Can you lend a hand (doctor)?

June 19, 2020, 3:31 PM · My daughter is a 14-year-old cellist. She has dull pain in her right thumb that is almost undoubtedly cello-related. (She does NOT do a lot of texting.) The bad news is that it's been that way for well over a year -- while the good news is that it's not getting worse. And it only flares up to the point where she can't practice if she overdoes it on something very repetitive and strenuous like Popper "Hochschule" etudes. We tried an local orthopedist, who gave her a brace to wear, which accomplished nothing. Two weeks of total rest ... nothing. Her (new) cello teacher has prescribed some hand exercises and is focusing on minimizing strain in her bow hand while playing. But we're concerned enough that I think we need really top-level medical advice. So I'm asking whether anyone can recommend a hand specialist. Someone with experience dealing with musicians is very strongly preferred. And I'd feel better if it's someone who you've worked with yourself, or who has worked with someone you know. We live in Blacksburg VA, so we're okay with someone as far as Washington DC, Charlotte NC, or Raleigh-Durham NC. Baltimore MD is starting to get a little far but I'd consider that if absolutely necessary. Thanks in advance.

Replies (19)

June 19, 2020, 5:53 PM · I can't help you with anybody in that area, but there is one great program near me and they are currently during Telehealth. I don't know the current doctors (I knew the previous two through various musical organizations), but it has always been an outstanding program. https://www.sralab.org/services/performing-arts-medicine
June 19, 2020, 5:56 PM · ...and that website led me to this one which lists all the similar programs in the US. http://www.artsmed.org/related-pam-websites#clinic Maybe one of those is closer to you?
June 19, 2020, 7:04 PM · Susan thanks I will check that out!
June 19, 2020, 8:43 PM · My own experience with injuries related to music is that two weeks is nothing. Think of your own injuries and what you know if injuries to athletes. Healing takes a longer period of time.

Getting a proper diagnosis (possibly involving an mri) is only half of it. Physical therapy, and other modalities can be invaluable.

Edited: June 19, 2020, 9:40 PM · I wish I had advice on doctors but I wanted to commiserate. Serious cello playing is tough on the body; my 14 year old cellist daughter has chronic neck and shoulder pain. A stretching regimen helps a lot and her teacher is very on top of advising her how to stay healthy. I have the idea that smaller-stature girls have to pay special attention to technique and stretching whereas guys can often power their way through things without worrying as much.
June 20, 2020, 4:24 AM · I realize that in my previous post I did not provide a recommendation of a doctor. The doctor that I saw has since retired. I also know that you said that Baltimore was a stretch. However, it has two centers that have expertise in music related issues:

https://www.hopkinsmedicine.org/center-for-music-and-medicine/care-for-performers/
http://www.curtishand.com/

I want to reiterate my experience is that these things take time to heal, regardless of treatment / surgery. Playing the cello will probably exacerbate the problem.

June 20, 2020, 12:01 PM · Thanks so far. Yes, I know two weeks is nothing. A scratch doesn't even heal in two weeks. But that's the longest experiment we've tried so far. I also agree that some imaging and PT are probably part of the solution, but I'm also assuming a good specialist would order all that if it's needed. I appreciate the links in Baltimore. I just need to think about how far we can drive without using a public rest room. Baltimore is almost 5 hours, but we can probably manage that.
June 20, 2020, 12:23 PM · There is typically a wait of several months to see a specialist. I do not know how long a wait there is at the places I recommended. Who knows what covid would look like then.

My advice is to make the appointment. While you are waiting, stop the cello playing, and wear the brace when awake / not in the shower. See how it feels in a few months.

Given that she already saw a doctor, he probably did not suspect something drastic, such as a tear, etc. Rest and some physical therapy are probably what is needed.

June 20, 2020, 2:15 PM · Hopkins is definitely worth the drive. We are an hour and half away and it is our go to place for serious matters especially after the wonderful care we have experienced.

Have you tried a turmeric curcumin supplement? I started taking it regularly a few years ago and have noticed an improvement. In my younger years I was very active- sports, motorcycle racing, lots of physical labor, and iffy genetics made getting out of bed a slow process. But Turmeric has really helped, along with vitamins as well.

Edited: June 20, 2020, 2:32 PM · I occasionally get bad pain in my wrist and fingers during the times that I work out and practise a lot. There is a myriad of creams for sports injuries and sprains that reduce the inflammation and pain, allowing me to continue playing. Your daughter's case sounds more like some kind of nerve pain, but those topical creams might be worth trying anyways.
June 20, 2020, 3:31 PM · I assume she has tried different bows and different types of bow hold? Everyone is different and the human hand has many muscles and nerves; it is not a good idea to continue playing with any type of pain. After all, from a biological perspective pain serves a purpose: It is the body giving a signal that something is wrong, and that we need to adjust our behavior. I hope she will find a solution!
June 20, 2020, 6:36 PM · Also, you can look around and see if you have anyone who does Alexander Technique, Body Mapping or similar in your area. These people often have great ideas both for prevention and treatment.
June 20, 2020, 7:33 PM · This'll sound stupid, but for now, I'd have her put her thumb on the frog. Yes, I know that's typically for beginners but it's surprisingly decent for even higher level music and would allow her to keep improving in certain areas without adding to a repeated use injury. See if it helps for now.
June 20, 2020, 7:35 PM · I second Alexander, or body mapping. Feldenkrais is similar and would likely be equally helpful.
June 20, 2020, 8:42 PM · Paul,
I would suggest seeing Brenda Jackson, Doctor of Physical Therapy here at VCU in Richmond. She is very interested in injury prevention for musicians and has come for the last two years to VCU Music Department to do special presentations. She is a certified hand specialist in PT, with an interest in musicians and prevention. Here is her linked in profile: https://www.linkedin.com/in/bljacksonphysicaltherapist/. If you have difficulty making an appointment, contact me through my VCU email and I will try to get contact info through a friend (I don't have the VCU health email directory directly). My email is sbklein@vcu.edu.
Edited: June 24, 2020, 4:50 PM · The mechanics of using a cello bow are very different than those of violin even though the basic principles are the same.

I've been playing cello for 71 years (10 years less than violin). I started cello at age 14 when my Dad brought home a cello and said "I need you to play cello with my string quartet next Friday (10 days later)." I spent the rest of that day reading some of my violin music down an octave and the next day Dad brought me some (bass clef) cello music. The Haydn and Mozart I played with the quartet worked out OK and 2 weeks after that I had my first cello lesson.

My teacher (an experienced professional who had played with the Minneapolis, Chicago, Philadelphia and Atlanta symphonies) immediately had to change the way I used my left and right hands, since I had been using them the way I had for violin. A NO-NO!

Advance 50 years and I started playing the cello more (in a weekly piano trio) - and with the advantage of video I could see how many professional cellists used their hands and it was clear that even some marvelous cellists hold their bows like a violinist, although most do not.

I think that Paul's daughter's teacher should be able to correct her right hand action easily. It really should just rest on the thumb (as a fulcrum), the thumb angle has to be "natural" without effort to have the pad of the thumb touching the bow - if that part doesn't touch - so be it - some part will! Some people advocate playing with a bent thumb, some with a straight thumb. Everyone SHOULD play with the thumb in a position that works for them. Any strain in the hand, while it may be possible in youth, will take a serious toll over time.

The strings and the thumb support the bow against gravity, although at a different angle than for violin - this gives the bent fingers of the right hand a slightly different additional task than for a violinist - but not that much different.

Popper is definitely not child's play (despite the names of some of his music) and strain (due to concentration) in the left hand can often lead to strain in the right hand as well.

June 26, 2020, 7:15 AM · Thanks to all for the recommendations and discussions! Always so helpful. Andy, her teacher changed from Popper to a more lyrical Franchomme study for now. Her teacher also mentioned the "communication" of tension between the RH and LH.
June 27, 2020, 9:16 AM · Sorry to hear Paul. Hope you and your daughter get some answers soon.

FWIW - I suffered an accident to my left hand in February, and it wasn't until mid-May that it finally felt fully healed and back to normal. But, I'm also older than your daughter by a couple of decades...

June 29, 2020, 10:33 PM · Had a left hand injury ( classical guitar ) and switched back to violin, but it took almost two years to play violin normally again. What I learned:

- total rest did not really help, even six weeks of rest and NSAIDs
- cortisone shot did not help
- what did help: physical therapy exercises ( gentle, progressive) and easy playing below threshold. When continuing to gently play easy music several times a week, hand slowly restrengthened and healed itself.

I would back off of playing anything that aggravates the injury, and re-examine technique/ bow hold thoroughly...even if it’s back to Twinkle Twinkle Star for a few weeks!

Because I kept trying to carry on injured, kept on relapsing, and I learned the hard way to be patient and careful. (Even now, two years later, I am careful of pinky use and reaches with my left hand). Hope it gets better soon! And I agree that Alexander method seems great for fixing tension!


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