This scoping review aims to explore risk factors related to piano technique that contribute to the onset of playing-related musculoskeletal disorders (PRMDs) and focal dystonia in pianists, providing a comprehensive synthesis of the current evidence. A scoping review was conducted using the PubMed database in September–October 2024. Eligible studies included professional pianists or students and investigated technical, ergonomic, demographic, or psychological risk factors associated with PRMDs or focal dystonia. Both qualitative and quantitative peer-reviewed studies were considered. Screening was performed in double-blind, and data were extracted regarding practice habits, symptoms, anatomical areas affected, and hypothesized risk factors. Seventeen studies met inclusion criteria. Key risk factors for PRMDs included small hand size, repetitive motion, extended practice sessions without adequate rest, and suboptimal ergonomic setups. The most affected anatomical regions were the wrists, shoulders, neck, and back. Psychological stress and performance anxiety were frequently associated with physical symptoms. For focal dystonia, repetitive technical exercises, poor neuromuscular recovery, early specialization, and stress were identified as critical contributors. Lack of awareness and education on injury prevention was a consistent theme, particularly among students. The review highlights the multifactorial etiology of PRMDs and focal dystonia in pianists. Effective prevention requires ergonomic adjustments, structured practice routines, repertoire adaptation, and health education. Piano pedagogy should integrate physical and psychological strategies to support long-term performance health. Standardized definitions and longitudinal research are needed to improve understanding and guide evidence-based interventions. Int J Occup Med Environ Health. 2026;39(3)