A violist with asymmetrical Raynaud’s phenomenon

We present a case study of a 21-year-old, right-handed violist (viola player) who is a smoker and does not have any other relevant medical conditions. The patient was examined because of pain, oedema and asymmetrical purplish discoloration in the right hand, which is consistent with RP. The onset of symptoms occurred during a period of increased work activity, when the right hand was exposed to excessive vibration. The aetiological study was negative: autoimmune (RF, CCP, ANA, anti-C1q, Sm, U1 RNP, SSA, SSB, ANCA PR3 and MPO, APL); cryoglobulins negative; parameters of acute inflammation without alterations (ESR, CRP and amyloid A). Angio-CT of the right limb was normal. Capillaroscopy (Fig. 1) revealed the presence of microhaemorrhages and microaneurysms in the right hand. Hand–arm vibration syndrome arises from heightened vasospasm in the digital capillaries and represents a secondary form of RP [1, 2]. The development of this syndrome is dependent on the intensity, duration and frequency of vibration exposure. Although there have been three reported cases of hand–arm vibration syndrome among stringed instrument players, specifically two cases in guitarists and one case in a bass player, there are no documented cases of hand–arm vibration syndrome resulting from vibrations transmitted through the bow of the viola. Capillaroscopy. Second finger of the right hand (R2) with greater expression of microhaemorrhage; second finger of the left hand (L2) with asymmetrical ectasias Relevant data are presented within the manuscript. No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Disclosure statement: The authors have declared no conflicts of interest.