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Old 06-10-2013, 06:49 PM
Gtrfinger Gtrfinger is offline
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Default Ulnar nerve entrapment in fretting arm

Posting this as I'm getting no joy from my Dr.

Noticed a burning sensation on pinky side of left wrist which quickly spread to forearm when playing in a pub nearly 2 months ago. Forced me to stop.

I play fingerstyle as you can see from YouTube vids.

Internet research established ulnar nerve issue. Probably from a huge amount of practice sessions this year. I was getting ready to do a lot more. Pain mainly in the wrist. Though it can go right through from whole arm to the neck.

Dr said I must stop playing guitar for about a month, but didn't give me exercises to do, nor isolate where the compression of the nerve was, simply stating it was an RSI, or tendonitis. The state of play in UK is that referrals are done with Physio helpline, which seems a ridiculous set up, as one cannot demonstrate exercises over the phone. I had a phone consultation with physio who confirmed it was likely ulnar problem, and they'd email me exercises.

Another appointment with Dr resulted in him saying just stick with the NSAIDS.

only thing is, the email does not in any way present exercises that can be understood in three dimensions, and any further contact with physio helpline is with an operator,who's not a physio, who speaks English in foreign accent.

the only exercises I can find are on YouTube and they don't hurt at all. I can bend palm back fine etc. I can do all standard exercises without issue. But if I play for a minute it really does. I'm thinking it must be to do with muscular activity from use of ring and pinky fingers. Consequently only played guitar for about 20 minutes over the last 6 weeks. Doing my head in.

Can anyone recommend specific exercises for a guitarist with fretting arm nerve entrapment? At my wits end. I've phoned Dr back several times, who says referral to a face to face physio must go through the phone service. The phone service say it must go through Dr.

get strong feeling I'm stuck with budgetary constraints, and bored to death, and very stresses at the thought of not being able to play.

Exercises anyone?
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Old 06-10-2013, 07:24 PM
Ron614-CE Ron614-CE is online now
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Default Ulnar nerve entrapment in fretting arm

In my work as an ergonomist I see this frequently in high stressor tasks such as high speed repetitive assembly work that involves the use of torque wrenches. I am not a Dr. But I've worked with enough cases such as yours to be inclined to think rest is needed before even beginning any exercise routine. I understand the desire to play your guitar but if you'll be patient you might be amazed at how the body will heal itself if its given sufficient rest time.
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Old 06-10-2013, 07:33 PM
vintageom vintageom is offline
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[QUOTE=Gtrfinger;3504071]Posting this as I'm getting no joy from my Dr.



The state of play in UK is that referrals are done with Physio helpline, which seems a ridiculous set up, as one cannot demonstrate exercises over the phone. I had a phone consultation with physio who confirmed it was likely ulnar problem, and they'd email me exercises.

only thing is, the email does not in any way present exercises that can be understood in three dimensions, and any further contact with physio helpline is with an operator,who's not a physio, who speaks English in foreign accent.



Thank you for the insight into the state-managed healthcare system of the UK. Emailing you a physical therapy session and and an out-sourced helpline. I believe your model is on its way here as well.


Hope your problem resolves fully. Actually rest and anti-inflammatories do help and it is the type of thing that "toughing it out" can lead to serious and permanent impairment.
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Old 06-10-2013, 07:35 PM
email4eric email4eric is online now
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^^^^^^^
This, exactly (What Ron16 said).

I'm a Family Practice ARNP but not an ortho specialist or a PT so factor that into the extent you consider this perspective.

With either a nerve entrapment or tendonitis, inflammation is at work and causing the discomfort. When you use the limb in a way that aggravates the area, you keep it in a state of injury (inflammation) which involves a cascade of chemicals and reactions. You will be starting the healing process from the beginning each time you re-ignite the pain. There is no way to heal this except for ceasing the activity that is causing it.

It's not an exercise thing or a lack of strength thing. It's an inflammatory thing.

NSAIDs (if they're appropriate for you) and tincture of time.

A steroid injection could be helpful (or surgical decompression if there is a specific and solvable pathology) but not always. Ice also is an anti-inflammatory.

While probably not what you want to hear, I hope it's helpful.
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Old 06-10-2013, 08:59 PM
Von Beerhofen Von Beerhofen is offline
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I've had this problem a long time ago when a nerve got trapped in my elbow. Same tingling sensation in my pinky too but not as painfull as you describe unless I bend the elbow more then usual.
It was pretty annoying but I gave it the appropiate restperiod as I assumed it was guitar related. I've had more problems by 'over' practising and once I understood it could dammage things in my arm I take a break away from playing as soon as I notice even the slightest pain.
The sooner you do that the sooner the problem goes away.
I've not experienced any further negative issues after these facts and am still practising, at 60+ years old, as much as I did when I was 20.

Ludwig
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Old 06-10-2013, 09:09 PM
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See an osteopath or chiropractor and have your elbow and wrist adjusted.
Medial adjustment on radial head can improve outcome rapidly.
Good luck.
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Old 06-10-2013, 09:25 PM
edmidlifecrisis edmidlifecrisis is offline
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I went through this a few years ago and was sent to PT for treatments. The treatments plus some NSAIDS plus tincture of time made it go away completely. Also don't rest your elbow on a hard surface (elbows off the table), this aggravates the condition as it puts pressure on the ulnar nerve where it crosses over the elbow and gets inflamed. Cold packs helped too, as someone else said. Also as someone else said, I did see a very good chiropractor a few times.

The doctor I went to (PMR, physical medicine and rehabilitation) was talking about nerve transposition as a worst case scenario. I thought that there was no way I would go through such an intrusive and risky procedure and was determined to see it resolve non-surgically. It did. Good luck.
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Old 06-10-2013, 09:47 PM
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Gtrfinger,

Is the problem only in your pinkie finger? The ulnar nerve supplies the pinkie side of the ring finger and the entire pinkie - which sounds exactly like what you describe. It can be irritated by stretching (I would not recommend any adjustment) or over use. NSAIDs and rest are appropriate. A month is a long time. But my rule of thumb (pardon the pun) is a week without pain. So take a week off past when you're pain. If you have pain after an hour of playing or less, take another week off. Steroid injections would be fine if you could localize the point of entrapment most commonly your elbow (ulnar canal i.e. funny bone) or wrist. EMG testing (nerve conduction studys) may help here too. If you gently rub either area - can you elicit the same pain? Finally, surgery does usually work, but is always a last resort.


I recently had the same issue with the radial nerve (thumb) after practicing holding barre chords and doing melody notes with my pinkie over and over for a week. I took a week off with NSAIDs and I just avoided holding prolonged barre chords. Yours, unfortunately, sounds more severe as it hurts after a few minutes of routine playing.

And yes, I am an MD, but not examining you personally and with no test results, please only consider this Guitar Forum advice and NOT medical advice. You see in the USA, we may be able to get you a quick referral and a battery of tests, but oh, do we have lawyers.....

Feel better,
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Old 06-10-2013, 09:48 PM
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Howard Klepper Howard Klepper is offline
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Quote:
Originally Posted by vintageom View Post


Thank you for the insight into the state-managed healthcare system of the UK. Emailing you a physical therapy session and and an out-sourced helpline. I believe your model is on its way here as well.
Way to politicize the thread.
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Last edited by Howard Klepper; 06-10-2013 at 09:53 PM.
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Old 06-10-2013, 09:52 PM
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This has helped me a ton!

https://www.youtube.com/watch?v=gdlt01rhRHk

Lots of vidoes of these on youtube
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Old 06-10-2013, 11:22 PM
hesson11 hesson11 is offline
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[QUOTE=vintageom;3504128]
Quote:
Originally Posted by Gtrfinger View Post
I believe your model is on its way here as well.
It can't make our system much worse! The OP's problem sounds very much like my own nerve entrapment. My problem is that I'm self-employed and the only health coverage I could find permanently excludes coverage for repetitive-stress injuries. I hope when the new health-care law kicks in that I can actually get coverage for the things that are wrong with me!

-Bob
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Old 06-10-2013, 11:29 PM
Jduprasiv Jduprasiv is offline
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Had the same issue in my strumming arm. Had the nerve transposition surgery. 8 weeks in a cast and several more of rehab. But, no more issue. I consider myself lucky.
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Old 06-11-2013, 12:39 AM
jibberibber jibberibber is online now
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Sorry to hear about your injury issues. It's no fun at all, I went through over 4 years of being sent around in circles by doctors to various practitioners. Some things helped the problems go away, but for me they always came back when I picked up the guitar again, sometimes in a different area.

I believe that for almost all of what we call repetitive strain injuries, what matters most by far is how you use your body as you play. This is your responsibility. For years I thought I was a victim of something , and it actually became a huge part of my identity. Now I believe if you have injury issues, you are most likely doing something wrong. But the approach most doctors and practitioners take is trying to get rid of your symptoms, instead of wondering why you got the problem in the first place.

What saved my playing life was Alexander Technique lessons, and since then I have completely changed the way I use my body when I play. They can help you become aware of patterns of unnecessary tension in your musculature that are under your radar, and that contribute to or entirely cause your issues. I believe AT lessons are covered by healthcare in the UK. Not a quick fix at all, but everything else I encountered was just a band-aid that didn't address the cause of the problem...which was me!

Keep us posted!
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Old 06-11-2013, 03:52 AM
Gtrfinger Gtrfinger is offline
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That's brilliant. Thanks everyone. I'm going to have to resist playing guitar for even 5 minutes I think, until I'm pain free for at least a week.

Just concerned that my level will have dropped significantly by then. Sounds like it could take months.

I'll make an appointment with chiropractor and Alexander Technique practitioner, though they are not normally publicly funded in UK.
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Old 06-11-2013, 06:00 AM
Pink Panther Pink Panther is offline
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Quote: "Internet research established ulnar nerve issue. Probably from a huge amount of practice sessions this year. I was getting ready to do a lot more. Pain mainly in the wrist."


Hi Gtrfinger! This is a condition I have encountered repeatedly over many decades amongst obsessive practisers, (it's the only way you are ever going to get perfect right?) and such thinking Players, intensely dedicated Players, and Professional Session Players. One very famous one of which had to drop out of Session Work for some while, and subsequently went into Musical Education.

You have to adjust your mental thinking, you have to moderate your methodologies, and you have to fundamentally change the manner in which you address your Instrument. If you do these things you can virtually eliminate the issue, and enjoy a long, happy, successful relationship with your Instrument Playing at a Professional Level.

If you don't do these things, this problem will continually dog you your whole Playing career and probably even Stop You Playing Altogether. I am not a Doctor. Rather I am someone who has Played at a Professional or Serious Level for Recordings for Fifty Years and don't have the problem at all, although when I was much younger, around your age I did. So I must have learnt something to great advantage.

Furthermore, it's an issue I have helped Professional Players with at the Highest Level, Repeatedly over the years, and is a Perennial Topic for Discussion And because it makes the difference between whether they can actually earn a living or not, it actually is a Life Changing Subject. I am also very interested in How Musical Instruments are Manufactured. So am fascinated by Factories and Production Methods. I also work directly with Large Corporations involved in Manufacturing at the Highest Level. High Productivity Ergonomics and Health and Safety are today at the top of the agenda for Companies, as there is a huge, entirely avoidable cost to the Business to bear, when workers suffer from Repetitive Strain Injuries.

So what I am going to discuss with you is based upon all that Professional Experience.



What you must realise, is that as a Totally Objective Fact for instance..

I take the view based upon my personal observation and experience, that 99% of Guitarists do not even know how to properly open their Guitar Case without doing damage to their Guitars.

Although you may find that difficult to accept, the evidence is there, plain to see all around you, to back that up. However, the Salient Point that relates to you and your problem. Is that you first Need To Accept, that there are issues related to Guitar Playing, that people assume to be merely a matter of common sense.

When that is clearly not the case. Areas where when beginning to learn to Play, they merely copy what they have seen many other Players do, or indeed simply do what feels convenient to them. It's just plain common sense right? We don't need to think more about these things than that.


Well just like the FACT, that you can do great damage to a Guitar simply by not opening the case in an entirely correct manner.

We can do also great damage to ourselves, and our Bodies by not Playing the Instrument in the Correct Manner. And there is an Optimal Manner to do so.

The thing is, we must First Accept that what we thought to be a matter that's simple, just common sense, requiring no thought whatever. is really Rather Complex indeed, when we consider it holistically, in its entirety, and with the full benefit of hindsight.

Unless you can Accept This, I fear the rest of what I write will not really help you much, as you will be reluctant to make the essential changes you need to eradicate the issue, as completely as possible, and thus the cure cannot possibly work and you will continue to have problems throughout your Playing Career.



Let me begin like this. Much of my experience, has come from helping Bass Players.

A recent one that comes to mind has a habit of jumping all over the Stage while he is Playing, and this places further strain on his hands. But basically, he had the same problem as you. Bass Playing is an easy way for you to understand my points.

If you ask any Bass Player, (many of which suffer with your type of problem, as a Bass String requires rather more strength that a Guitar to Finger, and the Scale Length creates far more strain), who their favourite Bass Player is. Pound to a Penny they will say James Jamerson. Or perhaps Jim Fielder, who is another good example.

Then I say, well why don't you hold your Instrument to your body like James Jamerson did, if you admire him so much?

http://prorecordingworkshop.lefora.c...1150068/JJ.jpg

http://prorecordingworkshop.lefora.c...1150505/ff.jpg


The point is Jamerson moved from Upright Bass to Electric Bass and carried over his technique from one Instrument to the other.

Like Jim Fiedler, he held his Instrument in the Optimal Playing Position. In other words, his Left Hand employed a Solid Classic Technique which was greatly enhanced by the fact that the Neck of his Instrument was addressed to his Body more vertically than usual.

This manner facilitated the Classic Playing Technique which involves the use of all four fingers, addressing the neck in a way that ensures they all can be utilised, with as little strain as possible being placed upon the muscles and nerves, through Incessant Repetitive Playing.

You should easily be able to see the sense of this for Upright Violin Bass Players. And hopefully, can now properly understand how Electric Bass Players too can have both an Improved Playing Technique, and far less Hand Strain Problems, by adopting a Similar Stance with their Instrument.

http://prorecordingworkshop.lefora.c...1150506/gg.jpg

http://prorecordingworkshop.lefora.c...150507/hhh.jpg


So now let's see what great Guitar Players do.

I have here some picture of Segovia, the man who single handed, defined what Classic Guitar Playing is, and should be in the context of an Orchestral Instrument, and thus set the Rules of Concert Playing for everyone that followed. Before Segovia, The Classical Guitar was not accepted in that Arena. People forget or usually don't realise that he invented the concept!


Segovia

http://prorecordingworkshop.lefora.c...%20%281%29.jpg


Djano Reinhardt

http://prorecordingworkshop.lefora.c...%20%282%29.jpg


Joe Pass

http://prorecordingworkshop.lefora.c...%20%282%29.jpg


Joe Pass

http://www.youtube.com/watch?v=MLGf5tPPfe8


Martin Taylor

http://www.youtube.com/watch?v=mxLU8md9JFg





P
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