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Serious left wrist issue

Health: 40+ year violinist with left wrist instability; possible serious damage done to volar radioulnar ligament, which prevents me from 'rotating' my left wrist to play

From Jonna Fitzgerald
Posted August 2, 2010 at 09:02 PM

Need to find a doctor with experience dealing with violinists and left wrist problems.  I've been told my volar radioulnar ligament is 'blown' and needs reconstruction - which would also leave me unable to play.  !!!  Need to find an 'expert' in the field - preferably in Texas.  But will travel wherever I need to in order to save my music career. 

Long story short, I've played for more than 40 years.  More than a year ago, began experiencing pain in my left wrist while playing.  The movement of even lifting the violin and rotating my wrist is VERY painful.  Local hand 'specialist' said there was a TFC tear, so did a debradement.  In subsequent physical therapy, my arm 'popped' one day and everything went downhill.  Another MRI indicated the ligament on of my arm had 'given way' and caused the wrist joint to become unstable.  Apparently the ligament was 'frayed' in the first MRI, but because it is apparently a rare injury, nobody thought to look at that. 

Who is the 'go to' person in the US for wrist injuries on violinists?  I am heartbroken that I've missed a year of playing already, and may not play again.  I've been told a ligament reconstruction (which one doc recommended) would leave me with only 40-50% rotation, and that I'd never play again.  Help!!!!!!!!!!!!!!!!!

From Lisa Fogler
Posted on August 2, 2010 at 09:20 PM

I know a great physical therapist that deals only with musicians. She is awesome and saved my shoulders. She's a published author, her name is Coralie Cousin. Unfortunately, she lives in Paris, France. I live not too far from her. I know it's very far from Texas, but she is a miracle worker.

From Timothy Hobbs
Posted on August 2, 2010 at 10:04 PM


I'm not a doctor.  I'm a runner, so I can't guarantee anything I say here,  but 40-50% mobility doesn't necessarily mean you wouldn't be able to play. It would be hard to find a surgeon willing to do things "wrong", but it may be possible to leave you with the mobility for violin at the expense of "standard" mechanics.


It may be possible for you to go into surgery planning to reattach the ligaments too long.  This would mean your wrist would be permanently twisted. You would then where an orthotic brace during the recovery stage after your surgery and probably for the rest of your life.  But maybe you could still play.


Looking at the wikipedia article for "orthotic" it says the word is derived from greek "ortho", to straiten.  But what you would be wanting, is a brace that would unstraiten...  

From Charles Cook
Posted on August 2, 2010 at 11:40 PM

list of hand surgeons in your area


If you have a physiotherapist ,you can ask them "who would they go to " .They deal with local patients and may have insite into this.



From Bruce Bodden
Posted on August 3, 2010 at 02:42 AM

As a supplemental therapy, I cannot recommend Alexander Technique highly enough.  It doesn't pretend to be a substitute for surgery, but can greatly assist in recovery (and sometimes prevention if you aren't sure you need surgery, but that doesn't sound like your situation).  If your injury is at all related to the way you use your body, AT can help you to avoid repeating the problem and/or making it worse.

Here's a page listing teachers in your state:  www.alexandertech.org/teachers/TX.php  It's probably not complete, it's just the teachers who belong to one of the main professional associations; but it will give  you someplace to start.

I have some idea how scary this can be.  Best wishes,


From John Cadd
Posted on August 3, 2010 at 11:44 AM

If you break a bone (in your leg ) it can be set in the wrong position.Let`s call that a different position.Are there surgeons who can cut the upper arm bone and change the lower arm/ hand angle? That` would just leave you with a minor inconvenience to replace the painful twist.  Technically it has less risks than some cosmetic surgery.  Serious question.

From John Cadd
Posted on August 3, 2010 at 11:53 AM

If you look at the body parts that achieve the twist to reach the violin strings you have to add up the collection starting at the shoulder Teres minor muscle.The elbow is a straight Hinge joint unlike the shoulder Ball joint.The two forearm bones cross over to give some of the twist, controlled by the forearm muscles (look them up).The wrist itself   ( hold it one inch from the joint ) will hardly twist at all.  Check out all that to get it clear in your mind what`s doing the twist.

From John Cadd
Posted on August 3, 2010 at 12:09 PM

There are many u tube videos of surgery on the wrist, forearm and elbow .The bit with the scalpel slicing down the arm is horrendous.

From Valerie Coon
Posted on August 3, 2010 at 07:13 PM

Not sure about this because of potential fraying, but there is also a treatment called "prolotherapy" that might be helpful.  It enabled my Dad to play soccer seriously again after blowing his ACL 15 years before and 3 surgeries later...  I'm not sure I understood exactly what's wrong though, to know if this would help or not...

and I agree with the comment that the wrist doesn't twist much, hence part of my confusion.

Talk with hand therapists!  They specialize in this stuff!

From Jonna Fitzgerald
Posted on August 5, 2010 at 02:48 PM

Thank you for the replies!! I have contacted someone regarding AT, so that will at least get me going in some direction.  Regarding the wrist rotation, my fourth finger is significantly shorter than normal due to a birth defect - so I must rotate and reach much more than most people do.  When I first began playing, my teachers weren't even sure I would ever be able to use the fourth finger.  I believe so much stretching through the years may have contributed significantly to my current problems.

From Michael Toma
Posted on August 5, 2010 at 10:56 PM

I think both a Physiatrist (MD) AND a hand surgeon who deal with sports injuries (at least), if you cannot find a Physiatrist who specializes in problems with playing instruments.  I know, in CT there is a Physiatrist who does this, and he is associated with UCON medical school.  His waiting list, I believe, is about three months.  There are doctors who have no idea what it takes to play the violin, believe me, I've been to one (hand surgeon), and I simply couldn't believe it.  However, you can demonstrate to them on your violin and they can study your movements, so bring your violin with you.


From John Cadd
Posted on August 5, 2010 at 11:14 PM

Jonna    Keeping on the hopeful side of the line,if your 4th finger is so short do a calculation of your reach-ability  (normally ) and compare it with a player with bigger hands.Maybe you could get a cutaway violin or a scaled down size to minimise the struggle.  If you like Yoga exercises the Indian way is sitting crosslegged and holding the violin with the feet. That`s the last resort before learning the wrong way round .

From Jonna Fitzgerald
Posted on August 9, 2010 at 03:52 PM

Interesting you mention a cutaway, as I'm actually commissioned one which is being made now.  Not sure what the tone will be like until it is finished, however.  Will also be making modifications to the neck circumference, and possible the angle of the fingerboard.  Most of my difficulty with the fourth finger is reaching double stops on 3rd and 4th strings.  Have toyed with a 3/4 size instrument, but that really doesn't seem to make a significant difference. 

From Ann Miller
Posted on August 10, 2010 at 04:08 PM


You mentioned much stretching to use your 4th finger over the years may be a contributor.  I am just a hair over 5 feet tall, and I have found this to be true with multiple body parts, doing many normal day-to-day activities, because most of the furniture, cars, and other equipment is designed for bigger people. 

I have switched to a 3/4.  Although I still can't reach to do some double stops, and a can't make a 1st finger to 4th finger stretch, I think the overall smaller size of the instrument has both shoulders, both arms, and my left hand doing much less stretching.  Over time, over many repetitions, that excess stretching with the full size, and even the 7/8 had been bad news. 

You may find that over time, a smaller instrument does relieve some of the strain.

From John Cadd
Posted on August 11, 2010 at 11:26 PM

Jonna and Ann     I did an outrageous modification to a fingerboard on my wooden skeleton practice violin.  I altered the fingerboard at the scroll end,If you look at the bridge it is the normal shape and position.But as you move away from the bridge it twists like a propellor.   I cut the separate lines for each string so they worked normally then blended the shape .The part near the hand on the E string side is much thinner at the scroll end.The G is thicker.It brings the lower chord notes into position . I drew a cutaway violin shape  with the G side full length and the neck curve is going to take some altering as I plan on a short set of strings.with a cutout to give an easy reach to the top of the fingerboard. It works on the skeleton. The main limit is finger thickness right up high.  No twist of the wrist is necessary.  The wrist angle is built in so I have no choice about that.  I have made a number of normal violins so I know the basic rules of plate tuning and volumes.  Tell us about your commission. It may become popular with us wee stunted folk.My name appears in a very old dictionary and it means a " short stumpy thing".  The other entry said " an alehouse loafer ".   Me and Del Gesu.

From Ann Miller
Posted on August 12, 2010 at 04:20 PM

I'd love to see a picture or even a sketch of your design, John. 

From Jonna Fitzgerald
Posted on August 23, 2010 at 08:32 PM

Wow, I'd love to see a sketch or something,too - sounds like a novel idea, John.  Will keep you folk posted on my commissioned instrument.  Am anxiously awaiting its delivery, and will let you know what type tone it has, post pics, etc.  I do plan to have some adjustments made to it once it arrives by a skilled luthier friend, so hopefully that will help a little with the volume and tone issues we are anticipating. 

From Jonna Fitzgerald
Posted on August 23, 2010 at 08:39 PM

Also, some of you may already be aware that Methodist Hospital in Houston has an entire program devoted to medical care for performing artists.  It's called the Center for Performing Arts Medicine.  I was directed to that group by some wonderful people connected to the Houston Symphony.    Will be seeing two surgeons in Houston this week, so am anxious to hear what their diagnosis and treatment protocol will be. 

From John Cadd
Posted on August 23, 2010 at 10:57 PM

Ann and Jonna   I got out of touch for a while.   Let me try to describe my altered outline. It is similar to the viola with the cutout .Is it Rivka Golani plays it ?The outline is Guarneri .First move shifts the end of the neck into the body.  Draw a line one inch inside the main body curve.The neck "bump" sits on top of that.   Left of that ,  the side will curve up to the original outline.      Right of the "bump" it runs level for 1/4 inch then runs down at 45 degrees till it joins the main outline again about an inch above the corner.The chopped off volume is counted up carefully and is blended in with changes in the body depth.I reversed the tilt between back and belly to make the player end shallower.The "deep end "is now near the neck  .The string length is very short but it suits my hand.  A child would find it easy to play.