Tendonitis in the hand. Anyone had to deal with this?

[TubaSteve]

I have developed a bad case of tendonitis in my right hand. It is mostly the thumb, but it is also the first finger also. My Dr. stated that the average case of tendonitis can last up to a year before it gets better. I find that I have a hard time holding my tuba, and the fast runs are sometimes a problem. If I play too much, I almost can't move my hand the next day. The Dr. said that I need to rest the hand as much as possible, but I work in a chemical plant with a lot of physical work, so resting my hand is really not practical. I hate to not practice between weeks, as I feel it really shows, but I want to get over this as quickly as possible. Anyone else here had to deal with this? Frustrating anyway! GRRR

Steve

[markaustinhowle]

I feel your pain. I had a similar problem while preparing to perform A Brass Menagerie on a tuba where the valve spatulas were positioned so as to cause my wrist to have a sharp bend while playing. I recommend you check to make sure you are not bending your wrist very far while playing, and if you are then you may possibly need to change tubas.

Mark Howle

[UDELBR]

Since the thumb is the main problem, consider having the thumb ring removed. They're rarely in the right place, and shouldn't serve as a way to support the instrument anyway, so best just to have it taken off.

I learned this via a thumb injury, and have never regretted taking the thumb rings off all my horns.

[scottw]

first off, when you say "my dr.", i am assuming you are referring to your general physician. my strong advice to you is to go see the very best HAND doctor you can find. you need a specialist not a generalist: trust me on this! i have undergone 2 major hand operations in the last 3 1/2 years [my typing right now is due to the latest one] and countless hours of rehab on them both. what a good doctor/rehab combo can do is absolutely unbelievable. the trick is to get treatment before the condition becomes grave--that is where the quickest and best results are to be achieved. do yourself a huge favor and take care of it now!

[Bill Troiano]

I don't know what your main horn is, but I had tendonitis many years ago. I was complaining about it to a cellist in the LI Symphony during a break. She watched me play and immediately saw the cause of my pain. I was greatly stretching my hand (fingers) to accomodate the large valves. I was playing a Hirsbrunner HP-1P back then. So, I started horn shopping, as the pain was not going away and I ended up with a Kalison DS tuba - smaller valves with less of a spread. The pain went away.

[Stefan Kac]

I had some trouble when I played a YFB-621. It was actually a combination of that and all of the mousing/typing I was doing with the computer (music notation programs can be demanding in this way, as I'm sure many here can attest to). It took some practice, but I eventually started using the mouse with my left hand, and that helped somewhat. I don't know if there's any way you can minimize the use of that hand at work; you wouldn't want to create another injury by favoring one hand.

When I got my MW 2141 (which has much larger and heavier valves than the 621), the first thing I did was remove the thumb ring. I haven't had any problems since.

[Dean E]

I have developed a bad case of tendonitis in my right hand. It is mostly the thumb, but it is also the first finger also. . . .

I had a similar injury a couple of years ago. I hurt my right arm gardening, and it was similar to tennis elbow. I wore braces on my wrist and elbow for almost a year before the weakness and pain went away.

http://images.google.com/images?q=wrist ... rt=36&sa=N

http://images.google.com/images?gbv=2&s ... rch+Images

Sounds like it could be an on-the-job injury. If so, treatment will be covered by the state workers' compensation plan. Your employer must give you time off for treatment and pay for the medical expenses and travel. Some states permit you to visit a chiropractor, which I would recommend, even if not covered by insurance.

[Art Hovey]

I agree that if your thumb is hurting then you should stop using the thumb ring. You might want to improvise a support to rest your hand on instead.
Some tubas can be played left-handed. When your right hand hurts enough that becomes a respectable option. I also once saw a rotary-valve tuba that had been modified to be played left-handed. They only had to move the linkage around a little; no tubing was altered.

[iiipopes]

Indeed. I got mine in my left arm from a combination of a pulled/hyperextended thumb, wrist injuries, and elbow injuries from bike wrecks as a boy. I had to get a custom fanned fret guitar and bass built to keep playing for more than twenty minutes at a time without completely cramping up in severe pain. Like the doc said, it took a couple of years, but I can now play a conventional guitar again if it's not too strenuous a gig.

As far as tuba, knowing what happened to my left arm, wrist and hand, when I went tuba shopping and got my 186, I had the paddles completely reworked for spread, angle, length, and even relative height to exactly fit my right hand in a relaxed position, then had the thumb ring repositioned where comfortable, just clear of the 2nd valve slide, but also at an angle where I could keep my thumb relaxed by resting the tip or pad of my thumb on it rather than having my thumb completely in it, which would tend to "grabbing" and tensing up.

Getting a valve geometry and ergonomic adjustment so the wrist is completely relaxed without being flexed or pronated, and the fingers completely relaxed at a slight curve is the key.

[oldbandnerd]

I had tendonitis as well but mine was work related . Mine was in my forearm and went all the way down to my ring finger. The so called specialist wanted to cut me up and disable my arm for months while waiting for the surgery to heal. I said "Hell no !!! " I spent the next 10 months just dealing with the pain with Tylenol and ice at night. It finally just dissappeared on it's own. All this was 10 years ago when I was 35 . Now that I am 45 I have done it again and fear the worst for the length of time it will heal. It's not nearly as severe as before but it hurts all the same. It hurts to shake hands ,use tools like pliers,vise-grips and PVC cutters that require a strong grip or lift heavy things with one hand . I do commercial dishwashing machine repairs and use my hands and arms to make a living . Once again ..... lots of anti-inflammation medicine (ADVIL)and ice at night . No cutting on me !

[StanOsborne]

find someone who is a member of

American Society of Hand Therapists:

http://www.asht.org/consumers/handtherapist.cfm

Of course there is lots of online advice too...

here is a list of 10 things one can do to prevent RSI.
Item 10 is particularly empathic:

http://www.albionresearch.com/astopnow/ ... ention.php

10. Do Something!

RSI symptoms may sometimes go away if you do nothing. Or
they may get considerably worse. Don't take that risk.

Change your work environment. Change your work habits.
Start taking regular rest breaks.

Don't wait until the pain becomes so bad that you need to
take time off work. Don't wait until the pain is so bad that you
can't sleep at night. Don't wait until you develop carpal tunnel
syndrome. Don't wait until you need surgery to relieve the
pain. Don't wait until your condition is so bad that you will
never fully recover.

Do Something... And DO IT NOW!

[TubaSteve]

Thanks for all the replies. I am really going to try some of the suggestions in the 10 things you can do to prevent RSI. I am sure that I have some CTS now as I get the fingers falling asleep when I drive or sleep. Other symptoms also. I have some wrist braces that keep my wrists from being bent while I sleep and add support at work. I am going to find other ways to move 55 gallon chemical drums at work also. Some recent material that we work with weighs 700#/drum. It is a phosphate salt water solution that is very heavy. That is too much to just wrestle around and get on scales by hand. As for my horn, my main horn is my Meinl Weston 25 BBb. I hate to modify it as I really love the feel of it when I didn't have any problems. I will look at with a different perspective as to what I would like to do with the thumb ring. I also really don't want to drop it if I am having trouble lifting it. I have a Reynolds TB-11 recording bass that is OK, but the hand position is less ideal than the Meinl, and that thumb ring is terrible, so you guys are probably right on with that suggestion. I have a Lyons "Monarch" 3/4 that is a top action and very light, just kind of small and very easy to overblow on. Thanks again.
Steve

[iiipopes]

With your 25 being a rotary, it should be a straightforward matter of going to your tech, sitting in a performance chair and adjust the paddles to where they are comfortable. Also, with the long valve slide right under the paddles, you might not even need a thumb ring, just anchor your thumb to a place on the tubing.

[Dean E]

Here's another idea that I forgot to mention earlier.

Using a tuba support takes a lot of strain off of the player's hand. Without a support, the right hand muscles, tendons, and ligaments are used for support, positioning, and stabilization--as well as operating the valves. Supports sell for under $100, and take a big load off of an injured hand.

[TubaSteve]

Yes, A tuba rest sounds like a great idea. I see one on e-bay now that I will be bidding on. I was thinking of one anyway, and now more than ever, it seems like I at least have a good excuse. Thanks again everyone who has replied!

iiipopes; How would a tech adjust the paddles? Forgive me on this one, I should know my own horn better, do they have to be re-soldered? Curious as to what I should expect to pay for such a service.
Steve

[StanOsborne]

Here is the response from a friend who is a hand therapist (CHT):

Your question about tendinitis in various hand parts is a very common complaint with all sorts of musicians. Unfortunately it is an extremely difficult problem to manage as the key is to "remove the stressor", in this case playing your instrument. Of course musicians, like athletes, are not anxious to not play or practice. Athletes usually get over it when their age forces retirement, but you musicians have an avocation (it is a true tragedy if one is a professional musician) that is designed to be pursued for a lifetime.

But back to management. Sometimes a clever therapist who is experienced in treating musicians can devise an alternate way to grip the instrument or a splint to limit motion which can reduce the stress to non-irritating levels. Drugs are unlikely to solve the problem. On top of this there is the underlying issue of understanding the core pathology. This is a hot topic in the "hand world", indeed in all of the orthopaedic profession. By that I mean what we casually refer to as a tendinitis may not in fact be an "itis" (inflammatory disease) at all, but rather an "osis" (or tendinosis if you like) which is more of a degenerative phenomenon. Hence the typical anti-inflammatory meds/interventions are not very effective.

[iiipopes]

Yes, the individual paddles are soldered onto the tangs of the linkage arms. Each has to be unsoldered and resoldered to its new place. Please don't be tempted to bend the arms, because all that will do is cause the linkage to bind and possibly damage the tubes the rod goes through. If you must bend them for verticality, have your tech do it with two repair instruments made for the purpose: one to hold the arm stationary, and one to adjust the height of the tang.

(There you go: a fancy way of saying two pairs of flat nosed flat jawed pliers)