200 Section - Diagnostic Ultrasound and Treatment of Performance-Related Musculoskeletal Disorders in Brass Instrumentalists: A Retrospective Study

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

CL

Chun Hsien Li, MD

Resident Physician
Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center
Tainan, Tainan, Taiwan (Republic of China)

Corresponding Author/Autor a quien dirigir la corr(s)

DS

Daniel Chiung-Jui Su, MD

Attending Physiatrist
Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center
Tainan, Tainan, Taiwan (Republic of China)

Co-Author/Coautor(s)

HL

Hsin-Te Lin, MD

Attending Physiatrist
Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center
Tainan, Tainan, Taiwan (Republic of China)

Objectives : Performance-related musculoskeletal disorders (PRMDs) are highly prevalent among orchestral musicians. Brass instrumentalists are particularly vulnerable because their performance requires prolonged, constrained postures and repetitive upper body movements. Although many report pain in the perioral muscles, neck, shoulders, upper back, or arms, the specific soft-tissue pathologies underlying these symptoms have not been fully characterized. In this retrospective study, we used diagnostic ultrasound to evaluate brass instrumentalists with PRMDs and to describe the predominant abnormalities and their association with clinical symptoms.

Design: This retrospective case series, conducted at a tertiary-care musicians’ clinic (Jan 2019–Dec 2024), included brass instrumentalists with PRMDs, excluding those with trauma or rheumatologic disease. Demographics, PRMD stage, pain sites, ultrasound findings, and treatments (postural retraining, manual therapy, injections) were collected following CARE guidelines. Data were analyzed using SPSS (v27), with statistical significance set at p < 0.05.

Results: Among the 51 brass instrumentalists included, stage 4 PRMDs were most common (68.6%). Structural perioral muscle lesions were identified in 29 players (56.8%), most frequently involving the depressor anguli oris and buccinator. Shoulder girdle and upper trunk involvement (serratus anterior, upper trapezius, and/or levator scapulae) was found in 9 players (17.6%). Overall, 92.1% of participants resumed playing within three months after intervention, with reported functional improvement and pain reduction. Management strategies included physical therapy, instrument or embouchure adjustment, ultrasound-guided regenerative injections (hypertonic dextrose and/or platelet-rich plasma), and structured postural retraining.

Conclusion: This study identified characteristic perioral and shoulder girdle lesions in brass instrumentalists with PRMDs, particularly involving the depressor anguli oris and buccinator muscles. Recognizing these patterns helps relate players’ symptoms to specific tissue pathology and supports targeted management that combines rehabilitation, embouchure or instrument adjustment, and regenerative injections. Our findings also suggest that, with structured multidisciplinary care, most affected brass players are able to return to playing within three months.