From the practice: Lack of supination

Discussion:

In the published examinations of Professor Chr. Wagner–Hannover music-physiological Institute at the Hochschule für Musik, about Supination and Pronation with musicians it has been proved that a biomechanically reduced supination possibility with young violinists, or pronation possibility with young pianists could not be Improved, not even with intensive training, after the age of 16 year. These problems lead on the age of 20-26 y. to serious problems in instrumental-technique. More special high positioning on the G-string or velocity for pianists.

1. Case

Person 1:	22 year old male student in the fifth year of his study at the conservatory. for orchestra-violinist.
Complaints:	Pains in the left sub- and upper arm.
Diagnosis:	Congenital limitation of the Supination, left arm over 25 degrees- caused over burdening of the left shoulder - and arm muscles. Violin playing was no longer possible.
Referred to:	Because of the talent and general disposition of Person 1, I send him to the clinic for reconstruction surgery in Rotterdam, at that time the most experienced clinic in Europe regarding professional problems with musicians about traumatic- or configuration diseases of soft tissues or bones. My suggestion was to improve the left supination excursion operationally.
Advice:	After discussion under management of Professor Dr.v.d.M. –Director of the clinic, Dr. van Drunen. operated, so that P1 could restart his career.
Discussion:	The problems with spatially disabled supination a/o pronation with violinist and pianists is already for years signalled by Professor Wagner of the Hannoveranian Institute for music-physiology. The P1 is- as far as I know - the first violinist, which has been operated with this diagnosis. After his operation he became some re-educational processing in violin-technique in our Institute.

2. Case

Person 2:	Violinist – 4^th. Year, female
Troubles:	strong pains left under- and forearm; progressive since a year.
Status presence:	Violin playing was no longer possible because of unbearable pains.
Diagnosis:	(Ossal = from the bone): reduced excursion of the supination. No accident in the Anamnesis. On base of this anatomically conditioned restriction of the supination of the left forearm it was impossible to continue her violin study. Although this supination–restriction was already diagnosed by Chr. Wagner diagnoses 6 year ago without token its consequences. After examination with Dr. V. Drunen ; this supination restriction was not operable, because of the structure and form of the bones (Ulna and Radius) in connection with the configuration of the handjoint. The piano-technique she had developed however reached for switching over to piano as main profession. P2 could - after my attest – transfer to piano in the third year of her study.

Person 2:

Violinist – 4^th. Year, female

Troubles:

strong pains left under- and forearm; progressive since a year.

Status presence:

Violin playing was no longer possible because of unbearable pains.

Diagnosis:

(Ossal = from the bone): reduced excursion of the supination.

No accident in the Anamnesis.
On base of this anatomically conditioned restriction of the supination of the left forearm it was impossible to continue her violin study. Although this supination–restriction was already diagnosed by Chr. Wagner diagnoses 6 year ago without token its consequences.

After examination with Dr. V. Drunen ; this supination restriction was not operable, because of the structure and form of the bones (Ulna and Radius) in connection with the configuration of the handjoint.
The piano-technique she had developed however reached for switching over to piano as main profession.
P2 could - after my attest – transfer to piano in the third year of her study.

3. Case

Person 3:	Geiger - male.1^st year study
Troubles:	Left forearm pain started in 1992 together with cramps and fatigue. P3 played violin since its 6th. year. He also studied from 1991 Viola.
Anamnesis:	for 6 year problems started and were medically treated by rest and physiotherapy. After restarting studying the problems came back quickly. Person 3 is not an athletic person. He told that with gymnastic at school he was slowly and not interested. On base of my observations, a deepening of the illness-history was necessary.
Birth:	Early-birth (7 month) with underweight.- Couveuse Sitting with 5 month – standing with 15 month – walking with 20 month-speech with 12 month understandable- with 19 month fluent.
Examination:	Anatomy: restricted supination of the left arm Lokalisation: pains ulnar side / forearm li > re
Attitude:	ad-centric motor dominance.
Tonus:	arm-muscle tone high
Stand:	" loosed " expression while playing
Sitting:	with deflection of the pelvis.
Body:	normal.
Motor-Develop.:	insufficient static coordination
Coordination:	Gross-motoric activity: -angular and little flowing.
Fine-motor activity:	too little development for a successful violin-study.
Expression:	The motor expression is predominant ad-centrically. Too little awareness about his playing-technique.
Function.:	Gross-motoric dominance in violin-technique
Vibrato	too artificially developed
Posture:	bad support with protraction of the left. shoulder.
Support:	to low
Musicality	his musical gift is undoubtedly great
Diagnosis:	His motoric ripening is a bit retarded so that he mostly overburden himself for this study
Discussion:	Repetitive Strain Injury by cause of insufficient motor ripening Strategy: A sensomotor training by means of Dispokinesiopaedy, followed by re-educational processing concerning violin technique after operation. After examination through Dr.van Drunen, he became a prae-operative training with Dispokinesiopaedy. After his operation he had a free supination and after reeducation of his violin technique, he could follow his study. Today , P3. is already during years an enthusiastic member of a German orchestra.

** = experience learned, that a prae-operative preparation by means of Dispokinesiopaedie, can limit the post operative treatment period.

International Center for Dispokinesis