Any advice for carpal tunnel syndrome?

November 15, 2009 at 11:04 PM ·

Please forgive me for making another post about carpal tunnel syndrome.  I know that there have been other posts, but I am hoping that perhaps someone will speak up with information that I have not heard, as I am starting to feel desperate.

I was recently diagnosed with mild carpal tunnel syndrome and I am grateful that it is only mild, however my doctor informed me (based on a nerve test) that it will probably progress to a severe case in about 5 years.  I am freaked out because I am only just starting to see some success for my career as a violinist, I am going to be starting my MM soon, and now this bad news which might destroy everything I have worked toward for all of my life until this point.  My doctor casually suggested that I give up the violin to prevent further injury.  Clearly by suggesting such an atrocity he does not have any concept of how that would affect me.  The thought of giving up on my beloved violin plunges me into deep depression.  I'm not exaggerating, I cannot bear it.

I have been told that if it gets bad that I could have a surgery done to fix it, but I have spoken with others who have had this surgery and some of their stories are very unsettling.  I have heard that in many cases the surgery has failed, that the space between the pieces of carpal ligament fill with scar tissue and hurt the nerve.  Christopher Payne recommended (in another post on here) a device called Flextend, which I am going to try.  I discussed the flextend gloves with my doctor and he scoffed at the idea, dismissing it as "not medically possible" and "a gimick".  My hope is now very low but I'm going to try the gloves anyway though, because I am willing to do anything.

Does anyone else have any information that could help me save my hands?  I will be grateful for all replies and I apologize once again if this is redundant.  I just really need the help.

Replies (22)

November 15, 2009 at 11:24 PM ·

My advice would be to get a 2nd opinion from a more sympathetic doctor who has documented experience of dealing with musicians suffering such ailments.

November 15, 2009 at 11:26 PM ·

Greetings,

I can`t honestly say I am a big fan of doctors who make such sweeping predictions no matter how cpmpetent.  Be careful that the negative outlok doesn`t drag you to precisely where you don`t wnat to be.   As an aside,  my mothe rlived two years longer than a very good doctor predicted in the late stages of cancer simply because she wa spisse dat him......

 

In the meantime,  if you can afford it get Alexcande rlessons.  With the best possible use of your body such things can be avoided .   Ther reare also otehr aspects like diet and generla exercise to explore.   The future is probably much brighter than you think,

Cheers,

Buri

November 16, 2009 at 06:57 AM ·

 Diet can be a factor. I found this to be an interesting read

http://www.valleyviewemus.com/emu-oil-information-articles/carpaltunnelsyndrome.htm

http://www.handhealthresources.com/repetitive_injuries.htm

http://www.healthbulletin.org/vitamins/vitamins13.htm

there’s  a lot to google

You really need to start analyzing your technique

           Keep fingers close to the finger board

           Keep the wrist straight

          Make sure you are not bending your wrist to the left when playing on E string

              If so then hold the violin more at a 45* angle and keep the 3rd finger                                          stretched over the E string and make sure the 1st finger fingernail is facing you.

      Use your elbow to help move with string crossings, or to lower strings

          Don’t bang the fingers on the finger board, practice in rock guitar mode to

            Help you learn to play with a lighter touch.

              http://www.youtube.com/watch?v=cktCx54EyZ0&feature=related

                                          Exercise lightly the opposite motion– make a fist with your left hand, then with your right place it over fist. Now apply some weight when moving fingers out. You can also put your hand on top of your other hand and do wrist push –ups.

                            Lift 1st and /or 2nd finger when using 4th

                            Loosen the thumb

                                       

These may or may not help or even apply to you, you really need to find someone that can help analyze your technique and correct what you are doing wrong. Not just any teacher, someone with actual experience with this. Keep phoning teachers and asking questions. 

November 16, 2009 at 08:49 AM ·

Please be very very careful about information you pick up on the web, especially medical advice.  Even if it's from a legitimate site it's all too easy to misapply things, misdiagnose, etc.

That said, there are standard exercises recommended on several legitimate sites to stave off carpal tunnel/repetitive strain injuries and I recommend you track them down and try them if you are not already.

 

November 16, 2009 at 01:34 PM ·

 Carpal tunnel seems to be a thing that specifically affects pregnant women who play the violin. It has happened in the orchestra that I play in more than once.  I wonder if any one has studied this. I would add that in most cases this seems to have been overcome. I subscribe to the other respondents views on this.... get more than one opinion.  

November 16, 2009 at 04:05 PM ·

 I found this site to be helfull ,the vidoes really aid in the understanding of carpal tunnel.

http://www.associatedcontent.com/article/29995/carpal_tunnel_

syndrome_causes_and_treatments.html?cat=5

 

There is some truths out there, and it may be labeled as pseudoscience, take it as so, it may or may not work.Use some common sense.

It doesn't sound like your doctor has a great success  rate if he's getting a lot  patiences coming back 5 years latter for surgery. You may wan't to see a specialist 

BTW These topics (RSI)  need to be discussed more ,not less in this forum.

November 16, 2009 at 05:03 PM ·

 >My doctor casually suggested that I give up the violin to prevent further injury. 

Oh, GRRRRR. 

You might casually suggest to your doctor, in return, that he cut out his tongue to prevent further injury to both his patients who have to live with his suggestions, and to his own physical welfare, for having offered such ridiculous, oblivious suggestions in the first place. 

Snarkiness aside, you have my sympathies and I'm wishing you good luck in a positive turnout for this all.

November 16, 2009 at 06:26 PM ·

I was told by one doctor that my back was bad, was causing my leg problems, and I would sooner or later need surgery.  This after specific treatment for my back didn't do one thing for my leg.

Turns out, it wasn't my back at all, and every other doctor who saw the same data said it wasn't my back.

Please treat yourself to a second, competent, opinion

November 16, 2009 at 07:20 PM ·

 While it may not be possible for Flextend to cure your carpal tunnel syndrome permanently, it may alleviate the symptoms and stop things from getting worse. It's probably best as a preventative measure for those that don't have it anyway. Have a chat with the people at Flextend, they are very knowledgeable and helpful.  They have a 30 day money back guarantee too.  www.flextend.com

I would also say to anyone with or without CTS to watch out for the computer mouse and keyboard and use a pen and tablet rather than a mouse. Take frequent breaks and stretch your fingers at regular intervals.

I was diagnosed with severe CTS but have been able to function as a working violinist doing 3 hour gigs on a regular basis without much problem at all.  I also compose a lot at the computer and manage just fine with the pen and tablet. Flextend hasn't made my CTS go away but it does keep me functional and is a great hand exercise for violinists with or without CTS. Basically exercising the opposite muscle group to the one you are using intensively is always a good idea. I was also recommended vitamin B6 to promote nerve growth and Ibuprofen to alleviate symptoms. I was however advised against having surgery as things can go wrong and results are not always permanent anyway, not to mention recovery time.

 

 

 

November 16, 2009 at 10:25 PM ·

Michael,

Ask your violin. It will probably tell you to give up your doctor.

Seriously, there are doctors who specialize in musicians' injuries. If you can, consult such a doctor.

Bart

November 16, 2009 at 11:48 PM ·

Michael,

I'm not a doctor, but I (along with many on this site I assume) have had recurrent episodes of carpel tunnel syndrome. How many hours a day do you practice?  Do you usually practice in multiple sessions or one long session? When did your symptoms start to appear? And, roughly, how old are you (20's, 30's, etc)?

November 16, 2009 at 11:57 PM ·

Do you work with a computer a lot?  I wear a wrist brace on my mouse hand...couldn't hurt for you to do the same :-) Little things add up, so I suggest paying close attention to how you do little things, like support yourself on counters, opening jars, pouring water, etc.  

November 17, 2009 at 01:31 AM ·

My mom had the surgery when I was a kid, one hand at a time. Other than a nasty looking scar things are completely fine... Though I might not suggest getting your current doctor to perform one...

November 17, 2009 at 01:35 AM ·

Greetngs,

what Johnathon says about paying attention is one of the reasons why Alexander Technique is incredibly successful in helping with/curing both tendonitis and other wrist problems.  One not only learns about use of the body inter alia but one is taught to make cnsious decisions about how we interact with our environment.  One of my teachers called these `choice moments.` For example,  how do you hold your body while cutting vegetable?   Do you walk into your house holding a shopping bag and reach across your body with the opposte arm to flcik the light switch ? etc.

One of the most crucial moments in a violin lesson is walking to the case and opening it.   Our emotional (read physicval/mental) involvment in this seeming unimportnat sequence is enormous.  It is completely different from walking across the room and turning on the TV.   I have often watch people actually stop breathing whle doing the former;)!!!!!!   How does one use the body while bending to open the case.  Frankly,  horribly!   Already we have set the scene for a less than joyful practice/performance session.

Incidentally,  over the last 7 years I have written the same commetary about how putting the violin up incorrectly (using the wrong side of the arm as fulcrum when rotating)  is a major cause of tendonitis (will try and find the old writing....).    I learnt this one from William Conable.  It is well worth visiting the Conable website to further explore the Alexander world.

Cheers,

Buri

November 17, 2009 at 02:55 AM ·

I have problems with CTS/RSI in my left wrist from long sessions in front of a computer.  Someone turned me on to B-Complex supplements and they have helped immensely. 

November 17, 2009 at 04:14 AM ·

I'm very touched by the kind words from you all.  To answer John's question I'm 26 and the symptoms only started very recently.  Pregnancy was mentioned on here as well but I'm male so uh...definitely not an issue there.  I practice about 5 hours each day but I take breaks after each hour so I don't overdo it.  The thing about my symptoms that doesn't seem consistent with what my doctor said is that playing the violin doesn't cause them to be more severe.  My doctor seemed very eager to blame my violin playing but I suspect that there are other things which may have contributed (years of waiting tables, computer programming etc.)

I've addressed my violin playing like this: I analyze everything I do now and make sure that there is absolutely no unnecessary hand movement or pressure.  My fingers have been touching the strings only has much as is truly necessary and are staying nice and close to the string.  In this manner I haven't felt any strain in my hand since Thursday.  My teacher is on the lookout for technical problems as well.  My left hand does feel tingly from time to time but I don't feel that I'm aggravating it with my strict relaxation-centered style of practicing.

It seems to me that if I can play in a relaxed manner with good technique that I should be relatively safe from the gloom and doom this neurologist has predicted right?  I have a competition coming up and I just had a very good practice session in which I was able to comfortably practice the first mvt of Tchaikovsky without having pain and with my hand feeling relaxed so I am feeling better. 

Also Mr. Payne thank you very much for your mention of flextend.  My pair of gloves arrived yesterday and my hands feel fine doing the exercise.  For now, symptoms are not getting in the way of my playing so I am going to do what I can to keep it this way.  If I can just prevent it from getting worse then I believe my playing will be fine in the long term, even if it never goes away completely.

Mr. Brivati I have been reading your blog and you indeed have a lot of very valuable information.  Thank you.

November 17, 2009 at 04:44 AM ·

Hi Michael,

I'm glad you're being proactive and not giving in to some specialist's prognosis. Please take Buri's advice to heart.  You need to consult experts who can optimize the way you use your body when you play and in daily life (especially if you don't have a violin teacher who can help you in this capacity).  You need to consult health care professionals who take a holistic approach to diagnosing your condition.  The Western medical establishment is better at dealing with trauma than chronic conditions.  They like to fix symptoms rather than reversing the root cause of your condition.
 
I know a violinist whose CTS surgery left him unable to feel with his fingertips, and therefore unable to play.  I think his diagnosis was similar to yours, progressive numbness in the fingers of both hands.  He'd received advice from a physical therapist to look at other less radical therapies, but in the end he chose to have surgery on the worse hand.  Later he discovered that the numbness was caused by degenerative spine disease and had to undergo more dangerous surgery.  With therapy he eventually recovered full use of the hand that didn't receive CTS surgery, but sadly never recovered full use of the hand with surgery. He still requires therapy simply to keep his bad hand from curling and seizing.
 
I wonder if excess pressures pregnancy places on the spine and neck has anything to do with increased occurrences of 'CTS'.  How do you hold your upper back, neck, head?  Does your playing position resemble v.com's logo in any way? Do you wrap your neck around the fiddle? Is there any twisting in your spine as you play while sitting - while standing?  I.e. is the axis of your shoulders parallel to the axis of your hips?  Do you push either shoulder forward excessively?  Is there anything you do with your shoulder/upper arm that might cause some pinching of some nerve somewhere?  I'm no medical specialist but it seems there are a lot of avenues that can be explored before resorting to quitting or surgery.
 
Best wishes,
JK
 

November 17, 2009 at 10:10 PM ·

Michael--I suggest you check out an Alexander teacher. I see there are a couple of teachers in Boulder (including James Brody at the College of Music) at www.ati-net.com, as well as Melissa Malde who teaches voice in Greeley at UNC. And there are workshops by the Barbara Conable group--check out www.bodymap.org for workshops. They also have a video on the right side of the website that has a few short excerpts from a DVD that you will probably find very interesting. I just got the DVD, but haven't had time to sit down with it yet. We attended a short workshop with Barbara a few years back, and she had some amazing results with the participants in just 15-20 minutes.

November 17, 2009 at 10:38 PM ·

Thank you all very much.  I will follow your advice and look into the Alexander technique.

November 18, 2009 at 12:00 AM ·

I have not read the other threads so sorry if someone already said this.  You have to ruthlessly look at what you do with your hands every day.  Is your computer keyboard one inch higher than it needs to be?  Even a tiny amount of tension in your arms repeated over time is going to give you a problem.  What if anything do you do that raises your forearms up? 

I say this because my mom has problems with this but every time I go to her house she always has the computer keyboard on a counter, which is way too high.  My hands hurt after less than one hour using it in that position.  So I always have to put it on my lap. 

November 18, 2009 at 12:35 AM ·

Bonny has made some very good suggestions. I type using the keyboard on my lap, and the mouse not very far from it, I pretty much let my arms drop down, do not have to keep them raised. I also raise the monitor as high as possible so that I am not looking down at all.

Michael, might I suggest a few things?

1) 5 hours of violin practice IS alot of time, is it possible you could reduce your practice time down to 3? Or better yet - Split your time up much better. Practice an hour or two in the morning before any activities, if possible an hour or two midday (If not then practice at night time)

My routine largely follows, I get up at 7am. Practice for an hour, get ready for work. Come up, relax then I practice from 7pm till either 9 or 10pm

2) It is my firm belief that any form of pain is due to a muscle weakness, by using some light/medium exercise; I am certain you can prevent any issues. I do atleast 15 ~20 pushups (I upped it up a bit :P) before playing violin, I find it gets my shoulders and elbows warmed up and the juices flowing.

3) Aswell as exercise - STRETCH. STRETCH. STRETCH!!! This is so important, without stretching I would just be a pile of nerves twitching voilently as I wonder where did I go wrong. There are soo many stretchs, as well as visiting an AT, please visit a Physio and learn stretchs from them, they will possible help you loosen up to begin with

You could possibly research into Muscle Memory (OR was it memory muscle LOL) anyhow - the point is, you do not need to over-do practice in certain areas, but rather learn to practice efficiently. I do not doubt your practicing abilities, but 5 hours IS alot of time to practice something - if you find yourself doing something without even thinking about it, perhaps its time to move onto something else to practice/refine.

 

Just some thoughts.

November 18, 2009 at 05:39 PM ·

At 76 years of age I have generated the problem probably by to much time spent on computer keyboards over the years, much more after I retired 12 years ago.  It is caused by too much use of the wrist or stress on the wrist joint which causes physical damage which it would be nice to heal.  Don't know if there is a way.  Some have used cortisone shots but that is a stop gap not a solution.

I use a velcro medical strap about 2 inches wide over my wrist joint when using the computer.  I believe this has really helped me but at my age don't expect to ever completely heal.  So far not used much with the violin.  There is also a wrist medical device about 5 inches long that will keep your wrist from bending while trying to rest it or get it to heal.  I found mine at Walmart but any decent pharmacy should have such things or be able to get them. 

Carpal is not a fun thing and like damaged knee cartilage may be something that you do the best you can with and get what treatment that is available and that cuts down further damage and maybe does some healing.  Good Luck  Don

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