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