 The Clarinet BBoard
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Author: WoodsyBloom
Date: 2022-08-14 10:08
Hi! I have DeQuervain's tendonitis in my left wrist from holding down the register key. I know it's primarily caused by overuse and that I should ideally rest more, but I've been getting by with using KT tape on my wrist while practicing. I've tried a neck strap and repositioning my hand, but neither of things seem to be helping. Has anyone else had this problem or any tips on how to deal with it?
Thanks!
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Author: Paul Aviles
Date: 2022-08-14 14:39
Let me say upfront that I completely agree with all answers to questions like this that medical advice needs to come from your doctor (hand doctor and Occupational Therapist), and NOT from us.
however
I am recovering from a broken left wrist (just happened on the 4th of July) so I have to add my 2 cents.
I am regaining the use of my left thumb (and ring finger) very slowly, with targeted exercises assigned by my Occupational Therapist based on notes from my hand surgeon. In my case there are targeted movement done in sets of ten repetitions, five times a day. There is also massaging of the wrist over the area of my scar (underneath which is a metal plate holding it together with nine screws). There is a lot of interconnected stuff involved and you DON'T want to make things worse. So you must consult your doctor.
I am somewhat curious about how the register key in itself is the culprit. Once you have addressed your current condition, I'd recommend re-assessing how you approach using your thumb on the clarinet. The thumb should cross the thumb ring at a natural angle and be at a comfortable, natural angle across the thumb tone hole when closed (or open really). The tip of your thumb should be pointed roughly at a 45 degree angle at that gap that exists between the register key, the thumb ring and the upper post holding the thumb ring. Actually the very tip of your thumb should be right over that gap! You engage the register key with the inner corner of your thumb.
Finally, make sure the spring tension is relatively light for the register key. That is a very small hole that is the register tube. The tension on that key can and should be quite light.
...............Paul Aviles
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Author: kdk
Date: 2022-08-14 17:23
I've never heard of DeQuervain's tendonitis, but Googling it brings up a lot of hits. Apparently, it's also called DeQuervain's "tenosynovitis." It's basically inflammation in the tendons (tendonitis?) at the base of thumb that control the thumb's movement or inflammation of the lining of the sheath that the tendons go through (tenosynovitis). As you say, it's most often a result of repetitive use or stress.
I found the information personally interesting. You don't mention "triggering" in your thumb movement, a painful hitch midway in the movement of the thumb that then releases if you continue to move the thumb past it. "Trigger thumb" (technically "stenosing flexor tenosynovitis of the thumb") seems from the articles (one from Mayo Clinic) to be similar or even identical to DeQuervain's. The swelling in the tendons or the sheath causes the tendon's movement to be constricted, causing the catching. I'd be interested in any commentary about this from medical people here on the Board.
I've had two experiences with "trigger thumb" (once in each thumb) and in both cases a hand orthopedist, after diagnosis, gave me several cortisone injections over a few weeks and the condition resolved and never came back in either thumb. I'm currently having a tolerable but annoying amount of arthritic pain around both thumbs, which is a different condition, but the same orthopedist also treated that with cortisone shots a few years ago and that pain is only now beginning to come back.
I don't think a neckstrap will help, if my experience is at all analogous to yours, because the left thumb doesn't bear the clarinet's weight. Trying to reposition my hand cause problems because it changes my finger positions as well, causing other fingers to miss their holes or keys. Resting might help but the time-out would keep you away from the clarinet for a long period of time, probably weeks.
If this was a hand specialist's diagnosis, you probably should go back, talk about what you've tried unsuccessfully, and see what he or she suggests. If the diagnosis was made by someone other than a hand specialist or it was a self-diagnosis based on a web search, you should see a hand orthopedist. It's worth asking specifically about cortisone injections, because they're probably the fastest and, in my own experience, most permanent solution. But YMMD, your tendonitis or tenosynovitis may be different in some way from mine, or the doctor may have a less positive attitude toward cortisone as a 1st line approach.
Karl
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Author: WoodsyBloom
Date: 2022-08-14 21:43
I've gone to a hand specialist and an OTalready. I've gotten a lot a of info from them, but they know much about clarinets. My finger tips are hyper extensive, so my thumb continues to bend backwards even after I've hit the key.
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Author: kdk
Date: 2022-08-15 00:00
WoodsyBloom wrote:
> I've gone to a hand specialist and an OTalready. I've gotten a
> lot a of info from them, but they know much about clarinets. My
> finger tips are hyper extensive, so my thumb continues to bend
> backwards even after I've hit the key.
If your problem is thumb pain, they don't really need to know much about clarinets, and what they need to know you can show them with an instrument in their offices. Your thumb hurts because of inflammation. That's a medical problem, not a clarinet one. The first thing to do is clear up the inflammation so you can function without pain. Then an OT may be able to make suggestions, based on what you do when you're playing, toward not recreating the problem.
The thumb you're having trouble with is not weight-bearing. The way you move it to operate the register key may or may not be efficient, but the pain isn't likely to go away for a long while without either medical treatment or a very long rest no matter what you change in your mechanics.
Was the hand specialist a orthopedist (MD or DO with an orthopedic specialty)?
Karl
Karl
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Author: WoodsyBloom
Date: 2022-08-15 00:28
Orthopedist, MD
I've had three steroid shots so far. Only the last one has done anything and now it's wearing off. What I really need to do is rest, but I have college auditions and all state auditions coming up and need the scholarships.
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Author: Slowoldman
Date: 2022-08-15 01:54
It looks like resting the finger isn't going to be possible for you in the short-term.
In the meantime, if you're not already doing so, apply ice for 10-15 minutes after every practice session to keep the inflammation down.
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Author: Philip Caron
Date: 2022-08-15 02:25
Just an uneducated guess here. You might consult a sports medicine specialist. They often deal with tendon problems in patients who need to remain active. They might suggest other options for treatment, and they might even have a way to stabilize the joint so it doesn't over travel (hyper-extend) in use.
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Author: WoodsyBloom
Date: 2022-08-15 04:15
Yes, I'm using that angle. The tape I'm using helps with the stability but only so much.
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