When Blue Turns to Gray: The Enigma of Musician’s Dystonia

Musician’s dystonia (MD) is an enigmatic neurologic disorder that selectively interferes with voluntary motor control required for music performance. In many cases it is evident only in certain passages of certain pieces. This contributes to the challenges of assessment and treatment. Oral medications and botulinum toxin injections have shown some limited efficacy, but with adverse side effects. Physical medicine and rehabilitation strategies generally have a lower risk of adverse side effects and show promise in efficacy but are difficult to incorporate in well-controlled studies. MD shares pathophysiologic features with other forms of focal dystonia, including abnormalities in inhibition, sensorimotor integration, and plasticity at many levels of the central nervous system. Theories for the pathogenesis include multiple etiologic factors, such as genetics, gender, and “use patterns.” Ongoing research on assessment, pathophysiology, and pathogenesis should provide rationale bases for managing and even preventing MD.