De Quervain’s syndrome

De Quervain’s syndrome

Today I saw a little feature in the Irish Times about De Quervain’s syndrome. The article mentioned pain around the thumb associated with motions such as gripping. This caught my attention right away…

I play whistle for a few hours most days, and sometimes I notice that my thumbs get quite sore. I always try to keep my hands as relaxed as possible while I play, but perhaps I’m still too tense.

Apparently this condition is diagnosed by something called the Finkelstein manoeuvre. You fold the affected thumb in towards the palm, wrapping the fingers around it (making a fist with the thumb inside the fingers). If pain is felt when the wrist is moved in the direction of the little finger, it could be De Quervain’s syndrome.

I tried this after playing for a few hours and it did hurt - nothing unbearable, but noticeable discomfort. After resting for a few hours I tried it again and it didn’t hurt at all.

The article doesn’t talk a lot about the treatment of the condition, but mentions resting the hands (stopping the action that caused the problem! - now, I can’t really do that, can I?)

Does anyone else suffer from sore thumbs while playing whistle/flute/pipes? I’m wondering if this is something that could become a big problem down the road, or if I’m just being a hypochondriac and just need to learn to relax my hands more while playing…

Re: De Quervain’s syndrome

Could be plain old RSI. I spend most of my day working at a computer (you need money to buy instruments and food) and I certainly notice a tightness in my hand from time to time. I’m a box player and I find it sufficiently different to coding that I never find instrument-playing uncomfortable.

I think it’s a normal reaction to the kinds of things we put our hands through. They’re designed for swinging from tree to tree and catching salmon from flowing rivers, not small repetitive manual movements. I’m sure that if you stopped playing for a week and you still felt pain then you might have some cause for worry. But it doesn’t look like that’s the case.

Re: De Quervain’s syndrome

Remember to take breaks—the usual "45 minutes playing, 15 minutes break" will help preserve the old bones.

Re: De Quervain’s syndrome

It could be a possible long-term consequence of the dreaded "death grip" you see with some fiddlers. The answer of course is a relaxed left hand. If you press too hard with the fingers you’re going to get an opposing reaction from the thumb which will manifest itself as tightness in the grip and unnecessary tiredness in playing. Eventually there could be more serious problems.

Re: De Quervain’s syndrome

De Quervain’s Tenosynovitis is one of a myriad of "over use syndromes" but one to which musicians are particularly vulnerable. It is caused by repetetive motions of the wrist while the thumb is pinched (poorly initiated vibrato?) . On a physiologic level, it is an inflammation of the tendon sheath surrounding one or both of the extensor tendons of thumb that pass over the radial aspect (thumb side) of the wrist.

The initial round of treatment is the same as it would be for any other over worked tendon; rest from the offending activity and non-steroidal anti-inflammatory medications (NSAIDS’s) such as Ibuprofen or Naproxen. These medications can be irritating to the stomach and some people are allergic so if you’ve never taken these medications before or if you have any stomach problems such as ulcers, gastritis or reflux, you should talk to your doctor or other licensed health care provider before initiating treatment on your own. Some providers advocate heat in the chronic cases while others recommend ice in the acute phase.

Left untreated this condition can result in scarring of the tendon sheath and a resulting narrowing of that passageway. This will result in a clicking sensation when moving the thumb and may even develop into a permanently restricted range of motion. This last condition may require surgical intervention.

One way to mitigate your risk is to concentrate on relaxing your left hand grip on the neck. I am guilty of this, myself. For whatever reason I take a death grip on the fiddle and find that I’m actually squeezing the neck as I press on the strings rather than gently holding the neck and placing my fingers in the right position.

Re: De Quervain’s syndrome

Yes, lazy and ceolgaelach are right. You only need a light touch on the
holes of the whistle -
just enough to seal the gaps. You’ll get crisper ornaments that way too.
You should release the tension of your thumbs frequently while playing,
shifting the position a little bit. Or just taking a break from playing every
few minutes. I never had this problem with the clarinet - much heavier
and more demanding.

Re: De Quervain’s syndrome

i actually was diagnosed with this syndrome during my first go-round with attempting to play itm, as a fiddler. i was mad to play "that music" on fiddle and broke my heart over it for several years, quitting every few weeks/months due to excrutiating pain not in my neck hand, but in my bowing wrist/forearm, emanating up from my thumb. ucla medical center diagnosed it as de quervain’s and introduced me to this condition.. ..i could not locate a thumb position orthodox or unorthodox, that wouldn’t create crippling pain in my inner/wrist forearm of my bow hand. i was told at ucla that it is often seen in dental hygienists, who grip instruments with their thumb & forefinger, and apparently also in cellists. rarer in violinists…..the option i was given was surgery, but that seemed a drastic step given that surgery apparently is only effective 40 or 50% of the time for this thing. i was devastated…..

funny, though, i played other genres of music (paris musette, tango, klezmer) for a couple of years on PA, which opened me up to the world of free-reed instruments and took me back to itm via b/c button box. now anglo concertina is my principal instrument and i am getting to play "that music" as fully as i dreamt of at the beginning…….and what was a second-best consolation instrument (well, instruments, since i play a few free-reed instruments) has become my first-choice expressive passion and i wouldn’t have it any other way…..

Re: De Quervain’s syndrome

Conventional wisdom keeps referring to these conditions as “repetitive strain injuries,” but that’s actually misleading. Research (and my own experience) suggests that a major factor in the injury is “static loading” – holding a joint in a fixed position while applying a steady force. This is why posture and relaxation are so important in avoiding the injury.

This type of injury should never be taken lightly. While it’s true that most people recover after a few months, the symptoms can actually last for years. Or they may go away for a while and flare up months or years later.

I acquired a case of De Quervain’s syndrome twenty-two years ago after several hours of using a weed whacker with my right wrist bent. The inflammation spread and became intractable and I lost most of the use of my right hand for two years. After several months of doing everything left-handed, I strained that wrist. I’m still recovering. And relapsing. If I had known then what I know now, I probably could’ve avoided the injury or at least minimized the damage with proper therapy.

The moral is – Take it seriously. There are other threads here where we’ve discussed this. Here’s one:
https://thesession.org/discussions/17228/comments

Re: De Quervain’s syndrome

I have this, and the test described above fits exactly. While concertina doesn’t aggravate it much, it keeps me off the Norton…

Posted by .

Re: De Quervain’s syndrome

Thanks for the responses and the link to the previous discussion. I will certainly keep an eye on it and go to a doctor if it ever appears to get any worse.

I think for now I need to focus on relaxing my hands more while playing, as well as taking more regular breaks.

Re: De Quervain’s syndrome

ceemonster mentioned that the syndrome is seen in the bowing hand of cellists. I won’t dispute that even though I haven’t personally seen it in 60 years of playing the instrument; but if a case does occur it would most likely because the player has been holding the bow with a straight thumb; which is also a sure way of tiring the player and preventing him from bowing fast with coordination and achieving other aspects of full bow control.

The bow hold on the violin and cello are very similar (I play both instruments and don’t make any conscious effort when transferring from one to the other) and the secret is always to have relaxed bent fingers and thumb, including a bent pinky when it is necessary to have it in contact with the stick. A straight pinky (which is commonly seen, including amateur classical players) will stiffen the hand and prevent full relaxation.

Re: De Quervain’s syndrome

Bob himself, you’re a rank amateur. Everybody should know to keep his wrist straight when whacking.
(I shouldn’t joke — there’s nothing funny about being out of commission for two years — sorry)

Re: De Quervain’s syndrome

Now you tell me!

Re: De Quervain’s syndrome

I was also diagnosed with this recently. Every morning my wrist hurt, possibly due to a lot of kayaking and fluting. Last week I tried putting an elastic wrap around it before going to bed, and the next morning was the first time in a month that it was pain-free. I now use it during the day, too, and I think the restriction of movement is helping it to heal. Hope this helps!

Re: De Quervain’s syndrome

shaskeen, I think you’re right, about restricting movement to promote healing. I had a bout of this some years ago, and they had me wear a thumb/wrist splint during the day, for just that reason. And I had to quit playing music completely, for a couple of months. I also made a point of becoming ambidextrous with the computer mouse.

They also told me to avoid sleeping with bent wrists (you know, hands tucked in like a dozing housecat’s front paws).