研究背景與目的：鋼琴演奏者為人數眾多之職能團體，早期與鋼琴演奏相關之研究主要以流行病學研究為主；為了更加完整的瞭解鋼琴演奏者之傷害機制，全面性地探討彈奏鋼琴時之手部生物力學表現乃是了解及避免傷害重要的一環，故本研究目的為應用客觀及量化之生物力學方法，探討(一)不同手距(hand span)大小之受測者彈奏和絃及八度音樂曲之運動學與力學表現，與(二)左手與右手在彈奏樂曲時之運動學與力學表現，以期將研究結果與臨床應用作結合。

研究方法：從台灣南部地區招募二十位鋼琴演奏者，所有受測者皆需接受手距大小之標準量測，重複彈奏指定之和絃及八度音樂曲片段各五次。彈奏時使用三維動作分析系統，以貼於手腕及手指背側之反光標記所組成之三度空間位置並計算出最大指間外展角度比值、指關節之屈曲伸展活動度、腕關節之屈曲伸展及橈側尺側彎曲活動度、及各指關節和腕關節之屈曲伸展動作單元此四個運動學參數。同時使用樂器數位介面軟體量測各指指尖作用力。資料分析則為比較彈奏和絃及八度音樂曲時，大手距與小手距兩組之運動學與力學表現差異，及比較左手及右手之運動學及力學表現差異。

研究結果：大手距與小手距的兩組受測者於彈奏和絃及八度音時，最大指間外展角度比值有達到統計上之顯著差異(P < .05)。兩組於彈奏和絃時，右手手腕之屈曲伸展活動度亦達到統計上之顯著差異(P < .05)。兩組在指關節屈曲伸展活動度、腕關節橈側尺側彎曲活動度、及指尖作用力參數無顯著之差異。但就左右手之各指指關節屈曲伸展動作單元及指尖作用力，右手皆顯著大於左手。

結論：小手距之鋼琴演奏者於彈奏和絃及八度音時，會出現過度外展之手指外展角度及較大之腕關節屈曲伸展活動度，故推論此可能容易導致相關部位傷害的產生。右手於彈奏樂曲時，比起左手會有較多不自主的手指預備彈奏動作產生，且會施予較大力量以彈奏琴鍵，故可呼應右手較易產生疼痛及傷害此論點。從各關節之動作表現差異解釋相關疾病產生之原因，可提供未來臨床於診斷、治療及復健上實值的運用。

Background & purpose: Pianists are an occupational group. To understand the injury mechanism associated with pianists, it is important to investigate the biomechanics of the hand in depth while playing the piano. The purposes of the study are: 1) to compare the kinematic and kinetic performance of the small hand span with those of large hand span; 2) to compare the kinematic and kinetic performance of the right-hand side with those of the left-hand side by the objective and quantitative biomechanical methods. The results could offer further insights to clinical application.

Methods: Twenty female pianists were recruited from the southern area of Taiwan. All subjects passed through the hand span screening and assigned to play a chord and an octave. The kinematic parameters, such as the ratio of maximal digit-to-digit abduction angle, the range of motion (ROM) of finger joint flexion-extension (F/E) angle, the ROM of wrist joint flexion-extension (F/E) as well as radial-ulnar deviation (R/U) angle, and the movement unit of flexion-extension (F/E) of each finger joint were measured using a video-based passive marker detection system. The fingertip force was measured using the MIDI interface and calculated by a kinetic equation.

Results: There is significant difference of the ratio of maximal digit-to-digit abduction angle between large and small hand span pianists while playing the chord and the octave. Significant difference of the ROM of wrist joint F/E angle between large and small hand span pianists while playing the chord is also presented. The ROM of finger joint F/E angle , the ROM of wrist joint R/U angle, and the fingertip force do not show significant differences between these two groups. When playing the chord and the octave, both the movement unit of F/E of each finger joint and the fingertip force of the right hand are significantly larger than those of the left hand.

Conclusions: The small hand span pianists use the wide-extent of finger abduction to play the chord and octave. Similarly, the pianists of this group use larger wrist F/E movement to play the chord. The left hand also represents smoother motions and less fingertip force as compared with the performance of the right hand. Accordingly we may claim that the small hand span and the right-hand side might potentially be the risk factors which could induce the injuries in piano playing.

An, K. N., & Bejjani, F. J. (1990). Analysis of upper-extremity performance in athletes and musicians. Hand Clinics, 6(3), 393-403.
Bejjani, F. J., Ferrara, L., Xu, N., Tomaino, C. M., Pavlidis, L., Wu, J., et al. (1989). Comparison of three piano techniques as an implementation of a proposed experimental design. Medical Problems of Performing Artists, 4(3), 109-113.
Bejjani, F. J., Kaye, G. M., & Benham, M. (1996). Musculoskeletal and neuromuscular conditions of instrumental musicians. Archives of Physical Medicine &Rehabilitation, 77(4), 406-413.
Bergquist, U., Wolgast, E., Nilsson, B., & Voss, M. (1995). Musculoskeletal disorders among visual display terminal workers: individual, ergonomic, and work organizational factors. Ergonomics, 38, 763–776.
Blackie, H., Stone, R., & Tiernan, A. (1999). An investigation of injury prevention among university piano students. Medical Problems of Performing Artists, 14(3), 141-149.
Bower, J. A., Stanisz, G. J., & Keir, P. J. (2006). An MRI evaluation of carpal tunnel dimensions in healthy wrists: Implications for carpal tunnel syndrome. Clinical Biomechanics, 21, 816-825.
Bragge, P., Bialocerkowski, A., & McMeeken, J. (2006). Understanding playing-related musculoskeletal disorders in Elite pianists: a grounded theory study. Medical Problems of Performing Artists, 21(2), 71-79.
Brumfield, R. H., & Champoux, J. A. (1984). A biomechanical study of normal functional wrist motion. Clinical Orthopaedics & Related Research. 187, 23-25.
Chung, I. S., Ryu, J., Ohnishi, N., Rowen, B., & Headrich, J. (1992). Wrist motion analysis in pianists. Medical Problems of Performing Artists, 7(1), 1-5.
Dawson, W. J. (2002). Upper-extremity problems caused by playing specific instruments. Medical Problems of Performing Artists, 17(3), 135-140.
Dawson, W. J. (2005). Intrinsic muscle strain in the instrumentalist. Medical Problems of Performing Artists, 20(2), 66.
Deahl, L., & Wristen, B. (2003). Strategies for small-handed pianists. American Music Teacher, 52(6), 21-25.
De Smet, L., Ghyselen, H., & Lysens, R. (1998). Incidence of Overuse syndrome of the upper limb in young Pianists. Annals of Hand and Upper Limb Surgery, 17(4), 309-313.
Donison, C. (2000). Hand size vs the standard piano keyboard. Medical Problems of Performing Artists, 111-114.
Eri Yoshimura, M. M., Paul, P. M., Dma, C. A., & Chesky, K. (2006). Risk factors for piano-related pain among college students. Medical Problems of Performing Artists, 21(41), 118-125.
Ferrario, V. F., Macri, C., Biffi, D., Pollice, P., & Sforza, C. (2007). Three-dimensional analysis of hand and finger movements during piano playing. Medical Problems of Performing Artists, 22(1), 18-23.
Furuya, S., Nakahara, H., Aoki, T., & Kinoshita, H. (2006). Prevalence and causal factors of playing-related musculoskeletal disorders of the upper extremity and trunk among
Japanese pianists and piano students. Medical Problems of Performing Artists, 21(3), 112-117.
Gerr, F., Marcus, M., Ensor, C., Kleinbaum, D., Cohen, S., Edwards, A., et al. (2002). A prospective study of computer users: I. Study design and incidence of musculoskeletal
symptoms and disorders. American Journal of Industrial Medicine, 41, 221–235.
Gohl, A. P., Clayton, S. Z., Strickland, K., Bufford, Y. D., Halle, J. S., & Greathouse, D. G. (2006). Median and ulnar neuropathies in university pianists. Medical Problems of
Performing Artists, 21(1), 17-24.
Goodman, G., & Staz, S. (1989). Occupational therapy for musicians with upper extremity overuse syndrome: patient perceptions regerding effectiveness of treatment. Medical
Problems of Performing Artists, 4(1), 9-14.
Grieco, A., Occhipinti, E., Colombini, D., Menoni, O., Bulgheroni, M., Frigo, C., et al. (1989). Muscular effort and musculo-skeletal disorders in piano students: electromyographic, clinical and preventive aspects. Ergonomics, 32(7), 697-716.
Harding, D. C., Brandt, K. D., & Hillberry, B. M. (1989). Minimization of finger joint forces and tendon tensions in pianists. Medical Problems of Performing Artists, 4(3), 103-108.
Hume, M. C., Gellman, H., McKellop, H., & Brumfield, R. H. (1990). Functional range of motion of the joints of the hand. Journal of Hand Surgery - American Volume. 15A(2),
240-243.
Jabusch, H. C., Vauth, H., & Altenmueller, E. (2004). Quantification of focal dystonia in pianists using scale analysis. Movement Disorders, 19(2), 171-180.
Keir, P. J., & Wells, R. P. (1999). Changes in geometry of the finger flexor tendons in the carpal tunnel with wrist posture and tendon load: an MRI study on normal wrists. Clinical Biomechanics, 14, 635-645.
Lederman, R. J. (1991). Focal dystonia in instrumentalists: clinical features. Medical Problem of Performing Artists, 6(4), 132-136.
Lederman, R. J. (2003). Neuromuscular and musculoskeletal problems in instrumental musicians. Muscle & Nerve, 27(5), 549-561.
Lee, S.-H., Hanks, K. B., & Schwartz, J. (2005). Pianist's rehabilitation: three cases. Medical Problems of Performing Artists, 20(1), 35-39.
Less, M., Krewer, S. E., Eickelberg, W. W. (1977). Exercise effect on strength and range of motion of hand intrinsic muscles and joints. Archives of Physical Medicine &
Rehabilitation, 58(8), 270-374.
Lim, V. K., & Altenmuller, E. (2003). Musicians’ cramp: instrumental and gender differences. Medical Problems of Performing Artists, 18(1), 21-26.
Palmer, A. K., Werner, F. W., Murphy, D., & Glisson, R. (1984). Functional wrist motion: a biomechanical study. Journal of Hand Surgery - American Volume. 10(1), 39-46.
Parlitz, D., Peschel, T., & Altenmuller, E. (1998). Assessment of dynamic finger forces in pianists: effects of training and expertise. Journal of Biomechanics, 31(11),
1063-1067.
Pak, C. H., & Chesky, K. (2001). Prevalence of hand, finger, and wrist musculoskeletal problems in keyboard instrumentalists. Medical Problems of Performing Artists, 16(1), 17-23.
Penn, I. W., Sun, P. C., Chang, H. A., & Hsu, T. C. (1994). Playing related health problems in Taiwan music students: a preliminary report. Taiwan Journal of Physical Medicine and Rehabilitation, 22(1), 105-110.
Revak, J. M. (1989). Incidence of upper extremity discomfort among piano students. The American Journal of Occupational Therapy, 43(3), 149-154.
Robison, D., & Zander, J. (2002). Preventing Musculoskeletal Injury (MSI) for Musicians and Dancers-A Resource Guide. British Columbia: SHAPE (Safety and Health in Arts Production and Entertainment). Retrieved June 8, 2006, from the World Wide Web: http://www.shape.bc.ca/resources/pdf/msi.pdf.
Rosety-Rodriguez, M., Ordonez, F. J., Farias, J., Rosety, M., Carrasco, C., Ribelles, A., et al. (2003). The influence of the active range of movement of pianists’ wrists on
repetitive strain injury. European Journal of Anatomy, 7(2), 75-77.
Ryu, J. Y., Cooney, W. P. 3rd., Askew, L. J. An, K. N., Chao, E. Y. (1991). Functional ranges of motion of the wrist joint. Journal of Hand Surgery - American Volume, 16(3), 409-19.
Sakai, N. (1992). Hand pain related to keyboard techniques in pianists. Medical Problems of Performing Artists, 7(2), 63-65.
Sakai, N. (2002). Hand pain attributed to overuse among professional pianists. Medical Problems of Performing Artists, 17(4), 178-180.
Sakai, N. (2006). Slow-down exercise for the treatment of focal hand dystonia in pianists. Medical Problems of Performing Artists, 21(1), 25-28.
Sakai, N., Liu, M. C., Su, F-C., Bishop, A. T., & An, K-N. (1996). Motion analysis of the fingers and wrist of the pianists. Medical Problems of Performing Artists, 11(1), 24-29.
Sakai, N., Liu, M. C., Su, F-C., Bishop, A. T., & An, K-N. (2006). Hand span and digital motion on the keyboard: concerns of overuse syndrome in musicians. The Journal of Hand Surgery, 31A, 830-835.
Shields, N., & Dockrell, S. (2000). The prevalence of injuries among pianists in music schools in Ireland. Medical Problems of Performing Artists, 15(4), 155-160.
Tsai, P. L., Huang, Y. T., & Hsieh, H. T. (2007). Music students’ playing-related health problems. Journal of Taiwan Occupational Therapy Research and Practice, 3(2), 118-127.
Wagner, C. H. (1988). The pianist's hand: anthropometry and biomechanics. Ergonomics, 31(1), 97-131.
Wolf, F. G., Keane, M. S., Brandt, K. D., & Hillberry, B. M. (1993). An investigation of finger joint and tendon forces in experienced pianists. Medical Problems of Performing Artists, 8(3), 84-95.
Wristen, B. G. (2000). Avoiding piano-related injury: a proposed theoretical procedure for biomechanical analysis of piano techniques. Medical Problems of Performing Artists, 15, 55-64.
Wristen, B. G., Jung, M. C., Wismer, A. K. G., & Hallbeck, M. S. (2006). Assessment of muscle activity and joint angles in small-handed pianists: a pilot study on the 7/8-sized keyboard versus the full-sized keyboard. Medical Problems of Performing Artists, 21(1), 3-9.
Zaza, C. (1998). Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. Canadian Medical Association Journal, 158(8), 1019-1025.
Zaza, C., & Farewell, V. T. (1997). Musicians' playing-related musculoskeletal disorders: An examination of risk factors. American Journal of Industrial Medicine, 32(3), 292-300.