?
Most wrist pain in pianists and guitarists is tendon pain that follows a jump in practice hours, such as before an exam or a recital. Pianists often feel it on the little-finger side of the wrist as the hand travels up the keyboard. Guitarists feel it in the fretting wrist, which stays bent forward for long stretches.
What is focal hand dystonia in musicians?
Focal hand dystonia is a neurological condition in which a finger curls, lifts or freezes on its own in one passage, usually without pain, and only when the person plays. A neurologist confirms the diagnosis and talks through the options. A GP can refer a musician who notices this pattern.
Why do my fingers go numb when I play?
Tingling in the thumb, index and middle fingers usually points to the median nerve at the wrist, in the carpal tunnel. Tingling in the ring and little fingers usually points to the ulnar nerve at the elbow, which is stretched when the elbow stays bent, as in a violinist’s left arm. Weakness in the hand needs a doctor.
When can I go back to full practice after a hand or wrist injury?
Full practice comes back on tests rather than dates: grip and pinch strength close to the other hand, the hardest passage played at performance tempo with no pain that day or the next morning, and practice time built up in small steps, only when the morning after is quiet.
Where are you with this right now?
1. It is settling on its own
If it eases week by week while you practice in shorter blocks, you are on the right road. Build the hours back in small steps, and bring the hardest passages back last. You do not need us for this, and we would rather say so.
2. It has stopped improving
It settles after a few days off and comes back within a week of your usual practice. You have changed a fingering to avoid a stretch, dropped a piece from the program, or started warming the hand up for twice as long just to get through. That pattern is usually a load problem in a tendon or a nerve, and rest alone rarely changes it. It is worth measuring. If it has been months, the Stalled Recovery Review runs over three weeks with the same therapist.
3. You have had surgery, or you have a date
A trigger finger release, a carpal tunnel release, a cubital tunnel release or a tendon repair each has a shape, with protected weeks before the instrument comes back. See hand therapy after surgery and the recovery programs. All of it runs on the four stages of the Phoenix Recovery Protocol: Calm & Protect, Move & Mobilize, Rebuild & Strengthen, and Return & Perform.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement, strength and control are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Sources
- Zaza C. Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ. 1998;158(8):1019-1025.
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