Fretting wrist tendinopathy—at (half)wit’s end

[Chicago Sandy]

Haven’t been on here for awhile, because I also haven’t played out since January, nor have I picked up a guitar since re-humidifying my collection about that time.

In early Feb. I fell upstairs—was wearing padded clogs, climbing carpeted stairs and did not feel one shoe falling off. Reached the top, and the height discrepancy between the wood-floored landing & the carpeted stairs threw me off-balance. I landed first on my right elbow and then (I think—it happened so fast) on my outstretched left hand. Was okay for a day or two, and it began to be a little sore, so I reached for the bottle of Tylenol. The stupid childproof-capped bottle of Tylenol. Yee-OUCH! Even sorer, clicking when supinating (pivoting outward). Iced it. Took Celebrex & Tylenol, slathered on Voltaren & arnica gels and menthol & lidocaine roll-ons. All to no avail after a couple of weeks.

Thought it was the stiff leather band of my Apple Watch; switching to the mesh dress band helped a little but going bare-wristed made no difference.

Went to the walk-in ortho clinic at my hospital system for X-rays & exam. Sports orthopod on duty called it a TFCC (triangular fibro-cartilaginous complex) strain exacerbated by an “ulnar variance:” my ulna is a tad too long because of spurs on its end. He said it would be counterproductive to immobilize it so long after the injury; advised me to use moist heat and whatever anti-inflammatories (oral or topical) I could tolerate, and to see the hand surgeon in six weeks. He said the Apple Watch had nothing to do with it.

Almost 6 weeks went by, and by Easter Sunday I felt good enough to start practicing gingerly for all the performances I have coming up in late spring/early summer. No pain or clicking on supination. That night, I got into bed and used my left hand to prop myself up to turn over...and I felt a searing pain. By morning, my wrist was not only sore but stiff—and now I couldn’t pronate it (roll it inward).

My follow-up hand surgeon appt. was the next day. He looked at the X-rays, noted the ulnar variance and “arthritic changes at the base” of the thumb, did some diagnostic manipulations and announced I had ulnar-sided tendinopathy—tendinitis that failed to heal. He gave me a cortisone shot and said to keep up the oral & topical NSAIDs, but to use ice instead of heat. He also gave me a stiff splint-brace to wear as much as I could but at least for sleep “so you don’t do anything stupid while turning over.” He opined that the watchband is itself acting as a brace and I should wear it if I take the brace off. It felt a bit better after a week—but then, without thinking, I used both hands to help propel myself out of a low-slung armchair. Uh-oh. And I was still having the “cortisone flare” from the shot—black, blue, swollen, sensitive to the touch.

Been wearing the brace faithfully to bed—I discovered on a flight to Rome a couple of weeks ago that there was no comfortable way to hold my arm while conscious when wearing it. Until a week ago I couldn’t play anything but dulcimer. It feels a bit better to attempt guitar—okay for first position chords., but it hurts playing movable chords up the neck and I can’t play barre chords cleanly because it is agonizing to apply the pressure I used to be easily able to use.

Here’s my dilemma: my surgeon appt. follow up is next week, May 16. But I have a gig this Fri.night (May 11) in Madison (I’m in Boston without access to a guitar for practice till I get home tomorrow night). It’s a gigshare, so it’s only an hour set which I can “pad” with dulcimer songs. BUT I have gigs—including two festivals—the last four weekends in June. One is a two-day dulcimer festival where I’m teaching; and one is a duet—not lead, thank goodness—on the processional for my best friends’ son’s wedding. They had requested dulcimer, but it has all sorts of chords that will not work on a diatonically-fretted instrument, not even by cheating with playing only one or two notes because the oboist on lead would intermittently stick out abruptly. The groom said in that case, guitar would be okay (he’s a virtuoso himself...no pressure), but the chords in question require barring.

I’m terrified I may have to stop playing long-term, perhaps permanently. Ironically, I am in top vocal shape. I have told nobody because both my doctors reassured me I’d be fine by now. Suggestions? Can anyone talk me down off the ledge?

[Jim Owen]

Sandy,

I hope the long-term is better than you fear. The short term will depend a lot on how well you respond to that cortisone shot.

Your plan for the upcoming gig sounds good—go with the dulcimer.

Practice is hard for you right now. But it’s important not to hurt yourself trying. We have all played with a little pain; adrenaline kicks in with some natural anti-inflammatory action. But don’t try just to tough it out. (I’ve done that with tendinitis in my left hand, and my healing time was longer because of my stubbornness.(

Keep us posted.

[Otterhound]

It may be time to consider playing left handed .

[Chicago Sandy]

Originally Posted by Otterhound

It may be time to consider playing left handed .

Considered that, as well as slide and Joni Mitchellesque open tunings. But time is of the essence—no way could I be up to speed in time for any of my upcoming gigs, not even this fall. You know what they say about old dogs & new tricks (at 67 I can’t memorize new chord forms or even remember to fudge barre chords by playing just the right partials). What I think I’ll have to do is level with my singing partner (who won’t be playing Fri. but running sound & emceeing instead) about just how much of the guitar slack he’s willing to take up. He’s a confident picker, but so many of our arrangements depend on switching chord-melody leads (especially my solos). I just hope he doesn’t hit the ceiling.

As to the wedding, the groom had asked for an Ashley MacIsaac fiddle tune called “MacDougall’s Pride,” which sounds as if it’s a trad Cape Breton tune (the groom’s mom—my BFF—is a native Nova Scotian). The plan was for me to play rhythm on dulcimer and the fiddle part taken over by oboe. Wish he’d chosen Pachelbel’s “Canon in D,” which I can play on dulcimer in my sleep. I could use my student model chromatic dulcimer which looks like dreck (I had to mark the standard diatonic frets with a Sharpie, for a gig in which I had to play a couple of Mitchell songs—one in her idiosyncratic tuning, which I gave up trying to learn and just figured out chromatically, and the other in standard DAD diatonic. I have since learned the Sharpie paradox: it’s permanent if you don’t want it to be but rubs off easily if you’re counting on it to be indelible...but what rubs off on fingers is indelible). And I haven’t tried playing it yet on chromatic—will have to use the sheet music and suss out the chords. (Dulcimer is easier with a sore wrist because the left hand doesn’t require wrist torque).

[aknow]

Originally Posted by Chicago Sandy

Haven’t been on here for awhile, because I also haven’t played out since late Dec. nor have I picked up a guitar since re-humidifying my collection in early Feb.

In early Feb. I fell upstairs—was wearing padded clogs, climbing carpeted stairs and did not feel one shoe falling off. Reached the top, and the height discrepancy between the wood-floored landing & the carpeted stairs threw me off-balance. I landed first on my right elbow and then (I think—it happened so fast) on my outstretched left hand. Was okay for a day or two, and it began to be a little sore, so I reached for the bottle of Tylenol. The stupid childproof-capped bottle of Tylenol. Yee-OUCH! Even sorer, clicking when supinating (pivoting outward). Iced it. Took Celebrex & Tylenol, slathered on Voltaren & arnica gels and menthol & lidocaine roll-ons. All to no avail after a couple of weeks.

Thought it was the stiff leather band of my Apple Watch; switching to the mesh dress band helped a little but going bare-wristed made no difference.

Went to the walk-in ortho clinic at my hospital system for X-rays & exam. Sports orthopod on duty called it a TFCC (triangular fibro-cartilaginous complex) strain exacerbated by an “ulnar variance:” my ulna is a tad too long because of spurs on its end. He said it would be counterproductive to immobilize it so long after the injury; advised me to use moist heat and whatever anti-inflammatories (oral or topical) I could tolerate, and to see the hand surgeon in six weeks. He said the Apple Watch had nothing to do with it.

Almost 6 weeks went by, and by Easter Sunday I felt good enough to start practicing gingerly for all the performances I have coming up in late spring/early summer. No pain or clicking on supination. That night, I got into bed and used my left hand to prop myself up to turn over...and I felt a searing pain. By morning, my wrist was not only sore but stiff—and now I couldn’t pronate it (roll it inward).

My follow-up hand surgeon appt. was the next day. He looked at the X-rays, noted the ulnar variance and “arthritic changes at the base” of the thumb, did some diagnostic manipulations and announced I had ulnar-sided tendinopathy—tendinitis that failed to heal. He gave me a cortisone shot and said to keep up the oral & topical NSAIDs, but to use ice instead of heat. He also gave me a stiff splint-brace to wear as much as I could but at least for sleep “so you don’t do anything stupid while turning over.” He opined that the watchband is itself acting as a brace and I should wear it if I take the brace off. It felt a bit better after a week—but then, without thinking, I used both hands to help propel myself out of a low-slung armchair. Uh-oh. And I was still having the “cortisone flare” from the shot—black, blue, swollen, sensitive to the touch.

Been wearing the brace faithfully to bed—I discovered on a flight to Rome a couple of weeks ago that there was no comfortable way to hold my arm while conscious when wearing it. Until a week ago I couldn’t play anything but dulcimer. It feels a bit better to attempt guitar—okay for first position chords., but it hurts playing movable chords up the neck and I can’t play barre chords cleanly because it is agonizing to apply the pressure I used to be easily able to use.

Here’s my dilemma: my surgeon appt. follow up is next week, May 16. But I have a gig this Fri.night (May 11) in Madison (I’m in Boston without access to a guitar for practice till I get home tomorrow night). It’s a gigshare, so it’s only an hour set which I can “pad” with dulcimer songs. BUT I have gigs—including two festivals—the last four weekends in June. One is a two-day dulcimer festival where I’m teaching; and one is a duet—not lead, thank goodness—on the processional for my best friends’ son’s wedding. They had requested dulcimer, but it has all sorts of chords that will not work on a diatonically-fretted instrument, not even by cheating with playing only one or two notes because the oboist on lead would intermittently stick out abruptly. The groom said in that case, guitar would be okay (he’s a virtuoso himself...no pressure), but the chords in question require barring.

I’m terrified I may have to stop playing long-term, perhaps permanently. Ironically, I am in top vocal shape. I have told nobody because both my doctors reassured me I’d be fine by now. Suggestions? Can anyone talk me down off the ledge?

Get yourself some manual medicine. The god of pharmacy hasn't figured out how to heal tendinitis, tendinopathy, or ligament sprains by a pill. ("The best you can tolerate"? What an attitude).......Find a physician who knows how to heal by placing their hands on yours.
Good luck.

[Silly Moustache]

Hi Sandy, so sorry to hear about this. I've had problems with my hads as well,suddenly second and pinky on both has developed "trigger" finger, and felt like sausages.and couldn't make fists in the mornings .... anyway, I won't go on, just to say, I used a brace at night, and bathed hands in as hot a basin of water I could bear, then smothered on Voltarol 12 hour and "Devil's claw" (a gel bought from a health food store, and tried to moderate playing, but kept hands moving. Slight improvement - had to wait six weeks to get an appointment with the one GP that can stab me with some cortisone in one wrist.

Considering the CTS operation , probably about a six months wait.

But, I can play play - and the experience has ed me to try to fret as lightly as possible.

Keep the faith. Thinking of you,

Andy

[Silly Moustache]

Oh btw - went to the physio today (other problems - too boring) and was told that chemo can cause nerve problems in hands ... sometime after ... (its been a year since mine).

Best, Andy

[jpd]

Sandy....open tunings?

[Mr. Jelly]

I sorry you have to deal with this. Good luck!

Here's my thoughts. I broke my fretting hand quit awhile back. My fingers are not where they used to be and don't work quit like they used to. My hand still aches often but not always. I found that the only thing that kept me playing the guitar was and is the passion I have for it. I have been playing for fifty years but it still came down to me picking it up and trying. Again and again. Still at times I have issues. Now I have a good excuse for "work arounds" that are what makes it possible for me to play. Some to get the job done and others to keep from trashing my hand. Which happened the other day and I was thinking, again, that this may be it. But I picked it up again and flat picked instead of finger picked and my hand felt better after a couple of days so now it's a little this and a little that. What I found for me was that I'm addicted to the thing and I have no choice in the matter really. I do love it. So good luck!

[Chicago Sandy]

I am terrified--the Madison gig is in less than 24 hours, and I have about half the range of motion in my left wrist that I used to. If I get a cortisone shot in the morning it'd have to be a systemic (Medrol) shot--a local one would only make it worse again (I am prone to "cortisone flares") before it gets better...which it hasn't. I'm pretty much back to square one. Saving grace is that I need play only one set, since I am sharing the bill with a touring duo from MA. But I have to ditch everything requiring a barre chord, pinky extension/add, or movable chord forms up the neck. Hot showers, arnica, Voltaren (Voltadol) gels all help but only for about five minutes.

My husband (an internist) says to take 40mg. prednisone, an NSAID and just "cowgirl up" and hope for the best before each gig. But what about practicing and rehearsing?

I've played through trigger fingers--for some reason they didn't interfere with my ability to chord or pick. This is different. I'd always been able to come back from injuries within a month or two, but I simply am not healing.

Andy, I didn't have chemo. The irony is that what I feared most about chemo would be neuropathy and hand-foot syndrome, and I rejoiced when I found out I could dodge that bullet. Nobody warned me that perhaps the aromatase inhibitor (estrogen-eliminating drug) I take to prevent my estrogen-receptor-positive breast cancer from recurring could keep a joint injury from healing--possibly becoming traumatic arthritis. It certainly caused the trigger thumb & forefinger on my picking hand, but those are at bay for now.

When I was in my late teens-early 20s, I had the neurological wherewithal to learn open tunings with myriad chord forms. At my age, though, the ol' synapses ain't what they used to be, and learning & memorizing new chord shapes (in several tunings, no less) is something that is likely impossible. And certainly not in time to reconfigure my entire repertoire to fulfill my upcoming commitments.

I don't know what would be worse--cancelling, screwing up with poorly fretted and muffled chords onstage, or having to quit mid-set. And I would be letting not only myself down, but my singing partner (after tonight, they're duo gigs). He is likely to hit the ceiling. Honestly--two orthopedists told me I'd be fine by now, and I saw no need to walk the plank prematurely.

Perhaps at 67 I have to face the possibility that music must--after all these years--become just a hobby again, and one that I may never be able to resume.

I will call my primary care doc in the morning--he will probably tell me to see my hand surgeon, who is not available till my appointment next week. I have to be in Madison by 6:30-7 pm the latest.

[Chicago Sandy]

Both docs told me to start the Medrol STAT. Primary (his PA, because he’s out of town) said they don’t do systemic steroid shots and that I should defer to the hand surgeon. Surgeon’s NP said don’t play unless I absolutely must, but if I must to immediately ice & elevate afterward. I see him Wed. for a regular follow up, at which time I will probably get an MRI to visualize specific soft tissue issues that x-ray & ultrasound couldn’t show—he doesn’t want to try another cortisone shot till he’s sure of what’s going on and whether surgery will be necessary or possible.And he says to get back into the brace/splint 24/7 except for showering (& if I insist, playing). Too early for physical therapy.

Both docs say the aromarase inhibitor could very well be impairing my ability to bounce back from a joint injury. But discontinuing it could make the cancer recur sooner.

Both docs told me to use my judgment about tonight (though surgeon prefers I not play guitar)
and level with my singing partner. Surgeon says to wait till Wed. before deciding on canceling future gigs. Tonight is a solo set on a double bill—my singing partner is running tech and emceeing. If the place has a fridge, and I can get through a set, I might store my ice packs there, go on first, and ice and elevate for the rest of the show. I am calling him and putting the ball in his court.

[Chicago Sandy]

So if I can’t handle playing in the round with the other act (a duo), I will go on first and hope for the best, playing at least two dulcimer numbers, two a cappella, and letting my singing partner back me up or be my special guest on those songs on which he plays most of the guitar. (On two of them, I can play harmonica). Will wear the brace on the drive up, a heat wrap before the gig, and ice afterward (place has a freezer for the gel packs). But no practicing once I get home.

[Chicago Sandy]

The gig wasn't as tough as I thought it might be. My surgeon & PCP both said I should avail myself of my emergency Medrol dosepak, taking all 6 first-day tablets before lunch. The surgeon said he'd prefer I not play till he sees me this Wed., but if I must, to ice and elevate afterward. So instead of playing in-the-round with the other act on the bill (a duo who recently moved from MA to NH), I went on first so I could do the icing & elevating while watching them. Wore the brace all the way up to Madison, then ran hot water over my wrist to loosen it up before going on, followed by a good slather of arnica gel. Put together a set list that didn't require any barre chords, and saved the toughest song (sliding chords up the neck to the 14th fret) for last. Hadn't planned to play it, but I figured if I was going to have to ice afterward, I should really have something to ice about.

My singing partner is turning out to be very understanding--says he'll configure our June gigs around my vocals & dulcimer; and he's sending me a book of jazz chords that can be fingered without barring or wrist contortions so I can begin practicing for my friend's son's wedding processional (assuming the surgeon says it'll be okay to play).

I will ask my surgeon about ultrasound/infrared heat therapies, as well as PT/OT before having to resort to another shot or heaven forbid, surgery (probably arthroscopic, to shave down the bone spurs on the end of the ulna so it doesn't irritate the tendon). He prefers to do his hand surgeries using only local or regional anesthetic (no sedation) so that patients can go back to work the same day if they have to.

[Chicago Sandy]

Had my followup today w/the hand surgeon (postponed 2 wks because he & his wife had baby #3). Good news/bad news. Good news: seem to have a bit more ROM than before. Bad news: still not healing well; tender point is further back along the ulna, and getting occasional spasms on the radial side as well as knuckles. Going in for MRI tomorrow to see if surgery is nec.; if so, will schedule it for July because I'd need 6-8 weeks to heal. Also, pending MRI results, I can start light supervised PT/OT. As for practicing guitar, the surgeon would rather I didn't (but if I must, moist heat before, <1/2 hr. per session, ice & elevate after); if I have pain the morning of a gig he will prescribe steroids to take only on that day. He thinks the problem may be bone spurs on the ulnar head inflaming the TFCC. Keep you posted.

[Dr. Spivey]

Best wishes, Sandy. I know how much you enjoy performing and hope this is just a bump in the road.