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

## TL;DR

A violinist with a forearm tumor was initially suspected of having dystonia, but surgery revealed a schwannoma, highlighting the need for careful diagnosis in musicians.

## Contribution

This case highlights how forearm schwannomas can mimic musician's dystonia and emphasizes the importance of precise clinical evaluation in professional musicians.

## Key findings

- A schwannoma in a violinist caused parasitic finger movements that interfered with playing.
- Musicians' specific functional needs require tailored clinical assessments.
- Cystic lesions can present symptoms similar to focal dystonia, necessitating thorough investigation.

## Abstract

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).

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.

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.

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

•Musicians have specific fuctional needs.•Some cystic lesions can mimic focal dystonia.•Certain non-physiological movements may be compromised by the presence of a lesion, even though it does not interfere with everyday movements.•A forearm schwannoma caused parasitic 4th/5th finger movements, interfering with violon playing.

Musicians have specific fuctional needs.

Some cystic lesions can mimic focal dystonia.

Certain non-physiological movements may be compromised by the presence of a lesion, even though it does not interfere with everyday movements.

A forearm schwannoma caused parasitic 4th/5th finger movements, interfering with violon playing.