Fingers curling or extending without control? Execution failure, computation mix-ups, intention blanks I have met

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Direct answer: Finger curling, sticking, or loss of control in fast passages while playing are among the hand symptoms of musician’s dystonia listed by the DMRF—but fingers that will not stay under control can have other causes, and diagnosis requires a clinician to examine you and rule out similar conditions (DMRF; NINDS). In my case, fingers extending or locking hard without control mainly came from two problems I call “execution failure” and “computation mix-up”; a third, “intention blank,” I have only met twice, both on stage. These three names are from my own model, not medical terms.

Medical information in this article is sourced; the “Author’s experience” sections are my personal experience and understanding, not medical advice, and cannot replace a doctor’s diagnosis.

What is musician’s focal dystonia

Musician’s focal dystonia is a task-specific loss of voluntary motor control that appears in highly trained movements such as playing an instrument (Altenmüller & Jabusch, 2010). The DMRF describes it as a neurological disorder whose symptoms usually show up when playing an instrument and generally do not affect other activities (DMRF). NINDS classifies “musician’s dystonia” as a task-specific dystonia—one that appears only during certain repetitive movements (NINDS).

Experts estimate that about 1% of professional musicians are affected (DMRF). A research review notes that its pathophysiology is still not clear (Altenmüller & Jabusch, 2010); MedlinePlus notes that researchers think dystonia may involve parts of the brain that process muscle-contraction signals, and that there is currently no cure (MedlinePlus).

How medical sources describe these symptoms

Hand symptoms of musician’s dystonia listed by the DMRF include slight loss of control in fast passages, lack of precision, finger curling, fingers “sticking” to keys, involuntary flexion of a string player’s thumb, and tremor; these symptoms are usually painless, generally appear only when playing, and do not affect other activities (DMRF). NINDS also notes, for example, that a musician may have dystonia when playing piano with one hand but not when typing with the same hand; early symptoms may only be obvious when stressed or tired (NINDS).

Separately, a review by Altenmüller and colleagues lists “choking under pressure”—performance-related motor errors tied to anxiety—as a different class of motor problem from musician’s dystonia (Altenmüller et al., 2015). Which category my “intention blank” belongs to, I cannot say without a clinical assessment.

Author’s experience: three problems I have met

Up front: can I still play?

Online writing about dystonia is almost all medical terminology. For someone who plays, the core question is one sentence: can I still play?

What follows are three problems on my own hands—not a diagnosis. Execution failure and computation mix-up appear as soon as I pick up the guitar; intention blank I have only met twice. The terms come from a five-step model I put together: intention (what sound you want), computation (deciding position and how to apply force), execution (the muscles that should fire do fire; the ones that should not stay relaxed), calibration (comparing result with target), and memory (turning the result into habit). For more detail, see A 5-step breakdown of guitarist dystonia.

Execution failure: gas and brake at once

When you play, the fingers that should move move, and the ones that should not are supposed to stay relaxed. In my model, execution is “power on” and “power off”: press the gas to fire the muscles that should work, and press the brake to shut off the ones that should not.

Execution failure is when the relax step fails. Other muscles do not shut off; to finish the movement, still more muscles are recruited to help, and compensation appears. One side needs to move, the other will not let go, and the muscle group locks. Fingers follow old wrong habits and involuntarily extend or lock hard, and playing cannot continue.

This is my main problem. In my case, once I find a mechanically more correct position without compensation, the spasm eases; that is a personal observation, not a treatment method. My view of compensation is that it is not protection—it is a reminder; see Compensation is a reminder, not protection.

Computation mix-up: the car computer is broken

The second problem is like a car’s computer is broken. You only need 30% throttle, but the output is always wide open; you want half a turn of the wheel, but the torque goes past a full turn. Positioning is also misread.

On the guitar, that shows up as loss of control over fretting pressure and fine movements. This problem often mixes with the locking of execution failure, and it is hard to tell which one it is by feel alone.

When I was relearning, I did a long stretch of slow practice, but for me slow practice itself did not fix this “algorithm.” A wrong movement done slowly is still wrong. What I think has to be recalibrated is what counts as correct and what counts as wrong; see Why slow practice alone is not enough.

Intention blank: the brain knows, the hand does not know the first note

The third problem I have only met twice—both on stage, and both times the in-ear monitors had a problem.

That passage was one I wrote myself; I had recorded, rehearsed, and performed it many times. My brain clearly knew what to play, my eyes were on the fretboard, but my hand did not know how to put the first note down. It was not that the fingers could not move, and not a lock—the passage suddenly went blank. It never happened in ordinary practice.

I personally suspect it had to do with the performance setting plus not being able to hear clearly. But I only have two experiences, so I cannot treat that as a general rule. If you have met something similar, feel free to leave a comment and tell me.

The three problems often mix together

These three problems have no fixed order, and they are not three stages. I often cannot tell myself whether a given moment is a lock or a wrong force calculation. When I debug, I try vision, hearing, spatial positioning, and touch one by one, to see which change makes the problem ease, then judge which layer it mainly sits on.

How my hand got here step by step is in How a pinky problem became dystonia, which also includes my 8-year review video.

Related video

This video is about the “intention blank” I met on stage. The video title uses my own wording; for medical information, please rely on the text above and the sources.

Bilibili version (for readers in mainland China): On-stage fingers suddenly “intention blank”? On a condition that has crushed countless professional musicians

Author’s channels: YouTube（@kwokyinchoi7380）｜Bilibili（yooyoyoyoy）

When to see a neurologist

The DMRF notes that a neurologist trained in movement disorders (a movement disorder specialist) is usually the most appropriate clinician to diagnose and treat musician’s hand dystonia (DMRF). Diagnosis is generally based on physical and neurological examination, personal and family history, and tests that rule out similar conditions (NINDS).

Before the visit, I suggest preparing these points:

  • videos of playing when symptoms appear, and videos of the same hand doing other everyday actions;
  • whether symptoms appear only when playing, or also in daily life;
  • whether symptoms are clearer when you are stressed or tired—NINDS notes that early symptoms may only be obvious then (NINDS);
  • whether anyone in the family has dystonia, because clinicians use personal and family history (NINDS).

My suggestion: do not fear seeking care, and do not rush into anxiety. If you are just curious, start by filming yourself and looking at your movement. If you suspect a hand problem, get it checked; if daily life is already affected, stop hunting online—book an appointment and bring your own videos and notes to ask a doctor or therapist.

FAQ

If fingers extend or curl while playing, is it always dystonia?

Not necessarily. Finger curling is one of the hand symptoms of musician’s dystonia (DMRF), but diagnosis requires a clinician to examine you and rule out similar conditions (NINDS). I am not qualified to judge for anyone else; this is only my own situation—please see a neurologist for assessment.

Is intention blank just stage fright?

I cannot be sure. A research review lists anxiety-related motor errors during performance as a different class of problem from musician’s dystonia (Altenmüller et al., 2015), but the two times I met it were both on stage with in-ear monitor problems, it never appeared in ordinary practice, and it was never clinically assessed. I can only say I personally suspect the performance setting plus not hearing clearly.

How do I tell execution failure from computation mix-up?

On me the two often mix. In my model, execution failure is unused muscles that will not shut off and a whole group locking; computation mix-up is wrong ratios of force and amplitude. That is my own classification, not a medical one.

Sources

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