Carpal tunnel Syndrome

[Tomzooki]

Last night I wore my splints for the second time. My LH did not get numb!!!!

[devrim]

Hi Tomzooki,

I have carpal tunnel on my LH. The symptoms are almost completely gone now, and i can play at least 3-4 hours without any problem. The tricks I followed are pretty much same things explained in previous posts. They worked for me:
1- For a few weeks: playing with the splints, sleeping with the splints. (actually for at least 1-2 weeks you should completely stop playing to be safe)
2- Simple backward stretching exercises for your wrist and fingers (there are some youtube videos you can find)
3- Applying ice after playing, for a few weeks, and whenever you feel an electric chock in your arm due to an awkward move.
4- always trying to keep low tension. If I feel that tension in my arm/hand starts increasing while playing, I will stop, stretch, relax, rest and rethink about my technique.

good luck!

[LVR]

One caveat: if you play with a splint on your left hand it will mark the neck of the guitar. (Don't ask me how I know this!) I know you have a new beautiful guitar and don't want to scratch it up . If you have to play and your left isn't up to it play some nice Carlevaro or Giuliani R hand exercises open-string, with an ugly metronome to make it fun and challenging.

[Tomzooki]

Thank you!! You are all so nice!

My CTS is still mild, so I son't have trouble playing yet. I just don't want it to worsen....

I noticed some problems when I begin a practice session. I feel some kind of light click in my wrist, then a little tingling in my fingers. In the LH, everything is OK with the RH. It is very mild, that's why I did not get alarmed before. Of course I was not warming up before playing.... I bought a stress ball to warm up slowly before playing; it works very well, no more "click"

[lagartija]

I know that "click" and then tingling thing.... but on a much larger scale (due to my recovery from major back surgery). When you "roll over" a nerve, it gets irritated and fires signals at you to let you know. Nerves hate being "twanged". They stay irritated for a very long time after the event that caused the sensation. Your muscles, when they are nicely warmed up, support your joints in their proper places better so you are less likely to impinge the nerve. But if you are having problems with inflammation, then you know the space you have left for the nerve is decreased by the inflamed tissues.... and more prone to being impinged. Listen carefully to your body, Tomzooki and if you have nerves that have been irritated by some activity... STOP the activity and allow your inflammation to decrease. Right now, you still have some motion you can do without pain. If you continue to irritate the nerves, you may find that your ability to do anything with that hand will decrease. So take LVR's advice and do right hand exercises and give that poor left wrist a rest. Reduce the inflammation in any way you can. Some people use ice therapy, some use NSAIDs. Some use other methods. The main thing is not to irritate the nerve and inflamed tissues any more than they already are.

[AsturiasFan]

From my readings stretching is the primary treatment. Specific movements on guitar in specific positions used to give me electric shocks right in the tunnel, but long term stretching has completely eliminated them. Use of ice and NSAIDS during an initial onset of CT reduces the inflammation that can contribute to further injury. A barely perceptible wrist injury immediately gave me an acute case of carpal tunnel (nerve shock when unscrewing lids or playing guitar) so I completely stayed away from guitar for three months. You already know wearing wrist braces at night is standard treatment since this prevents undue pressure and further injury.

[Fastfingers]

Hi
This being my field, i can assure you that computeruse has a weak evidencebase as causing factor. If you work with a good wristposition there won't be additional symptoms. Your thyroxine will of course increase symptoms if its too high. Its a good idea to check T4 and TSH. Your idea of etiology being the flexed position is probably right. Its a provocation test like that called Phalens test. The advice that you got to avoid the position and your initiative to use a night splint might be all you need. If you get weakness of your thumb or constant decreased sensitivity, you might want to see your doc earlier than april. In the states its a belief that local cortisone injection helps most for abt 8 months. Might be better or complete remission for some. The doc giving the injection must do it often and according to the latest principles.
Magnus

[rogerleec]

I had Carpal tunnel Syndrome from working too much on computers. I went to the Dr. and at first we tried a brace that prevented my hand and arm from going into the fetal position when I slept. This helped but I could not work with the brace on so the CTS would come back the next day. Finally had to do surgery and it worked great. Of course I was unable to use my right hand for a couple of months while it healed, but after it healed I had no more pain. I did have a funny feeling in the right hand for a little over a year, kind of like a numbness. But test prior to the surgery did show some nerve damage and I suspect this was the nerve's healing back up over time. The numbmess did not prevent me from working or anything, it was just a little annoying. After a year and a half my right hand felt perfectly normal and no pain, it has been that way ever since (over ten years ago). Definitly no regrets on the surgery.

[Fastfingers]

Carpal tunnel release is the golden standard of treatment. Easy surgery much like the minor treatments at the dentist. Local anaesthetic, tourniquet, takes 10 min if its easy and 15 if its tricky. The conservative treatment will save some from surgery, specially those with inflammation surrounding the finger flexor tendons at the wrist. By conservative I mean ergonomic advice, splint and injection. Other treatment exist but not in clinical praxis yet. Nerve conduction study is not mandatory with typical symptoms. It is always done in some countries like the US for legal reasons. It is not typical to have long term postop pain. Average sickleave in sweden is 4 weeks and this is a country with good workers allowance. Most people could probably play the guitar and work in an academic work by latest 2 nd week. Recent uk study of healthy heavy factory workers had 8/10 return to work within 2 weeks , same end result. Nerve conduction will for most remain slower despite treatment but symptoms are relieved.
I can go on and on but I'll spare you now.

Magnus

[rogerleec]

I had my surgery done in June of 2000 and I am sure the surgical methods have improved since then. I never even missed a day of work
except for the day I had the surgery. I did have a brace, kinda like a removal cast, that I wore for a short period of time. I did go to thearpy
after the surger and it helped to get my movement back. Really not a real bad experience.

[LVR]

Easy surgery much like the minor treatments at the dentist. Local anaesthetic, tourniquet, takes 10 min if its easy and 15 if its tricky.

This is minimizing to an absurdity. It's not a bit equivalent in difficulty or in risk to tooth drilling and filling. There are operators with good and with mediocre results. Carpal tunnel surgery can be great, but it isn't a light-weight decision; conservative measures should definitely be tried first and if you do need surgery, select your surgeon very carefully.

[lagartija]

Easy surgery much like the minor treatments at the dentist. Local anaesthetic, tourniquet, takes 10 min if its easy and 15 if its tricky.

This is minimizing to an absurdity. It's not a bit equivalent in difficulty or in risk to tooth drilling and filling. There are operators with good and with mediocre results. Carpal tunnel surgery can be great, but it isn't a light-weight decision; conservative measures should definitely be tried first and if you do need surgery, select your surgeon very carefully.

Yes. I served on a jury in a case where the carpal tunnel surgery was really botched and the guy was trying to sue the manufacturer of an item in his work environment saying that it was the design of this item that caused the nerve damage. I can only surmise that he lost his case against the doctor and his employer and was going for the last deep pocket he could find. We felt very sorry for him, but the evidence presented didn't convince us that the manufacturer was responsible for his injury and the resulting disability. He showed us his surgical scars and we all agreed in the jury room that we had never before seen such a botched job for CT.

[Fastfingers]

It is wise to be a little weary of surgery in general. But I have to insist that this is minor surgery. It has very good results and few complications. For the unfortunate few that have a deep infection or shoulder-hand-finger syndrome or even nerve injury its not a minor surgery as someone pointed out. Even the most experienced surgeon will rarely experience complications. There is no way to reduce postop infections to zero. Just by cutting down to the carpal tunnel a few tiny nerves innervating the skin is cut. In rare case it causes long time pain. But its is still the surgery with best results in hand surgical practise.
It is also a profitable operation in some healthcare systems which results in some marketing from health care professionals. When choosing carefully, keep in mind its easy to mess with the statistics of complications. Its possible to refuse surgery to diabetics, heartfailure, morbid obesity and patients in otherwise poor condition mentally or physically. These patients can be operated in the hospital thereby contributing to the complicationrates there. I agree its better to go see someone who is experienced but honestly the hardest thing is the desitionmaking thats hardest not the surgery. The surgeon should wear loupes and either the surgeon or the 2 nd surgeon should be experienced(100+ surgeries) Thats how you secure the best results.

Magnus

[ThomasBenBryant]

before I got into cg I played in a touring jam band. we would play 4-5 shows a week at a minimum of 3 hours a show, they were usually 4+ hours. On the days we weren't on stage we would set up in rented spaces and practice and write. I started having lots of trouble with my left hand and got a huge cyst in my wrist. It got so bad that I could not hold anything very heavy with my left hand without my wrist giving out. A friend of mine who did theraputic massage showed me a series of exercises and he did some massages that took care of the problem. The massages were extremely painful but after a few weeks of them and continuing to do the exercizes I haven't had any problems in a few years now. you might want to look into a liscensed sports therapist for something like this.

[ronjazz]

Aaron Shearer's "Learning The Classic Guitar" is a good method for teaching your hands the best positions to avoid injury. Knowing some anatomy us helpful as well.