Pain in Center of Palm and Pinky?

March 4, 2011 at 08:40 PM ·

Hi Everyone

I have had a question asked of me at my blog, and I'm afraid I don't have the answer. I recommended that this reader post her question here, but I'm going to post, because I want to find an answer as well.

Upon further questioning, Elizabeth experienced some swelling (in the center of her PALM!), and it responded well to ice and a brace. She's under pressure for her freshman juries, she is working on Bach Gminor Fuga and the Vieuxtemps Concerto #5....very athletic pieces, but she's been working on them for 45 days, with no problems. (I'm suspecting the repertoire exceeded her physical conditioning)


She wrote,  "I have not had any problems with pain until just recently when I started getting some cramping in the muscle along the pinky side of my hand. The past two weeks I have been getting small sharp pains in the inside of my hand (palm– right in the middle, like within the size of a golf ball) , and today it went into my wrist (pinky side) and the tendons along the palm side of my hand. The pain was so great that I had to stop, and the whole rest of the day it was aching and splintering. I wrapped it and that helped a bit, but I don’t know what to do now. My posture is fine– my teacher even commends how large, well-positioned, and agile my hands are, so what is wrong?"

I just can't relate to pain in the center of the palm....ANY ADVICE or insight would be appreciated. (I did a search, and it's hard to get specific results)

Thanks everyone...

Lora (Red Desert Violin)

Replies (9)

March 4, 2011 at 11:06 PM ·

 i have a medical insight: go to see a medical doctor.  good luck.

March 5, 2011 at 08:48 AM ·

 Hi-  A  physician is unlikely to be able to help you because he or she may know a fundamental medical fact: muscles DO NOT push and pull; they ONLY contract and release. Physicians know this, but they don't understand the implications of it: You need TWO sets of muscles to perform ordinary operations- one set, for example, to open the hand, and a different set to close the hand. If you activate both sets at the same time, you will have pain. If you really try to stretch the fourth finger, all you are doing is tightening up the muscles in the finger, thus causing them to contract, the very opposite of what you want. A very slight change in the angle of the hand, for example, can eliminate forth finger problems. But you really need some one to show you which muscle systems to use for a given purpose and, especially which NOT to use. I can do that, and have never failed to show a violinist how to play without pain within 30 minutes or so, but if you don't live near New York city, I strongly urge you to take lessons in the Alexander Technique, and if you can, try to find a teacher who knows Alexander Technique and has studied with a Dounis product.  Cordially,  Larry Johnston

March 5, 2011 at 06:24 PM ·

Posture can be fine, and tension within the posture will still cause problems. It is possible that physical condition played a role, but it is more likely that tension sources in the arm and hand that have done some damage after continued work on a few tough passages.  Though most movement is driven by muscles in the arm, the hand and fingers do have tiny muscles.  As I try to re-create tension from the lady's description of pain, I suspect hand muscles that shape the palm may be creating tension - maybe from Bach double stops - its impossible to be precise without seeing and hearing.  The alarming item is the new pain in the tendons. This appears to be a second problem source.  Muscle stress is bad enough, but tendon injuries are in a whole different category.  Severe tendon injury requires months of inactivity to allow healing, and is often followed by months of slow rehabilitation to gently rebuild tendon strength.  This is a very serious new development. Be very careful, at this point.

The young lady needs to work with a teacher who knows a lot about muscle tension and how to reduce it.  It is apparent that her current teacher does not know this subject.  Large metropolitan areas have specialists who work technique with injured violinists.  Professional orchestra members often know who to contact.  And some teachers know how to teach fluid, stress free technique because they have spent the time to figure it out.  The young lady needs to find either one of these teachers or an injury specialist and start to re-work her technique.  She needs hands-on, in the room presence. These kinds of problems cannot be specifically diagnosed or fixed via bulletin boards.

March 5, 2011 at 07:19 PM ·

Mike is right - diagnosis by forum is decidedly not the best way to manage an injury - but it can yet be useful by identifying causes that others within the violin community have experienced.  One additional possibility, not mentioned abvove, is that she has pinched a nerve and developed a small neuroma (nerve ending swelling).  These can be very painful and can be treated by surgery.

But as said, get thee to a hand specialist - one that is familiar with all the tissues (connective, muscular, bone and neural) that might be contributing to this awful problem. 



March 5, 2011 at 07:28 PM ·

Is this young lady in college/conservatory?  If so, they should be set up to evaluate this or refer her to someone who can.  I can't say it too strongly:  hands are very delicate and extremely complicated.  Connective tissue is easy to injure and slow to heal.  If this girl is hoping to major in performance she needs to get checked out by the best hand specialist she can find.

March 5, 2011 at 07:38 PM ·

 to me going to see doctors, even those i know as friends, is a pain in the butt, even if i am not getting a shot there.  i just hate to have others do thing to me:)   since i am healthy, this nightmare is not recurring and is only limited to physicals or an occasional dental filling.

usually much longer wait than i have anticipated, the magazines in the waiting room are usually all beat up and dirty, and then, the person next to you usually cough hideously, the visit is so quick that you don't have a chance to ask all the questions until you realize that going into your car.  darn!

but i remember this.  one time someone asked:  would you trade your left arm for 1 billion dollars? 

i suppose there are people in this world who would take on that offer.  after all, in the black market a kidney can fetch 600k.

but would any serious violinist do that?  i don't know although i doubt it.  may be a big toe, but not the arm!  (assuming if the arm goes, the hand goes with it)

so if someone treasures the upper limb so much, what is stopping the person from spending one hundred dollars as insurance to preserve this precious commodity?

because there is a chance on the internet a free advice can solve the problem just as well and going to the docs is a pain in the butt!?


March 6, 2011 at 01:32 AM ·

 It's very difficult to understand verbal descriptions of the physical motions involved in playing the violin. You need demonstrations for it to be clear and helpful. I have never been unable to show a violinist how to play without pain. This usually takes no more than 30 minutes. My approach (basically a version of Alexander Technique) is so gentle that there is no possibility of injury. The demonstration is free.   Larry Johnston

March 7, 2011 at 04:37 PM ·

Thanks everyone for the VALUABLE insight. I will send Elizabeth the link to this discussion so she can see your responses for herself.

By the way, she is a student at a major conservatory, and after swelling appeared, she scheduled a Dr. appointment. I'll give you all an update when I hear. (because although we shouldn't try to "diagnose by forum" hearing similar experiences from other VIOLINISTS can REALLY be helpful when talking to the doctor)

Also, she was starting to suspect a "ganglion cyst", which can be caused from over-use. 

I'll post an update when I have one.

--Lora (Red Desert Violin)

March 7, 2011 at 08:47 PM ·

Lora- I had a cyst at the base of my left index finger a few years ago and it was incredibly painful.  The good news is that they're easily treated.  If this is what she has, suggest she have it drained.  They prefer to remove them surgically, but I talked my doctor into the less-invasive option.  Worked fine.

Al, if there's anything I've learned over the years, it's to take my own magazine or book.  There's nothing like sitting for 45 minutes in an exam room with nothing to read but a 2004 copy of Road and Track to activate any homocidal/suicidal urges you may have!

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