 The Clarinet BBoard
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Author: tetiana
Date: 2010-05-09 23:11
I have a clarinetist friend who has come down with a condition in his rh little finger that has been diagnosed as "mallet" finger. It involves the tendon particularly at the first joint. Mobility is decreased and the joint appears tender and inflamed. My friend has consulted an orthopedic specialist, but I'm not sure that this specialist is sensitive to the particular issues facing musicians. Has anyone out there had this condition and is able to give some advice? Do you know of any specialists, that perhaps treat musicians, hopefully in the Montreal area?
tetiana
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Author: DaveF
Date: 2010-05-10 03:12
Mallet finger is an injury, usually from "jamming" a finger causing a rupture of the extensor tendon overlying the distal inter-phalangeal (DIP) joint......the distal knuckle. It will leave this joint sagging in flexion, unable to extend. Depending on which finger, this would be detrimental not only to playing the clarinet, but fine motor skills in general.
Proper treatment involves a simple but specific custom adjusted splint to the finger, keeping the DIP joint in full extension for 6-8 weeks. Rarely surgery needed.
Your friend must see a Hand Surgery specialist.
Dave F. (clarinetist, emergency physician)
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Author: dansil
Date: 2010-05-10 03:47
as an Australian family physician of > 35 years experience (and sadly less than 2 years of clarinet experience, sigh) I support what DaveF has recommended.
Without appropriate treatment the deformity and disability it causes will be permanent. In fact, even with the best of treatment the deformity isn't always completely rectified. However no treatment = permanent loss of function.
If a carefully applied and continuously worn customized splint doesn't fix the problem over 6 weeks, surgery may be necessary as a last resort. The quicker and more accurately the deformity is rectified with a splint the greater the chance of full recovery!
Go to a good specialist - remember the old medical saying "Pay peanuts, get monkeys"!
Good luck!
Danny Silver
a family doctor in Castlemaine, rural Victoria, Australia for the past 30+ years, also a plucked string musician (mandolin, classical guitar) for far too long before discovering the clarinet - what a missed opportunity!
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Author: Chris J
Date: 2010-05-10 03:47
In addition to the description of mallet finger above, your friend may need to question the diagnosis if there was no trauma or injury involved prior to the problem.
If there was spontaneous redness, swelling and soreness in his DIPJ then any number of problems may be possible depending on the age, past medical history (eg psoriasis, gout), medications, previous joint problems, infections - the list goes on.
In the abscence of a history of trauma, then a rheumatologist may be a good idea, but a hand surgery specialist should certainly consider rheumatological problems in his differential diagnosis.
Chris (GP)
Post Edited (2010-05-10 03:48)
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Author: dansil
Date: 2010-05-10 03:56
Chris J is also correct, IF trauma didn't cause the initial problem. "Mallet" deformity describes the appearance after traumatic rupture of the tendon (or ripping out of it's attachment to the base of the bone in the end of the finger) which straightens or extends the joint closest to the finger tip such that the tendon which bends of flexes that joint on the palmar side of the finger is unopposed and so the finger bends towards the palm at that joint.
Whatever the nature of the damage it often does hurt and swell on the back of the for a while until the inflammation settles.
HOWEVER, if the problem is just inflammation which has developed for other reasons such as gout or osteoarthritis or psoriatic arthritis, etc and NOT actually rupture of the extensor tendon then the swelling on the back of the finger might just give the false appearance of a mallet deformity.
However the moral of the story remains the same - get medical attention, SOON!
Cheers, Danny Silver
a family doctor in Castlemaine, rural Victoria, Australia for the past 30+ years, also a plucked string musician (mandolin, classical guitar) for far too long before discovering the clarinet - what a missed opportunity!
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Author: Rusty
Date: 2010-05-10 08:37
I don`t know if my problem is quite the same but I cannot extend my little Rt finger. the tendon was cut (Olympic fencing) and surgery didn`t fix it. The result has been that I can`t reach the key with the end of my finger. The solution has been to extend the keys that the little Rt finger would press. Works for me.
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Author: tetiana
Date: 2010-05-11 10:52
Thank you to all who have answered my post, most especially the doctors. I have passed on this valuable information to my friend.
tetiana
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Author: Bob Bernardo
Date: 2010-05-11 17:23
I found this thread interesting because I screwed up the same finger. The treatment discribed by the above doctors was the same I received.
After it heals it will be a bit tender and stiff, so he may wish to ask for physical therapy and get a few treatments, just to comfort him, that he is doing the right things not to mess it up again.
It took about 8 weeks for it to heal. Then another 8 weeks or so before the very mild pain went away.
What I did to continue to play was to put about a 1/4 inch cork attached to the bottom of the metal splint. I could actually play the clarinet fairly well. Adjusting the cork will let him hit the 2 upper keys required by your right finger. His left had can take over the other 2 lower keys. I wouldn't suggest performing any advanced concertos, but he surely can practice everyday and enjoy playing.
Email me if needed and I'll try to make some sort of attachment allowing you to play.
Designer of - Vintage 1940 Cicero Mouthpieces and the La Vecchia mouthpieces
Yamaha Artist 2015
Post Edited (2010-05-11 17:35)
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