Radial Collateral Ligament Injury of the Little Finger Proximal Interphalangeal Joint in Young Pianists

Purpose To report the features of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players. Methods Between 2005 and 2012, we treated 6 cases of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players at a single referral center. We conducted a retrospective review of charts and radiographs and telephone-interviewed all patients at a mean follow-up of 33 months (range, 12–66 mo) to evaluate features of this injury. Results All patients were girls with a mean age of 10 years (range, 8–12 y), and all had injuries in their right hands. Patients had been playing piano for a mean 3.8 years (range, 3–5 y) and practicing for a mean 1.8 hours per day (range, 1–3 h). Pain was commonly aggravated when they played octaves or advanced pieces requiring extensive finger movements. All patients were playing on standard-size piano keyboards and had generalized hypermobility with a mean Beighton and Horan score of 6.3 (range, 5–9). Two patients had an ulnar deviation deformity of 10° and 15° each at the proximal interphalangeal joint whereas the others had no fixed joint deformity. Five patients showed improvement with conservative treatment, but 1 patient underwent surgery. Conclusions In our practice, all piano-related radial collateral ligament injuries were in female preadolescents with evidence of generalized hypermobility; patients had been playing piano extensively, suggesting that the injury could have resulted from stress on the joint during piano playing. Future studies should further evaluate the efficacy of modifying keyboard size, techniques, and repertoires for piano lessons and of patient education for this type of injury. Type of study/level of evidence Therapeutic IV.