“This place is essential,” says longtime Performing Arts Clinic patient and violinist Judith Eissenberg, who brought her instrument to a recent appointment.

In 2008, violinist Judith Eissenberg received an invitation to perform Quartet for the End of Time, a piece whose haunting title evokes the conditions in which it was composed and premiered — in a Nazi prison camp during World War II, by French composer Olivier Messiaen while he was imprisoned there.

“It is the most fabulous piece, almost an hour long,” said Eissenberg, a chamber musician for more than 40 years and a professor of music at Boston Conservatory at Berklee.

Soon after rehearsals began, Eissenberg started to experience pain, numbness and tingling in her left arm. She pushed through the discomfort for the first concert, but during the next performance realized the issue was more serious than she had thought.

“I remember during the second concert seeing my bow do this really weird thing and my finger was sticking up in the air and shaking,” she said.

Eissenberg saw a sports medicine doctor and tried conventional physical therapy but did not see much improvement. A fellow musician referred her to neurologist Michael Charness, MD, founding director of the Brigham’s Performing Arts Clinic.

Established nearly 35 years ago, the clinic provides highly specialized care for musicians with performance-related injuries and disorders. The multidisciplinary team sees injuries including overuse injuries, musculoskeletal problems, such as tendinitis, hand, neck and other body pain, and neurological problems, including ulnar nerve entrapment, carpal tunnel syndrome, as well as movement disorders including tremors and focal dystonia (involuntary muscle spasms).

Surgery isn’t always required, but it can be beneficial for some patients. The clinic collaborates with the Hand and Upper Extremity Service in the Department of Orthopaedic Surgery for surgical treatments.

“Studies have suggested the overwhelming majority of symphony players will have an injury at some point in their careers,” Charness said. “The mechanics of their instrument may be contributing to their injury, so we can make modifications. We can sometimes help them by simply changing their time management and encouraging a break from practice every 20 to 25 minutes.”

Personalized Care That Strikes a Chord

Upon seeing Eissenberg for the first time in late 2008, Charness immediately recognized the source of her discomfort — in more ways than one. She had an ulnar nerve entrapment, a condition that occurs when a nerve that runs along the forearm becomes pinched, often due to repetitive movement. It is sometimes corrected with surgery to release the nerve, a procedure Eissenberg ultimately underwent at the Brigham in December 2008.

Part of the reason his patient’s symptoms were so familiar to Charness is that he is a musician himself, a pianist, who had suffered from ulnar nerve entrapment when he was a postdoctoral fellow at the University of California, San Francisco (UCSF) and played in a musical trio.

“I was fortunate the violinist in my trio at the time was a neurosurgeon who said, ‘I think you have an ulnar nerve entrapment. Let me fix it,’” Charness recalled.

Neurologist Michael Charness, the clinic’s founding director, is also a pianist.

That encounter shaped the course of his career.

After he healed from surgery, Charness started seeing musicians in the back of his UCSF lab who had their own hand and arm problems. The program became known as the Health Program for Performing Artists at UCSF. When he came to Boston in 1989, he started the clinic at Brigham and Women’s. Since then, the clinical team has grown to include Performing Arts rehabilitation specialists, including occupational therapist Kelly Belinsky, MS, OTR/L and physical therapist Joanne Bosch, MSPT, CHT, as well as neurologist Christopher Stephen, MD, FRCP, SM, physiatrist and hand specialist Scott Homer, MD and psychiatrist Samata Sharma, MD. The team’s three physicians are musicians, as well.

“It helps a lot to understand the precise nature of musicians’ movements, the postures they have to be in and the stresses they deal with,” said Stephen, also a pianist. “But with the incredibly complicated and dexterous things musicians can play come a lot of potential problems.”

The team’s vast personal and professional experience in performance-related injuries has given them a keen understanding of how best to care for this patient population and what matters most, Homer added.

“The act of jumping from provider to provider, looking for a reliable assessment, can be stressful and delay recovery — adding to the musician’s woes at a potentially high-pressure time in their careers,” he said.

‘Absolutely Essential’

For Eissenberg, getting back to performing after surgery wasn’t an easy feat, but it was one she was prepared to take on. She started practicing again for just one minute at a time, three times per day, and gradually built up her endurance for her next performance in March 2009. Charness assured her that while she wouldn’t be able play the whole concert during practice, she would make it through entire pieces.

“It was a prestigious concert, all Beethoven,” she said. “I got up there in March and we played it.”

Since then, Eissenberg has regularly returned to the Performing Arts Clinic to maintain her function and proactively address potential issues. It’s a message she passes onto her students at the Boston Conservatory, even referring some who report hand and arm pain.

“I just sent one of them to the clinic. He also started out with a sports doctor, but this is a different kind of sport,” Eissenberg said.

Just like athletes need specialized care, Eissenberg said musicians need the Performing Arts Clinic.

“This place is essential — absolutely essential,” she said. “I have my life back.”

Currently, the Performing Arts Clinic sees patients on Saturdays. The team hopes to add more providers to increase access and further research surrounding musician injuries.

“People are coming to us and saying, ‘How can I not lose my livelihood, my love of music, my love of playing?’” Charness said. “That really resonates with us.”