The present study examined the effects of psychological stress on performance quality, autonomic responses, and upper extremity muscle activity in skilled pianists through comparisons between stressful (competition) and nonstressful (rehearsal) conditions. We observed increased levels of subjective anxiety, autonomic arousal, and electromyographic activity in the competition condition, which could contribute to the impairment of performance quality. The results provide important practical implications for enhancing performance quality as well as preventing playing-related musculoskeletal disorders in musicians.