Index Finger Pain

Edited: October 13, 2019, 6:56 AM · It appeared suddenly, a sharp pain in the last joint of the index finger, one evening after a 3 hour practice session, and has been an issue for me for over 5 months now.

I tried abstaining from the violin for a couple of weeks, taking vitamin c and zinc, massaging the finger with aloe.
I changed my technique: I press as little as possible (this actually improved my vibrato), and use the base joint of my fingers more (so that the last join of the index finger doesn't need to bend that much).

I had an ultrasound and a MRI (both showed nothing significant), and also did 2 weeks of physical therapy (TENS, ultrasound, laser).
The conclusion of the doctor (orthopedic surgeon) and physical therapist was that it was just due to overuse.
Overall I can't say they showed much interest or had much experience in this thing, and understandably so; if it weren't for my violin playing I'd probably just shrug it off and accept the pain.

So, I need some advice from musicians, people who need their fingers to work smoothly and pain-free.

The only thing I've been able to find online is the following research paper:
Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/

The conclusion is that eccentric exercises, and use of nitroglycerin patches, can help heal the tendon.

Does anyone have personal experience with such a condition? What should I focus on, what can I expect?

-Thanks

Replies (13)

October 13, 2019, 7:05 AM · I think a pain in the joint is unlikely to be a tendonitis. The scans should rule out a bone spur or arthritis - so it is a mystery. Only thing I can think of that would not be visible by a scan is a neuroma - a cluster growth of one of your small nerves. These can be caused by trauma to the nerve and tend to clear up on their own.

If the problem persists you may have to visit a tertiary medical centre, best to find a doc who is also a musician!

[Disclaimer: not an MD, but with some experience.]

October 13, 2019, 7:29 AM · Hi,

This is unfortunate... A quick question: you mention pain in your left index but not the exact location - is it the overall finger, a specific joint, or the fingertip?

There are some natural things you can do, but it does depend on where the pain is in the finger.

Cheers!

Edited: October 13, 2019, 7:49 AM · Hi Christian. It's mainly in the location of the last joint, but also radiates along the length of the finger, i.e. along the tendon.

Dear Elise, a doctor or at least a physical therapist that has worked specifically with musicians is an excellent idea, unfortunately it seems it's not an option in my country.

October 13, 2019, 8:00 AM · Hi Ray,

Thank you for the feedback. For joint pain, the quickest natural way that I know of is to soak the hand, or just the finger, in hot water with Epsom Salts for about ten minutes at night, then apply peanut oil and keep the hand warm. Helps the body to drain inflammation, increase circulation and lubricate the joint. Often helps in as little as 3-4 days, if done daily.

If it is caused by the development of some kind of scar tissue due to injury, you can use castor oil in conjunction with or instead of peanut oil depending on the situation, as it is known to soften or even help the body dissolve scar tissue. However, should that be the case, it will take a longer period of consistent application.

Hope this helps... Best of luck!

Cheers!

October 13, 2019, 8:54 AM · "Dear Elise, a doctor or at least a physical therapist that has worked specifically with musicians is an excellent idea, unfortunately it seems it's not an option in my country" Not quite what I said ;) perhaps a language blip; I said a doctor that IS a musician.

Many doctors are musicians and if they are they will be much more sympathetic to your problem. My boss at Hopkins (head of Neuromuscular diseases, Neurology) was a clarinetist and when I was there musicians routinely came to him with their muscle issues (for example Leon Fleischer). You would need a good network to find one though...

October 29, 2019, 12:09 PM · Try reading up about Kyung Wha Chung, who had to interrupt her stellar career for five years after cortisone injections in her index ruined the tissues. her index is frequently bent back due to her tiny hands.
October 29, 2019, 12:33 PM · Another thought: do you have a professional orchestra nearby? How bout contacting them and see if they can recommend a physician?
Edited: October 29, 2019, 6:19 PM · I hesitate to suggest any medical advice or treatment, I am no doctor and cannot diagnose your finger issue. I can only offer what worked for me for arthritis induced pain in the index finger (from am old injury), which was the use of a squeeze ball (wax ball to be specific) throughout the day. For any other type of tendon inflamation (tendonitis in all its forms), I also find helpful to do gentle stretch of the tendons. Sometimes it works miracles. I recently developed such inflammation in both my heals, which have been painful since last Aug. Did the usual rest/ice treatment to little improvement. Last week I ended up stretching the right tendons while doing yoga (it was painful though) and the pain was gone 90% less than 2 days after! Best it has been in 2 months. Whatever you do, best to discuss first with a qualified practician/physio therapist however.
Edited: October 29, 2019, 11:53 PM · The usual caveat: see a specialist MD or physical therapist sympathetic to musicians, not us (incl. me) amateurs.
Arthritis is a symptom of something--- it is a greek word meaning inflammation of the joints; some combination of pain, swelling, heat. A Rheumatology textbook will have about 70 varieties of diagnoses. Take a look at the angle that the last digit of that finger makes to the fingerboard, it should be about 30 o from vertical. And consider the mechanics of your vibrato; don't move so sharp that that last digit goes past 90 o vertical. Maybe you are using the so-called finger vibrato? The advantage of the arm-vibrato is that it uses the large muscles of the arm to power the vibrato, the finger pivots passively. Also be sure that you are not trying to move that joint sideways, it only moves lengthwise. Beware of any drug therapy that only reduces the symptom without dealing with the cause. --JQ, (as a retired Med. Tech., I only know enough to be dangerous.)
October 30, 2019, 12:11 AM · The first three questions I would ask are

How old are you?
How many years have you been playing?
What music are you playing and what were you playing when this injury first appeared?

November 1, 2019, 5:41 PM · I'm not a doctor, but the "3 hour practice session" is worrying - were you practising for 3 hours without taking significant breaks?
Edited: November 2, 2019, 2:45 PM · @joel: I basically use wrist vibrato, I haven't been able to do a purely arm vibrato without stiffing up my wrist. Even without vibrato I have an issue with e.g. natural F on the E string.

@Adrian: That's scary. I had just recently found this Tchaikovsky of hers: https://www.youtube.com/watch?v=-Jtzq55kcQI
I have read that cortisone shots can weaken the tendon.

@Andrew: 30s, been playing about 2 decades now. Among other things was playing Bach solos.

@Gemma: Well, I'm sure to take small breaks now, though it hadn't ever been an issue before.

Thank you all for the responses. I have been following a regiment of eccentric exercises, and using nitroglycerin patches. I think there is some improvement, though it's hard to gauge (some days are better than others). So, I'll keep at it, and hope for the best.

November 2, 2019, 4:17 PM · Reading between the lines of this and other threads: complete rest, but keep moving!

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