Carpal Tunnel: I might be getting it?

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
uptempo

Carpal Tunnel: I might be getting it?

Post by uptempo » Thu Apr 07, 2016 2:30 pm

Hi

About three weeks ago I noticed that whilst playing I would kind of get tingling/numbness in my right hand fingers - noticeably the m and a fingers. It hasn't got any worse but also hasn't got any better either. I wouldn't say it is painful but it is 'there' and it affects my playing. I don't have full numbness but it is bothersome when playing.

I have a feeling (or not) that my right arm position has caused this because now I have looked at it I believe that the part of the arm that rests on the guitar is compressing the nerves/tendons etc and has caused the problem.

Does anyone feel like this is the culprit? I have started doing a range of stretches frequently throughout the day so hopefully I can keep it at bay. I have also started to practice with a straighter wrist and with more contact on the top with arm in a different position. I'm gutted really because I have put a fair bit of work into my playing over the last 6 months and seen some good improvement..

Any advice would be appreciated

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Re: Carpal Tunnel: I might be getting it?

Post by bear » Thu Apr 07, 2016 2:53 pm

uptempo wrote:Hi

About three weeks ago I noticed that whilst playing I would kind of get tingling/numbness in my right hand fingers - noticeably the m and a fingers. It hasn't got any worse but also hasn't got any better either. I wouldn't say it is painful but it is 'there' and it affects my playing. I don't have full numbness but it is bothersome when playing.

I have a feeling (or not) that my right arm position has caused this because now I have looked at it I believe that the part of the arm that rests on the guitar is compressing the nerves/tendons etc and has caused the problem.

Does anyone feel like this is the culprit? I have started doing a range of stretches frequently throughout the day so hopefully I can keep it at bay. I have also started to practice with a straighter wrist and with more contact on the top with arm in a different position. I'm gutted really because I have put a fair bit of work into my playing over the last 6 months and seen some good improvement..

Any advice would be appreciated
There are some exercises on utube. This is one that I do frequently. In the beginning I would do it against a mattress while lying on my side. The mattress has enough "give" so that I could ease into the position over several days.

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uptempo

Re: Carpal Tunnel: I might be getting it?

Post by uptempo » Thu Apr 07, 2016 3:44 pm

Thanks

I have started these exercises but perhaps more importantly I have really looked at my wrist on the right hand and adjusted it to be straighter. Hopefully I can ward this off before it becomes a real problem.

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Re: Carpal Tunnel: I might be getting it?

Post by Tomzooki » Thu Apr 07, 2016 4:08 pm

CTS (carpial tunnel syndrome) more typically affects the thumb, the index and the middle finger. The A will be affected on the middle finger side, and not on the pinky side. The pinky is not affected at all. But if it is not what you have you still have to find the cause and find solutions. My guess is it may be related to your RH technique.
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Re: Carpal Tunnel: I might be getting it?

Post by UKsteve » Thu Apr 07, 2016 4:39 pm

uptempo wrote:Any advice would be appreciated
Don't go looking for medical advice on the internet, or even on a classical guitar forum.

If the symptoms are much more than an niggle then there are a range of potential diagnoses. None of us here can sensibly help you without being appropriately qualified and taking a full history, examination etc.

uptempo

Re: Carpal Tunnel: I might be getting it?

Post by uptempo » Thu Apr 07, 2016 7:12 pm

Okay thanks all - I will go and see someone about this as soon as I can and get a proper diagnosis and some kind of plan to relieve it.

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Re: Carpal Tunnel: I might be getting it?

Post by D.Cass » Thu Apr 07, 2016 8:07 pm

As mentioned before CTS effects the first fingers, thumb index middle. Sometimes a pinch nerve in the neck affects the ring and pinky fingers. It is even hard to say the guitar is the issue. Once, I had student claiming the guitar was causing his right had going numb and causing pain in the forearm. He was later diagnosed by a doctor he had a torn labrum caused by something completely unrelated to the guitar. Apparently he took a fall and braced himself with his arm. My advise is to see a doctor for a proper diagnosis and then try to determine if it is guitar related or not.

uptempo

Re: Carpal Tunnel: I might be getting it?

Post by uptempo » Fri Apr 08, 2016 7:09 pm

Thought I would update:

Doctor hasn't got a clue. She "thinks' this is related to something in the neck and has suggested seeing a physio. I do suffer a lot with neck tension so it would not surprise me; however, in years of playing I have never had this issue.

I notice it most if I do arpeggios. The feeling is one of tension/numbness and it is very hard to describe because now I think about it the middle finger seems to be the issue. I have been playing a bit more in recent weeks and so I wonder if I have introduced tension into the hand. About five weeks ago I could do very fast p i m a m i arpeggios and right now they are stalling and feel very tense.

It is very frustrating.

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Re: Carpal Tunnel: I might be getting it?

Post by lagartija » Fri Apr 08, 2016 7:29 pm

Consider this a message from your body! Take a break here and find out what is going on. Are you working with a teacher? If not, I would recommend that you have someone evaluate your technique so that you don't hurt yourself. If you can't tell whether or not you have introduced tension into your pimami arpeggio, you need to consult with a professional.

If I were you, I would not push the speed thing until I undertood what is going on with my hand. At most, I would practice the arpeggio slowly, concentrating on what I am feeling in the back of my hand and at the point in the arpeggio where the exchange occurs between a and m on the change of direction. That is, am I releasing both i and m when a plays or am I holding in i?
I did go through this sort of careful training when I started to play Mertz' Fingal's Cave which has a pimami arpeggio in it. If you do this carefully and slowly with great attention to the sensation in your hand, does it get numb? Look in the mirror and see where your right shoulder is....is it relaxed or up somewhere around your right ear? This is where a teacher is indispensable in helping you fix what might be wrong. If you are busy doing speed and not aware of some of these things while you do it, then pay someone to watch you who knows what will cause a problem. It is the best investment you could make!
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uptempo

Re: Carpal Tunnel: I might be getting it?

Post by uptempo » Sat Apr 09, 2016 11:42 am

Some more thoughts:

In answer to Lagartija: I am indeed working with a good teacher and I really don't feel this is where the issue is. Moreover recently I had a world class concert player look at my position and it is fine. I don''t think it is related to guitar playing but something simpler that I had not really thought of until now.

It's either:

1. Every Friday I clean the house and without fail I smack my right hand fingers head on whilst rubbing surfaces with cloths wrapped around hand - particularly fixtures and fittings in the bathroom or kitchen. At the time - the middle finger - which takes the brunt of the hit is obviously lightly bruised but then it kind of goes away. I also bang the other fingers head on as well. Perhaps I have some soft tissue injury and need to be more careful from now on.

2. I usually, play without nails, but every so often I grow them out for the sheer hell of it. About a month or so ago I grew the nails but when a few of them split I tired various products to repair and harden them - the most severe being 'guitar player nails'. I used clear acetone to remove nail polish etc and I am wondering if this has also caused some injury. The guitar players nails require some brutal sanding by the way!

It might be a combination of the above two things.

Anyway, in the meantime my nails are now short, I use 'Burts Bees' to keep them healthy (incidentally I like this product) and I am stretching the median and ulnar nerve after every session of about half an hour.

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Re: Carpal Tunnel: I might be getting it?

Post by lagartija » Sat Apr 09, 2016 1:14 pm

Ok, that is useful information and I am very happy to hear that you are working with a teacher. :-D
Have you considered wearing padded gloves if you are going to be that rough on your hand when you clean? :-P
Having practiced karate for decades and suffered knuckle bruises and other soft tissue injuries, I cannot remember a time when that resulted in numbness or tingling in the fingers.
:-?
However, tweaking or pinching a nerve did result in numbness and or tingling and slowness of function. If I were you, I would see what a physiotherapist says and if that is not immediately helpful, make an appointment with a neurologist.
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Re: Carpal Tunnel: I might be getting it?

Post by Paul Janssen » Sat Apr 09, 2016 2:33 pm

One other thing that is worth looking at (for all of us actually) is how often you use a mouse on a computer. I necessarily have to use a mouse for my work (I sit at a computer for most of the day). So I invested in a large "gaming" mouse that fitted my hand well and complimented it with a gel mouse pad. You'd be surprised how much pressure you can put on your carpel tunnel by resting the weight of your hand down on it when using a mouse incorrectly. There are also some specific ergonomic mouses (or is it mice?) designed to reduce the risk and/or help alleviate the symptoms of CTS. Could be worth investing in something like this if you use a mouse fairly often.

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Re: Carpal Tunnel: I might be getting it?

Post by mverive » Sat Apr 09, 2016 4:59 pm

uptempo wrote:Thought I would update:

Doctor hasn't got a clue. She "thinks' this is related to something in the neck and has suggested seeing a physio. I do suffer a lot with neck tension so it would not surprise me; however, in years of playing I have never had this issue.

I notice it most if I do arpeggios. The feeling is one of tension/numbness and it is very hard to describe because now I think about it the middle finger seems to be the issue. I have been playing a bit more in recent weeks and so I wonder if I have introduced tension into the hand. About five weeks ago I could do very fast p i m a m i arpeggios and right now they are stalling and feel very tense.

It is very frustrating.
Without knowing what tests your doctor preformed, it's impossible to give much more medical advice. Regarding the advice to see a "physio", was that a physical therapist? If so, that is an EXCELLENT idea, as physical therapists are well trained (more than most of us physicians) in the assessment and management of carpal tunnel and other musculoskeletal conditions. Ditto for nerve injury from holding your neck in a position that can put strain on the nerves and nerve roots in the neck.

To prevent further injury in the meantime, it is imperative to lay off guitar, or at the very least make sure that you are holding your wrist in a "neutral position":
IMG_3846.JPG
The wrist position used by many guitarists places the wrist in a significant degree of flexion, which compresses the carpal tunnel and ulnar/Guyon's tunnel as well:
IMG_3847.JPG
Note the position of the median nerve and ulnar nerves:
IMG_3848.JPG
Injury to the nerves involved can cause weakness to the muscles involved, and can result in PERMANENT and DISABLING injury if not appropriately diagnosed and treated. We used to refer to carpal tunnel and ulnar tunnel injuries as "repetitive stress" injuries, but they're really due in most cases to improper, non-ergonomic posture, since many individuals are able to type, play guitar, etc. without injury despite the repetitive nature of what they do.

So, while it's important to take a break from activities that cause pain, it's far more important to use posture and body mechanics that don't predispose to injury in the first place.

By the way, if you go to physical therapy or revisit your doc (or see a different doc), bring your guitar with you so that the doc/PT can see exactly what you are doing.

Best wishes for relief and avoiding further injury!

Michael Verive, MD
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uptempo

Re: Carpal Tunnel: I might be getting it?

Post by uptempo » Sat Apr 09, 2016 7:39 pm

Thanks ever so much for those photos and information.

I have still been practicing with a little discomfort but with a much better 'neutral wrist'. I must admit that I had gravitated to an arched, or higher wrist position but I don't think it was as extreme as I have seen in a lot of guitar players.

Come to think of it - it surprises me how some professional players get away with the high wrist action? I am sure we can all cite world class players who have a high wrist so maybe they are just lucky.

And as mentioned I am now performing regular stretching exercises for the nerves.

uptempo

Re: Carpal Tunnel: I might be getting it?

Post by uptempo » Sat Apr 09, 2016 7:41 pm

Paul Janssen wrote:One other thing that is worth looking at (for all of us actually) is how often you use a mouse on a computer. I necessarily have to use a mouse for my work (I sit at a computer for most of the day). So I invested in a large "gaming" mouse that fitted my hand well and complimented it with a gel mouse pad. You'd be surprised how much pressure you can put on your carpel tunnel by resting the weight of your hand down on it when using a mouse incorrectly. There are also some specific ergonomic mouses (or is it mice?) designed to reduce the risk and/or help alleviate the symptoms of CTS. Could be worth investing in something like this if you use a mouse fairly often.
I use a laptop on my knee - not good and this is something else to address isn't it.

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