Hand Difficulties Among Musicians

To the Editor.—  Hand difficulties among musicians are, as pointed out by Dr Hochberg and associates, of a group of occupational maladies that have been around for a long time. Although various aspects of the occupational etiology have been discussed in a multitude of articles, there seems to me to be only one factor that is common to all—sustained contraction of a muscle group (or groups).Whenever digits occupy a "fixed position" or are "held rigidly," their associated muscles are contracted and their blood supply largely obliterated. On the contrary, fingers moving rhythmically to and fro are actuated by muscles that, with the assistance of venous valves, are actively pumping blood and, because of this, are apt to be able to perform longer than those maintained in a contracted state for prolonged periods.The mechanism for this phenomenon can be readily grasped by looking at the accompanying illustration. Mr