Topic: right hand/wrist pain and numbness

Firstly, thank you all in advance for your support and advice. I'm new to the IDRS and upon looking over the site and the forum, I see that this a very practical, knowledgeable, and supportive organization.

Like many oboists and bassoonists, I'm suffering from a chronic tendonitis in my right thumb that began near the beginning of my musical studies from having an instrument that was, to say the least, in very poor adjustment. Now, I'm a 22 yr old oboist in my final year of music school who, after somewhat successfully managing the tendonitis of the thumb after 6 years of struggling with it, is now dealing with a completely different(?) type of pain in the thumb in addition to having a strange numbness in the right index finger.

The tendonitis issue has been diagnosed and unsuccessfully treated by doctors who were well-intentioned but not in tune with the needs of an active performer and teacher. The last time I had an especially bad flair-up (roughly last February), I took three months off actual playing/performance upon the suggestion of a different doctor. The only playing I did was the playing of long tones while using a fhred to keep the chops going. For around a year and a half before this flair-up even happened, I had been working privately and in a classroom setting with an Alexander Technique teacher, which certainly taught me a great deal, but as it's not a miracle "cure," it can only help so much with damage that has already been done. When I did come off the three month break, I came back to playing gradually, with all practice being done in front of a set of mirrors so that I could observe my motions in the hopes of noticing and stopping anything that could be problematic before it becomes a habit again. The only thing I notice that cannot seem to shake, even with a neck strap and hand/arm exercises, is that the middle joint of the thumb always hyperextends towards the chair from even light pressure from the thumb rest of my instrument. Fhreds help with the weight issue, but they do not allow much for pitch flexibility or fluidity of motion while playing, and, at least in my case, cause strain on the lower back because of the inherent need while using one to go to the instrument instead of allowing the instrument to come to you.

I always warm-up methodically and stretch well before playing, as well as cool down and stretch again after a session or during one if I start to feel tense. I never have had any other problems, save for a back injury that seems to be no longer an issue (am I wrong?) as far as pain and posture are concerned.

I have not had problems with my hand after this methodical approach to returning to performance until about two weeks ago. I was preparing for a competition while remembering to be mindful of my practice time and efficiency in order to prevent unnecessary stress/fatigue. While I was working on some technical things near the end of my session, I noticed that the thumb pain was much worse than normal (a very sharp, pointed pain where the thumb joins at the wrist, in addition to the aching pain in its middle joint as well), and as soon as I noticed that, I felt my right index finger go numb. The numbness is not the entire finger, though. The outermost phalanx goes completely numb (I can move it, can vaguely feel the difference between hot/cold, can't feel it being touched, pinched, or anything else - goodbye sense of finger speed/velocity), and the rest of the index finger goes numb in a similar way, but only on the side closest to the thumb. I immediately stopped playing until the pain subsided and the sensation returned to my finger. This pair of issues is usually accompanied (but not always) by knots of muscle in my forearm by the elbow (just below the crook of the joint, on the right side if you were to look down at your own) and in the back of my upper arm just above the elbow's point. The other problem I have is that when I go to play, I will be thinking, say, "put 1st finger, right hand, down", and instead 2nd or 3rd finger will move.  This happens even when playing slow things, where there is time to think all the motions through. This is not a consistent problem; however, it is far too frequent for me to write it off as "needing to practice more".

Now upon keeping some notes on observations with this, it seems to be that I can play for about a half hour before my thumb starts getting bad, and at first, the index finger issue was about the same time. While my finger doesn't hit "the worst point" as described above until the thumb gets to its worst (inflammation putting pressure on a nerve?), it starts to go about 5 minutes into playing. I have been taking anti-inflammatory meds around the clock for three days now, but nothing has changed enough to notice. My ability to grip strongly with that finger or by using a "pinching" motion is also cut back to what I would guess is about 70% of normal strength when the problem is happening, pain aside. Playing with a Fhred helps with the thumb pain, but it does not address the inherent interface issues with an oboe when you happen to be the owner of smaller hands with rather short pinkies. I'm observant of the angles of alignment from fingers through shoulders, and things are as natural as I can keep them while still being able to reach keys, but there's only so much I can do. In an attempt to buy some more time to think on this, I've made the investment in a Ton Kooiman maestro model thumb rest for my oboe and am currently waiting for it to arrive so that I can have it installed. (any thoughts on this product?)

Has anyone gone through this before? I apologize for this being so long, but I have been doing much research on my own and have turned up nothing. My current teacher doesn't know what to make of this, nor does the other teacher at my school. My old teacher also is at a loss. And the doctors I have spoken with are really confused by this, and the ones that aren't as much so are not willing to so much as talk to me beyond over the phone as they don't take my insurance (severely irked by the system at the moment). I manage my practice time well, I do a great deal of mental practicing before I even pick up the instrument, I'm very aware of my body, I do my homework especially as far as injury research is concerned, and still the situation continues to go downwards, exponentially so when playing English horn, which I do a great deal. In a few months I am to have job and grad school auditions, and I'm not sure that I can do either with any effectiveness without longer-term risks to the health of my limb if I do not devise a better management plan for this situation.

All feedback is welcome here. Any insight would be immensely appreciated.

Thanks again to everyone who takes the time to read,
Sarah H.

Last edited by hautboismusique (2008-10-09 08:57:17)

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Re: right hand/wrist pain and numbness

You have not mentioned where you live -- there are physicians who specialize in musicians' problems around the United States and in many other countries. I may be able to direct you to one if I know your location.

The problem to me may be a tendinitis, but possibly also a strain of muscles. Also, you mention your index finger going numb -- does this happen to other fingers also? This symptom is not muscular, but possibly nerve-related -- all the more reason to see someone skilled in musculoskeletal medicine who has experience with instrumentalists.

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: right hand/wrist pain and numbness

Thanks for your response. And I apologize to everyone for yet another lengthly post. I live in Pittsburgh at the moment as that's where I go to school. However, I'm from the Hagerstown, Maryland area originally, and as I still share health insurance with my family back home, there are few places or people that accept my insurance up here.

If necessary to travel back to Maryland, I can easily access the Baltimore or Washington D.C. area.  Finding possibilities in or around Pittsburgh would be the best as since I'm on a student budget, traveling to MD regularly would not be financially feasible for me or my family.

More details with the hand:
The numbness seems to generally stay in the right index finger, and the musculature associated with it along the thumb side of the hand. My other fingers/rest of hand will get colder as I play, but they never lose sensitivity to heat/cold or velocity of motion - they just get stiff from the lack of circulation. Wrist warmers seem to help this situation a bit.

The only major concern I have with the other fingers is when they move due to being confused with the index finger, and thankfully, at the moment that is not a regular occurrence. The top of my hand just before it meets the wrist often gets very sore just before the index finger acts up  (and sometimes there will be a stabbing pain that precedes the aching pain that feels pretty deep).

The bones of my thumb and wrist (on both sides, right wrist) often feel like they want to be somewhere else in relationship to the wrist joint. There's a lot of audible cracking and popping from the bones of the outer side of the wrist shifting around regardless of if I'm playing, and the outermost joint of both of my thumbs will sometimes "catch" and a distinct popping/clicking sound can be heard when it is moved from this somewhat locked position. In short, my hand is a complete and utter mess sad

I did receive the Kooiman thumb rest today, and after installing and and going through two hours of adjusting the thing, I have found a little relief of the tension in the index finger. It hasn't cured the numbness issue, nor the thumb issue, but it does give me more time before things start going downhill. However, (I'm guessing because of the pre-existing issue with the tendonitis in the thumb) I find that the pain I get in my forearm further down the thumb's tendon (about two inches past the wrist) is rather intense. Again, I've only worked with this for a few hours, and I'm sure I will need to live with it some more before I have it in optimal position, but, in your opinion, should I switch back to my old thumb rest for practicing until I have the new one adjusted, should I try to get used to it to see if the shooting pains clear up as my hand adapts to the overall more comfortable position, or should I just put my oboe away until I figure out what's going on with my limb? (and should I be scared yet?)

thanks again for your reply, I'm really at a loss as to what to do or not do. All I want to do is practice without having the burning desire to cut my right  arm off shortly afterwards.

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Re: right hand/wrist pain and numbness

Sarah, your reply was most thorough regarding symptoms and feelings as you play. It seems you have issues with the nerves (nervous system) as well as the muscles/tendons in the hand and wrist. I'd suggest contacting a hand surgeon in Pittsburg as the most likely person to give you a good initial evaluation. Definitely bring your instrument and thumb rest to the visit so he/she can see you playing and help understand the mechanics and actions of playing oboe. Unfortunately, I don't have any personal contacts in that area, so perhaps discussing this problem with your health service physicians could provide a suitable referral.

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: right hand/wrist pain and numbness

Thanks for replying. I kind of figured as much when you mention that it's a nerve issue in addition to the muscle/tendon issue. The health clinic here at school is a joke in the worst kind of way, but through dumb luck, it turns out my neighbor is a doctor here in Pittsburgh. He's been a doll in being willing and able to at least help with the pain management until I can find a doctor to work on the actual problem. Also, some who have read this have emailed me with some names to look into as far as treatment for this set of problems.

I'm wondering if some of the nerve issues could be related to a disk in my back, as over the summer I did sustain a back injury, and the doctor thought it was a herniated disk. We opted for the most conservative approach (rest, PT, etc) and it seemed okay after a month or so, but I wasn't playing much - especially not much english horn. I was playing a concert with the school orchestra the other day, and the weight of the instrument on the strap shifted/I sat weird/something else happened, and I got terrible pinching/stabbing pain right where I hurt my back this summer - upper back, in between the highest point of the shoulder blades. Any thoughts? If this is a possibility, should I still be looking for a hand specialist or someone else (chiropractor, neurologist, orthopedist) as a starting point? Thanks again for your input, everyone!!!

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Re: right hand/wrist pain and numbness

PS - this pain radiated down my problem arm... thought that would be important

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Re: right hand/wrist pain and numbness

All hand surgeons are very familiar with the nerves in the neck and upper extremity -- and that sounds like the prob

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: right hand/wrist pain and numbness

Sarah, sorry for the truncated message. The neck certaily seems like the site of one of your difficulties, and a hand surgeon can tell if you should see additional specialists. Many hand surgeons are first trained in orthopaedic surgery, and this would be an added benefit to you.

Hope this helps.

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: right hand/wrist pain and numbness

All this time later, I finally have an answer to what has been going on in my body! Turns out that there's a slipped disk in the upper back, a compressed disk in the neck, a tiny bone spur in my right shoulder, and a pinching of one of the nerves in my right elbow. Months of PT later, lots of progress has been made. I'm basically back to my regular playing schedule, and I'm enjoying the oboe again. English horn is still a little sketchy, but I'll take the 90% improvement (and counting!)

I'm swearing by the Kooiman Pro thumb rest these days. Physical therapist and Alxexander Technique professor both think it's the coolest thing since sliced bread. It looks weird, yes, but it literally has saved my hand, and my beginning career!!!! Thanks everyone for your input and support!

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Re: right hand/wrist pain and numbness

Sarah,

You might want to  investigate the MUTS (Michael's Ultimate Thumb Saver) It takes all weight off the right thumb & is designed for oboe & EH. Made from bicycle spokes, springs & black vinyl. A nifty rig that really  works. No website:

Michael Benthin
24 Poor Farm Rd
Pennington, NJ 08534
1-609-737-3867
benthin@prodigy.net

Best,

john

Best,

john

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Re: right hand/wrist pain and numbness

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Re: right hand/wrist pain and numbness

hi
i know hand pain pains synflex a lot one should immidiately recommend to his doctor
All hand surgeons are very familiar with the nerves in the neck and upper extremity -- and that sounds like the prob

Last edited by Abbot (2010-04-28 00:34:46)