Medical problems of brass instrumentalists: prevalence rates for trumpet, trombone, French horn, and low brass

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Authors: Kris Chesky, Karendra Devroop and James Ford, III
Date: June 2002
From: Medical Problems of Performing Artists(Vol. 17, Issue 2)
Publisher: Science & Medicine
Document Type: Article
Length: 3,612 words

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Abstract--This study examined the medical problems of musicians who primarily perform on a brass instrument. Data for this study (N = 739) were extracted from the University of North Texas Musician Health Survey data set. Subjects were included if they indicated either trumpet, trombone, French horn, or low brass as their primary instrument. Prevalence rates for one or more musculoskeletal problems were determined for the whole group and by instrument. For those subjects who reported problems at specific sites, average severity levels were derived from responses to a five-point grading scale. Additional prevalence rates for non-musculoskeletal problems were established for the whole group and by instrument. About 60% of the brass musicians reported having one or more musculoskeletal problems. The trombone group reported the highest rate (70%), followed by French horn and low brass (62%), and then trumpet (53%). Results suggest unique physical performance requirements and risks across the four main brass instrument groups and that future studies should examine each brass instrument group individually. Med Probl Perform Art 17:93-98, 2002.


Performing a brass instrument requires physical demands to hold and position the instrument, press the mouthpiece against the lips, produce and sustain blowing pressure, and either press valves and/or pull and push slides. It is assumed that these physical demands may contribute to performance-related medical problems. For instance, studies suggest that blowing pressure during brass performance may cause increases in intraocular pressure and glaucomatous damage, (1) respiratory problems, (2) cardiac arrhythmias, (3) and orofacial dysfunction. (4) Injury to the orbicularis oris muscle (5) and other embouchure problems including lip pain and limited flexibility, (6) as well as tooth displacement, (7) are related to mouthpiece forces against the lips. Additionally, medical problems linked to brass performance have included dermatitis, 8 hand and wrist problems, (9,10) and overuse syndromes. (11-13)

For trumpet players, intraoral pressures, measured as high as 25 kPa, (14) may lead to neck abscesses due to microperforation of the anterior pharynx, (15) laryngoceles, (16) pharyngeal diverticula, (17) spontaneous epidural hematomas, (18) transient ischemic attacks, (19) and visual field defects associated with increased intraocular pressure. (1) The compressive forces against the lips, at times greater than 100 N, (7,20) are substantial enough to alter tooth position up to 100 [micro]m (7) and cause serious injury of the orbicularis oris muscle. (5)

Blowing pressures generated during French horn performance have been linked to acute nose blow palsy, a variant of sudden facial paralysis, (21) increases in diastolic blood pressure, (22) cardiac arrhythmias and electrocardiographic (ECG) abnormalities, (23) and increased incidence of wandering atrial pacemaker. (24) Compressive forces against the lips may lead to tightness of the lips including the facial muscles, (25) temporomandibular joint (TMJ) and jaw pain, (26) and embouchure dystonia. (27)

Overinflation of the lungs and high intra-alveolar pressure, both of which may result in alveolar rupture, have been associated with blowing pressures generated during trombone performance. (28) Apparently, this blowing pressure is proportional to higher pitches and louder dynamics. (29) Measures of mouthpiece force during trombone performance...

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Source Citation
Chesky, Kris, et al. "Medical problems of brass instrumentalists: prevalence rates for trumpet, trombone, French horn, and low brass." Medical Problems of Performing Artists, vol. 17, no. 2, June 2002, pp. 93+. Accessed 30 Nov. 2022.

Gale Document Number: GALE|A173230576