Wittgenstein gave the premiere with Robert Heger and the Vienna Symphony Orchestra on 5 January 1932. Before writing the concerto, Ravel enthusiastically studied the left-hand études of Camille Saint-Saëns. The first French pianist to perform the work was Jacques Février, chosen by the composer himself.
Ravel is quoted in one source as saying that piece is in only one movement and in another as saying the piece is divided into two movements linked together. According to Marie-Noëlle Masson, the piece has a tripartite structure: Slow-Fast-Slow, instead of the usual Fast-Slow-Fast. Whatever the internal structure may be, the 18-19 minute piece negotiates several sections in various tempi and keys without pause. Towards the end of the piece, some of the music of the early slow sections is overlaid with the faster music, so that two tempi occur simultaneously.
The concerto begins with the double basses softly arpeggiating an ambiguous harmony (E-A-D-G) being the background to an unusual solo of the contrabassoon. Although these notes are later given great structural weight, they are also the four open strings on the double bass, creating the illusion at the start that the orchestra is still tuning up. As is traditional in a concerto, the thematic material is presented first in the orchestra and then echoed by the piano. Not so traditional is the dramatic piano cadenza which first introduces the soloist and prefigures the piano's statement of the opening material. This material includes both an A and a B theme, though the B theme receives little exposure. An additional theme introduced at the beginning exhibits several similarities to the Dies Irae chant.
An excerpt from the faster section, sometimes referenced as the scherzo, is shown in the example. Throughout the piece, Ravel creates ambiguity between triple and duple rhythms. This example highlights one of the more notable instances of this.