Fiddler's neck
Fiddler's neck | |
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Other names | Violin hickey, viola love bite |
Specialty | Occupational health |
Fiddler's neck is an occupational disease that affects violin and viola players.[1]
It is a
Although the presence of fiddler's neck is sometimes used as an indicator of a violinist's skill, or 'battle scars' from constant practice, many violinists never develop fiddler's neck, due to differences in skin sensitivity, playing habits, and the materials used in the construction of the instrument. An accomplished professional player could practice hard their whole life and never develop fiddler's neck.
Signs and symptoms
Fiddler's neck usually involves highly localized
The
Causes
The proximal causes of fiddler's neck are friction and pressure, but both repetitive shearing stress and occlusion with consequent trapping of sweat give rise to progressive damage.[1] This damage along with poor hygiene predisposes the area to local infection, and such infection can progress to scarring and other long-term effects.[1] Hot weather is reported to exacerbate fiddler's neck, as are tiredness, playing emotional music, and playing in smaller groups where individual stress is higher.[2] Type I hypersensitivity reactions may also be involved, particularly to rosewood and ebony in the chinrest and tailpiece, as well as to varnish of the instrument body when chinrests are not used and to rosin deposits on the instrument and on chin cloths.[3] Nickel or other metal allergies are common causes if the chin rest has a metal clip that comes into constant contact with the skin. Rosin exposure in particular may lead to abietic acid dermatitis.[3]
Diagnosis
Differential diagnoses
The
Treatment
Treatment for fiddler's neck is unnecessary if it is painless and shows minimal swelling,[3] particularly since minor cases are taken as a mark of pride. But fiddler's neck may lead to worse disorders. The primary methods of treatment involve adjustments to playing of the instrument:[3][5]
- good hygiene for the affected area and for the instrument
- use of a clean cotton cloth that is changed frequently
- use of a comfortable pad to absorb sweat and reduce friction between the instrument and skin
- use of a shoulder rest to reduce pressure below the jaw
- a suitable chin rest, especially one carved or molded for the individual
- covering or changing potentially allergenic materials on the instrument.
- shifting the chin rest to the center of the body over the tailpiece
- smoothing coarse surfaces to reduce abrasion
- for males, growing a beard to avoid folliculitis
Surgery is necessary for sialolithiasis, parotid tumors, and cysts.[3] Cervical lymph nodes that are larger than 1 cm must be biopsied.[3] Connective tissue can be removed by excision when a non-inflamed mass is large, and there is generally little recurrence.[3] Infections should be treated conservatively, and causative species should be identified through smear and culture for appropriate antibiotic selection.[3] Reduction of playing time may be helpful for cases without inflammation, but in 30% of cases this did not improve the symptoms.[3]
Prevalence
Fiddler's neck does not usually form unless the musician is practicing or playing for more than a few hours each day, and only seems to develop after a few years of serious playing.[2] Thus, when not infected or otherwise problematic, fiddler's neck may be known as a benign practice mark and may be worn proudly as an indication of long hours of practice.[3] Blum & Ritter (1990) found that 62% of 523 professional violinists and violists in West Germany experienced fiddler's neck, with the percentage among violists being higher (67%) than among violinists (59%).[3] Viola players are believed to be more predisposed to developing fiddler's neck than violinists because the viola is larger and heavier, but this has not been empirically confirmed.[2]
The development of fiddler's neck does not depend on preexisting skin problems, and Blum & Ritter find that only 23% of men and 14% of women in their study reported cutaneous disorders in other parts of the face (mainly acne and