Klarinet Archive - Posting 000266.txt from 1996/09

From: "Steve L. Gordon" <SGordon688@-----.COM>
Subj: Re: Authoritative advice needed
Date: Sat, 14 Sep 1996 23:37:00 -0400

Dear Neil:

You asked several questions, and I will offer at least a few answers.

Overuse syndromes are very difficult to treat - namely because they need
rest, and professional musicians usually can't afford to rest (actually we
hear this from any patient who comes in ill - "I can't afford to be sick
right now.") Wearing a brace will offer some help in relieving the strain
being placed on your wrist. Go to a medical supply store in your area
(usually a pharmacy which also carries supplies) and look at the different
splints and be sure to try them on. Unfortunately, all of your finger
tendons pass through the wrist, so most splints will hinder playing somewhat.

Wearing a neck strap is a better idea if you are not already doing so. This
will truly take weight off of your wrist.

Ice the wrist after playing (reduces swelling). Try applying heat at other
times (increases circulation which helps inflammation).

All of the nonsteroidal anti-inflammatory medications can be useful. You
should not take these if you have stomach pain or a history of peptic ulcer
or kidney disease or if you are on blood thinners.
Advil (ibuprofen) can be taken in prescription doses for a few weeks with
greater effect than OTC recommendations, eg., 800mg 3-4 times daily. This
would be twice the dose recommened on the package, or 4 pills each dose.
Alleve can be taken at twice its recommended dose as well. It's best to
stay with one for one to 2 weeks to build up its anti-inflammatory effect.
Aspirin will work as well, in doses of up to 12 or 15 daily if you have a
strong stomach. If you get ringing in your ears or other temporary
alteration in hearing (eg., like you are in a tunnel) it means your aspirin
level is too high. Reduce the dose and these symptoms will improve. None of
these drugs will make the problem worse - eg., they will not just cover up
the problem.

Tylenol is a good pain reliever but has no anti-inflammatory effect, so it
will likely be less effective.

A specific diagnosis from a physician can be helpful, esp to sort out some
of the less common conditions. DeQuervain's synd involves the "snuffbox" at
the base of the thumb. If there is inflammation here, a cortisone injection
can get you back on the road to recovery more quickly. Carpal tunnel
syndrome usually presents more with numbness and tingling in the fingers with
or without wrist pain.

Now I can't remember all of your questions. I can't imagine a brace that
would be so tight it would cut off circulation without impairing mobility of
you tendons.

I hope this was a little helpful, if not particularly authoritative! It
just occurs to me that typing on your keyboard places extra strain on your
wrist as well!

Steve Gordon, M.D.
Internal Medicine
Beaverton, OR