Newsgroups: rec.music.makers.guitar.acoustic Subject: 3 Letters Guitarists Fear The Most! All (especially any performers), Let's talk about CTS! Whoah, I know no one wants to hear those letters - definitely not me - I think mine has come back pretty bad!! I've got all the classic symptoms; numbness, tingling sensations, swelling, etc.. I'm going to two different doctors on Tuesday so I'll know more then and I'll know how bad it is. Last time I was forced to put the guitar away - I don't think I can take that answer again..... Anyway, what I was wondering is, have any of the performers in the group ever had CTS? Did you continue to play out or did you have to quit playing for a while? If you're not a performer and have it, can you still play (perhaps at a reduced level)? Has anyone had the operation? If so, do you feel it was a successful one? Newsgroups: rec.music.makers.guitar.acoustic Subject: Re: 3 Letters Guitarists Fear The Most! I missed the beginning of this thread. I had severe CTS in both my wrists, less than 50% nerve impulse conduction through my wrists. It developed over a very long period of time, probably 15 years or so. My left hand got so bad that I couldn't even get through a single song chording in open positions. I tried anti-inflammatories and splints at night, they helped some for a while, but it continued to get worse. I finally had surgery on my left wrist in Dec 98. The surgeon said my nerve was constricted and inflamed worse than any he had seen before. The numbness, tingling and pain were gone right away. However, there was pain and tenderness at the incision site for several weeks, diminishing as time passed. My hand felt really weird at the surgery site - this diminished in time, but it still "feels different", and theirs a small knot at the base of my palm. I lost a great deal of grip strength at first and had to build it back up. I think my grip is now almost what it was before the surgery. It seemed like I needed to re-learn some of my playing skills in terms of finger placement and dexterity. I really need to work on increasing strength and endurance in that hand though, as my hand tires easier than it did before. Sometimes my left hand just feels clumsy. I don't know if it is due to CTS, or the surgery, or if it is just a result of getting older. My right hand, on which surgery has not been performed, continues to get worse as time goes on. It is getting to the same point that I was at with my left hand - playing is becoming increasingly difficult and I can only play for short period before I need to take a break. I plan on getting it operated on before the year is out. I play in a couple of gospel groups, and playing in them is becoming harder and harder to do. I switch off between guitar, banjo, so that gives me a little bit of a break in that the demands on my right hand are different for each instrument. Still, with the severity of my condition it is difficult and I often play in alot of pain with no feeling in my right hand. It sure can take the pleasure out of performing. I would recommend that you see a specialist who can perform the nerve conduction tests to determine the severity of your condition. The first thing to try is splints and anti-inflammatory drugs. That could be sufficient. Unfortunately they didn't do the trick for me. One more word about the surgery, my surgeon said that some doctors do orthoscopic surgery for CTS as opposed to the normal incision in the hand method. He said he would not do the orthoscopic surgery, as it is impossible to see the nerve while cutting the ligament that way. 95% of the time the nerve is below the ligament, but sometimes it is above the ligament. If it is and it gets cut while performing the orthoscopic surgery that's it, you have permanently lost use of that nerve. As for me - was the surgery worth it? I have to say a definite yes. My hands were becoming useless, even for doing something as simple as carrying a book or a folder. Without the surgery I honestly don't think I would be able to play at all right now. Hope this is helpful. Newsgroups: rec.music.makers.guitar.acoustic Subject: Re: 3 Letters Guitarists Fear The Most! Imagine this in large red letters: DON'T PANIC!!!!!!!!!!!!!!!!! Carpal tunnel syndrome is a bummer, but for a performer it is nowhere near as big a deal as chronic tendonitis. I no-longer have a carpal tunnel in the right wrist at all, it wasn't removed for decompression, but during some major surgery after an accident a few years ago, in order to repair the median nerve. Decompression surgery is extremely effective in CTS, but one delicate issue to raise first...... Weight. My sister has CTS quite badly. This is purely because she is very overweight. When it gets too bad she loses weight and it gets better. This is by no means the only cause of CTS, but it is probably the most common seen in the majority of clinics. Also if you have mild CTS, obesity makes it much much worse. The reason is pretty obvious, it squashes the carpal tunnel, which then squashes the median nerve. Obviously I don't know if this is an issue for you Steve, because I haven't seen a photo of you, I checked the RMMGA photo page :) If you do have a weight issue, then look on the bright side.... you have a choice potentially between non-surgical intervention (dieting) and surgical intervention. Most orthopaedic surgeons I know in the UK will point this out to people. But then they don't get paid any more for operating :) I assume since you imply you've had CTS before that it is following the classical track, ie. the numbness and tingling is mostly on the palm side of the thumb and first two fingers. If not, there are many other potential explanations. Regarding surgery, if you don't have a weight issue and you have a recurrance of long-standing CTS that is debilitating, then if surgery is offered I would advise you to take it. It is a low risk, high reward operation provided you have a good surgeon. If you take this option I would also suggest you insist on a hand specialist rather than a general orthopadic surgeon. It certainly takes a few weeks to recover, but then that is pretty well inevitable whatever you do. I certainly think you should be planning your submission for the next RMMGA CD Steve, I don't believe this should be allowed to seriously hinder your playing. For now though, take it easy. Listening to "Underdog" at the moment. It really is cool. You have a strong right hand attack. How hard is your left hand grip? It sounds like you use quite firm pressure, but I might be mistaken. Have you tried reducing your pressure on the strings a little? This shouldn't impact too greatly on the sound, though you might find it has a benefit, minimum pressure is important for speed, if you want to play quick passages smoothly. It also helps in smooth changes generally and does wonders for your vibrato. I hope this is some help Steve. but just in case I repeat...... DON'T PANIC!!!!!!!!!!!!!!!! Newsgroups: rec.music.makers.guitar.acoustic Subject: Re: 3 Letters Guitarists Fear The Most! That's interesting. I'm not saying that's wrong, because I'm no expert, but when I asked my doctor (an internist) if weight had anything to do with CTS he told me no. Is there support for this? If it's true, maybe it'll give me more incentive to stick to my diet =). Newsgroups: rec.music.makers.guitar.acoustic Subject: Re: 3 Letters Guitarists Fear The Most! There's a lot of room in between these two positions. It is well known that carpal tunnel syndrome can be brought about by diabetes and also by pregnancy, both of which induce edema (fluid retention and swelling) in the extremities and thereby increase pressure on the median nerve. The burning and tingling that most CTS patients experience in the middle of the night is also most probably because of the decrease in muscle tone during sleep in conjunction with the horizontal orientation of the body during sleep, both of which allow fluid to accumulate in the extremities, once again increasing pressure on the median nerve. It's also true that people who are in good shape have lower body weight, less subcutaneous fat, and better muscle tone, and as such they are less likely to have a lot of health problems involving joints (such as CTS). So although the internist may be correct in saying that weight is not a definitive causative factor in CTS (because there are overweight people who do not have CTS), it's probably also true that being in good physical shape could lessen the severity of the symptoms. I recall from previous threads that several people on this newsgroup have undergone the surgery for CTS (snipping the ligament that surrounds the median nerve) and this procedure is generally very successful, although as with most medical procedures you will occasionally hear of someone whose condition deteriorates afterwards. I've had CTS for the past few years, due to the combined effects of lots of typing, lots of cycling, and lots of guitar playing. I've found that by stretching, warming up, paying attention to my posture and hand position, taking periodic breaks, and maintaining good muscle tone in my forearm I've been able to keep the syndrome at bay. I still experience some problems, and I may eventually need surgery, but for the present I seem to be handling the situation without the need for additional intervention. Here are a couple of sites where you can read more about CTS: http://www.eatonhand.com/hw/hw100.htm http://www.engr.unl.edu/eeshop/music.html I don't have your original post in front of me, but if you have not already done so I would also advise that you discuss with your internist the possibility of seeing a neurologist, who can make an exact determination of your situation (there are other possibilities besides CTS) and assess the extent of your problem. This involves a brief in-office procedure in which mild electrical signals are applied to your arm and shoulder and timings of the nerve impulses are taken. I've had this diagnostic procedure done and I found the results very helpful, because it confirmed that I had CTS (as opposed to other disorders) and gave me an idea of exactly where I was in terms of the progression of the syndrome. As someone else said, don't panic. This is generally a manageable condition. Newsgroups: rec.music.makers.guitar.acoustic Subject: Re: 3 Letters Guitarists Fear The Most! The median nerve, which sits in the carpal tunnel, enervates the thumb, index, and middle fingers, along with the lateral border of the ring finger. The pinky and medial border of the ring finger are enervated by the ulnar nerve, which passes through the cubital tunnel at the elbow, and through Guyon's canal at the wrist. It sounds to me as though your problem is not carpal tunnel syndrome, but either cubital tunnel syndrome or Guyon's canal syndrome, depending on whether the ulnar nerve is being compressed at the elbow or the wrist. This is not as easy to isolate as you might think, because pressure on the nerve at any point can cause pain all along the nerve pathway. For example my carpal tunnel syndrome sometimes produces pain in my upper arm and shoulder, even though the nerve is being compressed at the wrist. My understanding is that cubital tunnel syndrome is more likely to come about from gross movements of the arm, and it's one of the syndromes covered under the blanket term "pitcher's elbow" because it can be caused by the twisting motion needed to throw curveballs and sliders. Guyon's canal syndrome is more likely to be caused by wrist movements of the type musicians make, so it seems to me that this is the more probable explanation in your case. I need to advise you that I am not an M.D. (yet) so I am not qualified to give you professional advice. The nerve conduction test that the neurologist will administer should pin down the locus of your problem. Good luck, and remember that no matter what the diagnosis the odds are excellent that with proper treatment you can continue to play the guitar. Newsgroups: rec.music.makers.guitar.acoustic Subject: Re: 3 Letters Guitarists Fear The Most! > That's interesting. I'm not saying that's wrong, because I'm no expert, but > when I asked my doctor (an internist) if weight had anything to do with CTS he > told me no. Is there support for this? If it's true, maybe it'll give me more > incentive to stick to my diet =). Jim, that is certainly the view held (rather strongly) by rheumatologists and orthopaedic surgeons of my acquaintance. It is also discussed in specialist textbooks. Several recent studies of patients undergoing decompression surgery have shown a considerable excess of obese people compared with the general population. Given the fact that a significant proportion of decompressions are performed on people with CTS secondary ro rheumatoid arthritis and a range of other conditions, the true excess is probably greater than calculated. Being a little overweight isn't an issue here. It will only become a factor if you are significantly overweight. Musicians who flex or extend their wrists for considerable periods are at risk of CTS, as are meat packers and typists etc. CTS can be caused either by pressure outside the tunnel which squashes it, or by internal pressure, usually caused by excess synovial tissue, as is the case in people with RA who get it. But the range of possible causes in the average textbook is pretty considerable. Most of these tend to be secondary to a defined medical condition such as RA, diabetes, gout etc. It is possible that your doctor had identified a specific cause for your CTS, so the answer to your question, in your own case was no. I'm a little surprised at the unequivocal nature of the answer though, because even with a defined cause, overweight has been show in studies to exacerbate the problem. I'm afraid this has to be my last contribution to this discussion. I'm a little busy at the moment. Guitars and RMMGA are about my only source of 10 minutes relaxation right now :(