Repetetive strain injury

[KeithHandy]

My left hand has felt cold about 60 - 70% of the time over the past several days, and it snaps when I gently rock it back and forth. I play guitar and I know it's related to playing a lot of barred chords (using the index finger to "barre" across all the strings while using the other three fingers to make the chord shape).

On some preliminary searches on the symptoms, I'm seeing a lot of "consult your doctor" - well, I don't have a doctor until January. So what is the doctor going to have me do, so I can bypass the middleman and start reversing the problem now?

Thanks ...

[Baltar]

Stop playing, that alone should be enough. Reducing computer usage (typing in particular) may be necessary as well. You just need to let your hand rest for a while. What has also helped me is wearing a wrist brace/splint to keep the wrist from bending. This speeds up the reduction of swelling in the carpal tunnel. I was able to get braces for both hands at my local CVS, for about $10 each. You should also read about carpal tunnel syndrome to get some idea of what it's all about.

Common activities that have been identified as contributing to repetitive stress induced carpal tunnel syndrome include:

* Computer keyboarding or typing
* Playing video games or computer games
* Playing a musical instrument

[KeithHandy]

Originally Posted by Baltar

Stop playing, that alone should be enough. Reducing computer usage (typing in particular) may be necessary as well. You just need to let your hand rest for a while. What has also helped me is wearing a wrist brace/splint to keep the wrist from bending.

Thanks. I already do more thinking/reading than actual typing while on the computer so that shouldn't be an issue, but quitting guitar for a few weeks will be really hard. I suppose I'll limit it to playing with a slide for now.

[Lotus]

Ok, this is what I'm going to college for... at least part of what I'm throwing a hella lotta money at. OT: occupational therapy. Keep in mind that I don't have a license, and if I did, I wouldn't try to diagnose a person over the internet.

Do you have any pain or tingling in your hand/s at night?

Other than that, be sure you do Phalen's maneuver and check for Tinel's sign, both of which are linked to the Wiki page that Baltar provided.

If you choose to buy a brace until you can see a doctor, be sure you buy one which immobilizes the wrist in a neutral (0-degree flexion, 0-degree extenstion of the wrist) position to a 10-degree extension. Do NOT get a brace that jacks the wrist up in full extension. The studies that started that trend are out-dated and have been debunked.

And Balthar,
Comparisons between pre-computer typing on manual typewriters and current typing on computers suggests that mouse-use may be the hidden culprit. There is little difference, ergonomically, between old typewriters and new, but the addition of the mouse has come with a boom in CTS. (Although, perhaps we are just diagnosing CTS more now because typing for long hours is now a common practice in the US. It used to be just be "secretarial" work, but is now child's play.) Just an FYI; thought you might be interested.

[KeithHandy]

Originally Posted by Lotus

Do you have any pain or tingling in your hand/s at night?

Just the coldness and that it snaps when I flex the wrist. Not pain-pain or "tingling".

Originally Posted by Lotus

Comparisons between pre-computer typing on manual typewriters and current typing on computers suggests that mouse-use may be the hidden culprit.

It's not my mouse hand, which is why I'm so sure it's the guitar.

There's a part of me that wants to brag about this -- there's a certain novelty in sustaining an injury with something you love. But you certainly don't want to tell your mother about it or she'll shriek every time she sees you doing it from that day forward, long after you've healed.

[Lotus]

Originally Posted by KeithHandy

Just the coldness and that it snaps when I flex the wrist. Not pain-pain or "tingling".

Erm... that is not classic CTS.

Which tendon is "snapping" ? is it on the thumb side, the pinky side, or in the middle? Is it snapping or does it feel more like it's "catching" on something? Does it feel like it snaps from somewhere on the medial surface toward the palmar surface?

Is your entire hand cold, or just certain regions/fingers?

[Baltar]

Originally Posted by Lotus

Ok, this is what I'm going to college for... at least part of what I'm throwing a hella lotta money at. OT: occupational therapy. Keep in mind that I don't have a license, and if I did, I wouldn't try to diagnose a person over the internet.

Great to see that we have an expert here! Even if you're not licensed yet you still know way more about this than the rest of us.

Originally Posted by Lotus

And Balthar,
Comparisons between pre-computer typing on manual typewriters and current typing on computers suggests that mouse-use may be the hidden culprit. There is little difference, ergonomically, between old typewriters and new, but the addition of the mouse has come with a boom in CTS. (Although, perhaps we are just diagnosing CTS more now because typing for long hours is now a common practice in the US. It used to be just be "secretarial" work, but is now child's play.) Just an FYI; thought you might be interested.

Thanks Lotus. A mouse is certainly easy to misuse and I think trackballs are supposed to be more ergonomic, but in my opinion standard keyboards are just as bad. I've been using an ergonomic (split & raised) keyboard for years and haven't had a recurrence of wrist pain in a very long time. Also the way I use the mouse is probably different from most people. I use a fairly small mouse and rest my fingertips on it with the palm about an inch above the mouse, so my wrist remains straight.

[Matt]

If you are careful, you should not get RSI just from playing the guitar -- or typing for that matter. A couple things to look out for is to make sure your technique is good; don't put unnecessary strain on your wrist, and stretch out the wrists and fingers before and after playing.

Good luck, I hope your injuries are not too serious.

[KeithHandy]

Originally Posted by Lotus

Which tendon is "snapping" ? is it on the thumb side, the pinky side, or in the middle? Is it snapping or does it feel more like it's "catching" on something? Does it feel like it snaps from somewhere on the medial surface toward the palmar surface?

Is your entire hand cold, or just certain regions/fingers?

I can't imagine how silly I must look, snapping my wrist right in front of my nose with my eyes closed to try to locate the sound in the stereo field. I also can't get the "snap" every time now, it's maybe one out of three or four times.

The cold feeling is spread pretty evenly through the middle of the hand and the wrist. A fairly small amount of heat from a heating vent or a cup of coffee is enough to make it feel perfectly fine, I'm just concerned because it's been a few days now.

Believe me, as unofficial as your diagnosis is, it's better than nothing. And it's probably helpful information for way more readers than just me.

[KeithHandy]

Originally Posted by Matt

If you are careful, you should not get RSI just from playing the guitar -- or typing for that matter. A couple things to look out for is to make sure your technique is good; don't put unnecessary strain on your wrist, and stretch out the wrists and fingers before and after playing.

My technique is a lost cause ... I'm the only one I know of who actually pushes and pulls on the neck of an acoustic for vibrato/chorus* and to "smear" imperfect tuning ... but yeah, the before and after stretches are definitely something I should start doing. I've always just leaped right into it.

*It actually does create a chorus-like effect on an acoustic, because of how the resonant sound interacts with the original string sound.

[Julie Donnelly]

Hi Keith,

I found your message because I'm taking a class with Steve Pavlina, the owner of this forum. My expertise (18 years experience) is in repetitive strain injuries, including carpal tunnel syndrome and hand/wrist pain and numbness. I've worked with many thousands of people, including musicians, and I'm happy to say that you CAN learn how to self treat the muscles that are causing the strain on your carpal tunnel and the median nerve. The odds are your primary problem is a muscle called the pectoralis minor. This muscle inserts into a bone at the top of your shoulder and when it goes into a spasm it will pull on the bone and put pressure on the axillary artery (slowing circulation) and impinging on the median nerve (causing tingling and numbness). If it's tight enough it will also put pressure on the ulnar nerve and cause tingling/numbness in your ring and pinky fingers.

You can learn about these muscles and why they cause pain and numbness by going to Carpal Tunnel Treatment Center - Therapy for Repetitive Strain Injuries, Carpal Tunnel Syndrome, Trigger Finger, Hand/Wrist Pain and Numbness. and then looking at the section that shows the graphics of the muscles. There is text that explains each muscle and why it's a cause of pain and numbness. You can also read about muscles and repetitive strain injuries by going to Julstro - sports injuries, muscle pain, sports medicine and going to the section titled "Muscles and Pain" and then "What's Happening Really."

The bottom line is that you need to learn how to self-treat the muscles if you are going to continue to play the guitar. You're straining the muscles on a daily basis, you need to learn how to release the tension on a regular basis, and it's not difficult to do this.

Wishing you well,
Julie

[Lotus]

Originally Posted by Julie Donnelly

This muscle inserts into a bone at the top of your shoulder and when it goes into a spasm it will pull on the bone and put pressure on the axillary artery (slowing circulation) and impinging on the median nerve (causing tingling and numbness). If it's tight enough it will also put pressure on the ulnar nerve and cause tingling/numbness in your ring and pinky fingers.

Julie,
I think that this probably is a repetitive use injury, but I want to point out that the only nerve(?) involvement he seems to be experiencing is a sensation of "coldness" in the affected hand, which rather puts me off the idea of CTS. I'm questioning nerve involvement and leaning toward circulatory problem, as you are. But I'm a tenative student, and I hate to speculate too much about tightness or spasm without putting my hands on the client. I've only been in my degree program 2 years, and haven't done my clinicals in phys rehab yet. (But ask me about the frail elderly, children, or traumatic brain injury! I have lots of hours there. )

KeithHandy,
Might be what Julie suspects; easily remedied with some basic exercises, stretches, and/or self-massage. I still recommend that you see a doctor in January if symptoms persist.

[kat]

I had a diagnosis of tendonitis; but beyond sore tendons, I also had extremely cold fingers, numbness, tingling, etc. I found a book on trigger point therapy, "The trigger point therapy workbook - Your self-treatment guide to pain relief" by Clair Davies, which explained myofascial trigger points (basically, small parts of your muscles, called sarcomeres, get stuck contracted - it's what people usually call a "knot" in the muscle).

After a few hours working some of my muscles and finding a lot of trigger points, the numbness was basically gone, and my fingers weren't cold anymore, and I was in way less pain. Full healing of the tendonitis is being a slower process, but the targetted massage has helped it be much less unpleasant.

Trigger points cause a lot of pain, but the pain is usually in a remote part of the body from them (but which trigger points cause pain where is fairly consistant between people.) They can be identified in a few ways: if you're searching for them on yourself, they stand out because they hurt a lot when you touch them (sometimes, especially with the really bad ones, the place it refers pain to hurts more as well when you press on it.)

The book I mentioned is quite helpful, since it not only recommends some massage techniques (major points: be careful with your hands - use balls / tools / etc as much as possible instead, and use your knuckles or one hand pushing the fingertips of the other rather than kneeding, as it's much, much gentler on your hands), but is organized into chapters based on where you have pain, and talks about exactly which muscles to cause pain in those places, as well as showing where some of the more common trigger points in those muscles are (depending on the type of muscle fiber, they can be anywhere in the muscle, or much more likely to be in some characteristic places.)

It aims to be a more easily readible source of the information in an earlier book by doctors, "Myofascial Pain and disfunction: the trigger point manual", by Travell and Simons (which I haven't seen, unfortunately.)

Anyhow - I hope this helps. Feel free to ask me questions.

[KeithHandy]

Thanks so much to everyone who is contributing to this thread, but I think I just had a revelation about the cause of the discomfort. Last tuesday I went food shopping and consciously chose to buy things that were healthier and meat-free; one thing I picked up was some organic chips and salsa, and the lid to that salsa jar was a mo-fo. I remember having to squeeze it so tight that it actually hurt my wrist & hand. I think I pulled the muscles a little bit. Then for some reason I forgot about that, and started associating the discomfort with the guitar neck, since that was when I was feeling it the most.

None of this minimizes the helpfulness or usefulness of all your comments, since I'm sure I am a candidate for RSI in the future.

[Ati]

Originally Posted by KeithHandy

My left hand has felt cold about 60 - 70% of the time over the past several days, and it snaps when I gently rock it back and forth. I play guitar and I know it's related to playing a lot of barred chords (using the index finger to "barre" across all the strings while using the other three fingers to make the chord shape).

On some preliminary searches on the symptoms, I'm seeing a lot of "consult your doctor" - well, I don't have a doctor until January. So what is the doctor going to have me do, so I can bypass the middleman and start reversing the problem now?

Thanks ...

Originally Posted by KeithHandy

Thanks. I already do more thinking/reading than actual typing while on the computer so that shouldn't be an issue, but quitting guitar for a few weeks will be really hard. I suppose I'll limit it to playing with a slide for now.

Originally Posted by Matt

If you are careful, you should not get RSI just from playing the guitar -- or typing for that matter. A couple things to look out for is to make sure your technique is good; don't put unnecessary strain on your wrist, and stretch out the wrists and fingers before and after playing.

Good luck, I hope your injuries are not too serious.

Originally Posted by Julie Donnelly

Hi Keith,

I found your message because I'm taking a class with Steve Pavlina, the owner of this forum. My expertise (18 years experience) is in repetitive strain injuries, including carpal tunnel syndrome and hand/wrist pain and numbness. I've worked with many thousands of people, including musicians, and I'm happy to say that you CAN learn how to self treat the muscles that are causing the strain on your carpal tunnel and the median nerve. The odds are your primary problem is a muscle called the pectoralis minor. This muscle inserts into a bone at the top of your shoulder and when it goes into a spasm it will pull on the bone and put pressure on the axillary artery (slowing circulation) and impinging on the median nerve (causing tingling and numbness). If it's tight enough it will also put pressure on the ulnar nerve and cause tingling/numbness in your ring and pinky fingers.

You can learn about these muscles and why they cause pain and numbness by going to Carpal Tunnel Treatment Center - Therapy for Repetitive Strain Injuries, Carpal Tunnel Syndrome, Trigger Finger, Hand/Wrist Pain and Numbness. and then looking at the section that shows the graphics of the muscles. There is text that explains each muscle and why it's a cause of pain and numbness. You can also read about muscles and repetitive strain injuries by going to Julstro - sports injuries, muscle pain, sports medicine and going to the section titled "Muscles and Pain" and then "What's Happening Really."

The bottom line is that you need to learn how to self-treat the muscles if you are going to continue to play the guitar. You're straining the muscles on a daily basis, you need to learn how to release the tension on a regular basis, and it's not difficult to do this.

Wishing you well,
Julie

All this sounds good and great to have a few experts in on the question. (Don't forget that folks in training are probably in the expert milieau day in day out so have a lot to add...the rest of us may or may not keep up. Julie sounds she's one of the ones that is )

I've a few suggestions from the internal medicine field:

1. The coldness is curious and if it doesn't go away, might certainly warrant a visit to the right sort of practitioner. Does sound vascular, but an overall look to see why may be in order.

2. The carpal tunnel splints of the sort that keeps your hand in "anatomic" or neutral--not extended position, used at night, are often helpful.

3. For directly after whatever exercise is causing symptoms: ice to the area of usual pain and possibly (if you are under 60 and don't have stomach or reflux problems)--ibuprofen or other non-steroidal anti-inflammatory at double the OTC dose--not daily but episodically. Both to reduce inflammation.

4. And last something I just discovered for myself this weekend,( although I did molecular lab research on it 15 years ago!!) an over the counter product Capzasin-HP--its from hot peppers and blocks a neurochemical called substance P. Substance P is what hits pain fibers to cause pain (among its other functions, but it's significant in this role). Substance P also cause release of inflammatory factors (that was my research work ), so there seems to be a vicious cycle of inflammation causing pain, then pain leading to more inflammation.
In any case, this stuff will erase your pain I think. Now I don't know abt long term use and prevention which is more important long run and shouldn't be disregarded. I also don't know that it would be smart to erase the pain and then keep playing in a way that causes more pain But it should give you some symptomatic relief. Have to be real careful to follow the instructions abt double washing your hands and not leaving around kids, get your hands in your eye and you'll think you're swimming in jalapeno juice!!

hope that's helpful, a slide sounds a good idea for the time being til you heal and most of these things seem to require first rest and then a different , more ergonomic way of doing things to prevent recurrence.

all best,

[elainevdw]

I don't know how serious your condition is, but it might be worthwhile to do some yoga. I found that Sun Salutations, and particularly Downward Dog position, stretched out and strengthened my hands, wrists, and shoulders, which were getting sore and cramped from clicking too much at my old IT job.

[Julie Donnelly]

Thanks for the vote of confidence Ati, you're right, I've really kept up with this repetitive strain injury topic because I kept getting injuries for a multitude of reasons (sports, doing deep muscle massage, computers, etc.) and I had to figure out how to treat myself because I couldn't find anyone who could work deeply enough and be focused on just the muscles causing the problem. "Necessity is the mother of invention."

I've used capsaicin topical creams for years and it was great to read the "why" of the healing properties. I can attest that they definitely work topically and I didn't know they could be taken internally, so thanks for sharing that. There isn't any limit to the amount of times it can be used topically, and boy, are you right about not getting it into your eyes!!! OUCH!

As for the circulation problem, when the pectoralis minor muscle contracts it pulls down on the coracoid process of the shoulder blade (scapula). This puts direct pressure onto the axillary artery that goes to the arm and diminishes the blood flow to the arm and hand. It's really easy to self-treat the pectoralis minor muscle and quickly see if it's involved. If there isn't any pain (tight muscles are always painful to touch when you press deeply on them) then there is a good chance that it could be more serious. But before jumping the gun, it's also easy to self-treat the biceps and flexor (under side of the forearm) to make sure they aren't trapping the artery.

If all of those muscles are fine, then I'd head for the doctor because once you eliminate the muscles, you can be dealing with something more serious and it's good to get it checked out by a qualified medical professional. Fortunately the vast majority of times it's only the muscles, so that's a plus.

Wishing you well,
Julie

[Ati]

Originally Posted by Julie Donnelly

I've used capsaicin topical creams for years and it was great to read the "why" of the healing properties. I can attest that they definitely work topically and *******I didn't know they could be taken internally*****, s

Hi Julie,

First, I've no information that capsaicin cream can be taken internally!!!!


Maybe that's not what you meant to write..?

I was thinking about crushing up some jalopenos or other peppers or using some hot thai or other hot sauce just to see how it would work. However the way they formulate the cream, it really gets right through the skin--keep rubbing and your skin is dry as if you didn't put anything on it, so there's probably something there.

Interesting stuff on the anatomy. I remember learning what you described in anatomy a long time ago, but reading your post makes me want to go back to the books just for self re-edification.

I agree that muscle work may make the vascular symptoms of coldness go away and that if not, a proper medical evaluation is in order, or if symptoms worsen, swelling develops or anything else suggesting progressive blood vessel involvement. I also agree the good news is probably not !

all best, please don't put the capsaicin cream on your toast in the morning!

Ati

[moltar]

Originally Posted by Lotus

Comparisons between pre-computer typing on manual typewriters and current typing on computers suggests that mouse-use may be the hidden culprit. There is little difference, ergonomically, between old typewriters and new, but the addition of the mouse has come with a boom in CTS. (Although, perhaps we are just diagnosing CTS more now because typing for long hours is now a common practice in the US. It used to be just be "secretarial" work, but is now child's play.) Just an FYI; thought you might be interested.

I gotta blame the mouse as well. I type tons. But only had pains in my right hand. I learned to use the mouse with my left hand, and started getting pains in the left hand as well.

So I switched the mouse, got a really good one, Logitech MX1000. It's pricey, but totally worth it.

Also exercise and good nutrition helps a lot. I eliminated pains from my left hand all together, and my right hand is still recovering (for a year now) and I am sure it will get better.

P.S. The doctor told me to wear wrist support ONLY at night, and not during the working hours.

[Ati]

Moltar, agree that the increase in typing time is probably really contributory. Also agree with the night use, not day use of the splint. You don't want to weaken muscles by using splints during the day for indeterminant periods of time.

Now if one is doing something regularly and it's causing problems, isn't that the time to see an occupational therapist in order to make subtle corrections in technique so as to continue doing what one needs to do but in a better or more individualized fashion? (Everyone typing or using a mouse doesn't get hurt doing it)

Julie?

[Lotus]

Originally Posted by Ati

Now if one is doing something regularly and it's causing problems, isn't that the time to see an occupational therapist in order to make subtle corrections in technique so as to continue doing what one needs to do but in a better or more individualized fashion? (Everyone typing or using a mouse doesn't get hurt doing it)

You almost always need a referral from a physician before you can see an OT and get your insurance to pay for it (if in the US). Similar to PT services.

An OT would probably advise that
1. a person get more ergonomically correct keyboard and mouse (rather than correcting technique, because the right tools force you to use better technique without you having to remember to use good technique)
2. a person take frequent breaks from using the computer (ex: 5 minutes out of every 20min are spent not typing or using mouse)
3. a person use stretches, self-massage to relieve tension in muscles
4. certain strengthening exercises may be recommended
5. a splint can be constructed if you need one. The OT would determine how often and when it should be worn.
6. warm and/or cold water baths can help with pain or discomfort, depending on your situation

Severe cases go to an OT with certificate in hand therapy (CHT certification).

(I'm not trying to provide a cheap intervention for pple who don't want to seek professional therapy, but that's fairly standard for a general case of "my computer use is causing hand/wrist pain.")

[hazerfazer]

I have a feeling you have TMS.
Read a book called "The Mindbody Prescription" by Dr. John Sarno.
This stuff is HUGE. Check it out..