 The Clarinet BBoard
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Author: JJAlbrecht
Date: 2009-07-27 20:51
OK, here's one I haven't heard of before today...
I have been having problems with my left hand, especially where the hand bones connect with the middle finger. It's been getting progressively worse over the past few months and was starting to affect my playing, my hand strength, my ability to make a fist or type.... Anyway, I went to a hand surgeon today, who diagnosed it as a "trigger point" issue, where the tendon running along the middle of my palm is swollen, and that's what is causing the issue. He gave me a steroid injection into the tendon, which seems to have helped somewhat already. I'm supposed to go easy on it for the next few days and see what comes of this. I can get another shot in about 3-4 weeks if the problem persists, but after that I might need minor surgery if the problem keeps up.
I'm hoping this will fix the problem, as I would really hate to lose the dexterity of the hand and finger, and not be able to play much any more. Has anyone experienced something along these lines, and if so, what was your outcome?
Thanks in advance,
Jeff
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Author: DougR
Date: 2009-07-27 21:50
Jeff--not as such, no.
However, I would refer you to a book called "How Doctors Think," written by Jerome Groopman, a Harvard Medical School professor, in which he explores the cognitive patterns that go into how doctors arrive at diagnoses. Impetus for the book was partly his own experience, in which he visited several different hand surgeons for some tendinitis, and got wildly different reactions and diagnoses from each. Everybody who sees a doctor even occasionally ought to read the darn book, because it's really eye-opening, but what I'm really trying to say to you is, don't be afraid to seek a 2nd opinion, pre-surgery.
Good luck!
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Author: EEBaum
Date: 2009-07-27 21:59
You might also seek out a reputable chiropractor. Might have solutions that are considerably less painful (and more effective) than an injection.
Swollen tendon might just be slightly dislodged, which can be pretty simply rectified by someone who is properly trained/skilled. I've slipped a handful of tendons in various places over the years (due mostly to various poor postures) and had them each reseated in a single visit (ok, sometimes two visits before it took). Would highly recommend seeking alternative solutions before even considering surgery a possibility.
IIRC, the injection is to reduce inflammation, which makes it easier for the tendon to find its way back, provided you're not doing things that make it do otherwise (e.g. poor posture, repetitive overuse). The chiro just puts it back himself, usually in one swift motion. Swelling can be reduced with drugs, or by reducing strain by putting the tendon where it belongs. Either way, the problem is likely to persist or recur if you don't address and rectify the underlying cause (e.g. via stretching, exercise, fixing posture).
I find it easier to achieve proper use and posture if the limb in question is properly aligned, which is why I find a good chiropractor to be the preferred remedy.
-Alex
www.mostlydifferent.com
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Author: DavidBlumberg
Date: 2009-07-27 22:59
JJ - exactly what you have I have - same finger, same location.
I got the shot this past Friday for it. Mine was from being a meathead at the Gym and doing pulldowns with too much weight. Felt the damage almost immediately and the clicking came within a couple of days.
Never locked up though, but did hurt! Couldn't do things such as make a fist tightly (so good thing I never need to!  or put any pressure in that palm.
Mine happened last December - gave it a lot of rest time. So after this shot, maybe I'll take a second, and if that doesn't work then snip, snip.
http://www.SkypeClarinetLessons.com
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Author: JJAlbrecht
Date: 2009-07-27 23:47
Yeah, for non emergency surgery, I would definitely get at least one more opinion. Even an hour after the shot, it started to straighten out a little. I'm going to take it easy and not do much with it (there goes our rehearsal on Wednesday!) and see how it shapes up. I guess my daughter will have to operate the lawn mower this week, too.
Thanks for the input, folks. I'll keep you posted.
Jeff
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Author: Grabnerwg
Date: 2009-07-28 03:31
Jeff -
So sorry to hear of your misfortune. I sincerely hope you can get the problem resolved. It would be terribly sad if you had to stop or limit your playing.
I have a friend here in Chicago who has the same problem. He went the surgery route and is now recuperating. For now it looks like the trigger issue has been solved. If you want more information, e-mail me offline.
Walter
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Author: JJAlbrecht
Date: 2009-07-28 16:46
Thanks, Walter. I'll see how this goes. Already today, I feel about 1000% better, I can close my fist and also lay the palm totally flat on a table, which I haven'tbeen able to do for a few weeks.
Jeff
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Author: reedwizard
Date: 2009-07-28 19:37
I have not had a problem with my hand but I have had many musculoskeletal issues, including plantar fasciitis. I would recommend trying other treatments before surgery. I have had intramuscular injections of lidocaine from a physiatrist, acupuncture, chiropractic, osteopathic, physical therapy and neuromuscular therapy.
A good neuromuscular therapist, one that goes deep into the connective tissue to "massage" may be worth a try. My plantar fasciitis finally resolved after several intensive treatments. To locate a therapist in your area I would contact the St John school of Neuromuscular Therapy in Florida. Here is there website. If you have any more questions you can e-mail me offline.
http://www.stjohn-clarkptc.com/html/paul.htm
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Author: JJAlbrecht
Date: 2009-07-28 21:07
Thanks, Reedwizard. I'll look into that.
David, I didn't bruise much at all on my injection. I iced it down as soon as I got to work--in fact, I carried around a 44 ounce plastic ice cup with me most of the day.
So far so good.
Jeff
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Author: EEBaum
Date: 2009-07-28 21:45
Ugh... plantar fasciitis. Had that on and off over the past ten years until I thought "maybe I don't have a lingering, hard to find splinter in my heel." Two visits, fixing the way I walk, and some home treatment, and in three weeks it's just about cleared up.
-Alex
www.mostlydifferent.com
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Author: Ralph Katz
Date: 2009-07-29 19:08
I have the same issue, same fingers but with both hands. My hand specialist initially suggested stretching and heat. If this didn't work, the the next thing to try would be the steroid injection.
He also recommended a heat glove, one that is warmed up in the microwave, and this seems to help if things get worse. But stretching the finger back, gently but firmly, before I play, every time, has helped the most. When this is done with all fingers, several times, I am less sore than expected after playing a 3-hour wedding. My brother, a professional ceramist (potter), has the same issue, and the stretching routine has also helped him.
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Author: sdr
Date: 2009-07-30 00:52
Perhaps your doc said, "trigger finger," not "trigger point." These are two very different things.
Trigger finger is a very common problem. Trigger finger occurs when one of the flexor tendons (on the palm side of the hand) develops a nodule of swelling. These tendons glide back and forth through a series of slings, sort of like pulleys or like the line guides on a fishing rod. If there is a swollen area it gets trapped and cannot pass through the sling. A steroid injection is often successful, taking down the swelling and curing the problem. If not, the sling can be cut surgically to allow the tendon to glide again despite the nodule.
Trigger points are not related to tendons. They are localized areas of spasm and inflammation in muscles. They are painful to touch. If they are chronic and unresponsive to local care with massage, heat or ice, and NSAIDs (non-steroidal anti-inflammatory meds; e.g. ibuprofen), then steroid injections are often indicated. A trigger point in the hand would be very unusual.
-sdr
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Author: DavidBlumberg
Date: 2009-07-30 01:01
Trigger finger for me - but it never locked at all. However, the damaged tendon (sheath?) could easily be felt.
Does feel a bit better and the shot(s) ((one for the pain, other one was the steriod)) didn't hurt.
Still can't put any pressure on it though.
http://www.SkypeClarinetLessons.com
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Author: alanporter
Date: 2009-07-30 01:27
Sounds like you have a case of Dupytren's contracture. Google it on the Mayo Clinic website, (other sites may be "quack" ones).
Good luck.
Alan
(retired MD)
tiaroa@shaw.ca
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