Diagnostic and therapeutic management of a left forearm tumor in a violinist: Clinical case and literature review

Abstract

Introduction: The management of forearm tumors requires a precise clinical examination and the performance of further examinations before considering possible surgical management is necessary, particularly in the case of professional musicians. In this specific population, certain differential diagnoses may fail to identify an organic cause for a painful symptomatology. Among the known causes is musician's focal dystonia (https://pubmed.ncbi.nlm.nih.gov/20590806/, n.d.; Rozanski et al., 2015).

Case: 65-year-old patient, professional violinist, who consulted for a tumor of the forearm, with involuntary tremor-like movements which recently made it impossible to play the violin. Tumor removal was performed and anatomopathological analysis revealed a schwannoma. The patient was able to play the violin from the first week after surgery and the tremors disappeared.

Discussion: Musician's dystonia could be envisaged here, given the presence of discomfort only during instrumental practice. The management of this tumor required a precise clinical examination, with the musician's instrument. Musician's dystonia must remain a diagnosis of elimination.

Conclusion: We report a misleading case of a nerve tumor in a musician that could easily be mistaken for dystonia at first glance.

Keywords: Case report; Dystonia; Musician.

Fig. 1

MRI of the forearm showing the lesion. A) T2-weighted coronal section B) Gadolinium-enhanced T1-weighted coronal section C) T2-weighted axial section D) Gadolinium-enhanced T1-weighted axial section.

Fig. 2

Intraoperative photographs of the lesion. A) Subcutaneous appearance of the lesion. B) Dissection and demonstration of a well-defined cystic lesion. C) Macroscopically complete removal of the lesion. D) Surgical zone after lesion removal.

Fig. 3

Clinical examination with violin at 1 month post-operatively. Disappearance of symptoms bothering the patient.