Works Cited

Carpal Tunnel Syndrome. (2010, May 25). Retrieved June 16, 2011, from PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469/

Croghan, L. (n.d.). Study Questions Use of Wrist Braces. Retrieved June 17, 2011, from Cats Paw: http://catspaw.com/carpal_tunnel.php

Hagedorn, A. (2011, June 17). Injuries with the Cello. (A. Hagedorn, Interviewer)

How to Eliminate Carpal Tunnel Syndrome in Musicians. (2006). Retrieved June 17, 2011, from Balance Systems, INC: http://www.repetitive-strain.com/Articles1/carpal-tunnel-syndrome-in-musicians.html

Musicians and Injuries. (n.d.). Retrieved June 16, 2011, from UN-L Engineering Electronics Shop: http://eeshop.unl.edu/music.html

 

Alexi playing a Suite from J.S. Bach

Alexi's Story

My mother has experienced symptoms of carpal tunnel syndrome herself. Being a cellists for forty plus years has put a strain on her fingers, hands, and wrists. One particular time a few years back, a Vivaldi’s Gloria piece required repetitive use of her forth finger. She experienced severe pain directly after a performance and was required to rest her forth finger for months. She went to an orthopedic surgeon specializing in hands. He suggested hand exercises for the forth finger but only time would allow it to heal. Like many musicians, she experiences mild symptoms of carpal tunnel syndrome on her right hand, the hand she uses to play with her bow.

Forth finger injury is very common among cellists because it is the weakest finger and requires extreme extension in order to get into proper position. Although she has not had an episode as severe as that one, she still uses extreme caution while playing making sure that she doesn’t over use that forth finger. My mother has experienced both forth finger injury and carpal tunnel syndrome due to playing the cello. Although these symptoms have developed, they are not extreme enough where she has to completely stop what she loves most.

 Shown here, proper fourth finger, wrist and elbow positioning on the cello. 

 

This etude (a study) involves a lot of forth finger positioning which can lead to serious injury.

Proper bow position of the wrist, improper positioning and repetitive movement may lead to symptoms of carpal tunnel syndrome.  

Musicians

Musicians have an increased risk of developing carpal tunnel syndrome due to the repetitive unidirectional motions used to play their instruments. When this syndrome develops in a musician, they must modify their practice and performance routines so that they can decrease their pain while still doing what they love to do most, play. All musicians must have precise dexterity and responsiveness in the fingers and wrist in order to play an instrument. Pianist must quickly mover their fingers across the keys, woodwind players must quickly maneuver their fingers to hit the correct keys on their instruments and violinists and cellists must manipulate their bows.

Carpal tunnel strikes without warning making it a musician’s nightmare. Crippling pain could occur in the middle of a performance making it extremely painful and even possible to continue playing. The first line solution is rest but many musicians refuse to stop playing especially if they are a professional performer and make a living off of their music. They simply cannot afford to stop playing.

Just as athletes do, it is important to warm up before playing. Specific hand, wrist, finger and elbow exercises can help decrease the chances of developing this syndrome. Evaluating the technique of how a musician plays is also important. Many musicians are taught the improper technique of how to play their instrument leading to strenuous work on their nerves. Constant tension and repetitive motion does not allow the body to flush away metabolic waste products so it is important to take breaks and relax while playing. In the middle of playing a piece it is important to sometimes take a break and restore circulation in the hand or arm. Over training can actually decrease performance, so playing for hours at a time may increase skill but also increase the chance of developing carpal tunnel. 

                                       Wrist exercises suggested before and after playing.

Treatment?

There is treatment for carpal tunnel syndrome but it depends on the severity of the symptoms or any underlying diseases. The initial treatment includes rest, splint for the wrist and ice. Proper range of motion exercises of the wrist may prevent carpal tunnel syndrome in the first place.


Medications have been used in the treatment of carpal tunnel syndrome. Vitamin B6 has been reported to relieve symptoms and nonsteroidal anti-inflammatory drugs decrease inflammation and reducing pain. Corticosteroids can be given by mouth or injected directly into the wrist joint although it could aggravate diabetes and should not be taken if infections are present.

Surgery is also an option if symptoms are severe. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. This surgical procedure is called "carpal tunnel release." It can now be performed with a small diameter viewing tube, called an arthroscope, or by open wrist procedure. After carpal tunnel release, patients often undergo exercise rehabilitation. Though it is uncommon, symptoms can recur.

 

Musicians usually chose not to go through with surgery in fear that there might be complications such as loss of grip strength, loss of range of motion or lost sensitivity in their fingers. These risks may mean a change of profession or even worse, the end of their playing career. Musicians are so passionate about playing and their music that surgery is not an option for them.

Carpal Tunnel Syndrome

So what is carpal tunnel syndrome exactly?

"Carpal tunnel syndrome is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and finger"- Pubmed Health

The median nerve provides feeling and movement to the "thumb side" of the hand. The area in your wrist where the nerve enters the hand is called the carpal tunnel. The tunnel is narrow so any swelling can pinch the nerve leading to carpal tunnel syndrome.

This syndrome occurs in people who perform repetitive motions of the hand and wrist. Causes include typing, sewing, painting, writing, assembly line work and playing some musical instrument.

Symptoms:

-Numbness or tingling in the thumb and next two or three fingers of one or both hands

-Numbness or tingling of the palm of the hand

-Pain extending to the elbow

-Pain in wrist or hand in one or both hands

-Problems with fine finger movements (coordination) in one or both hands

-Wasting away of the muscle under the thumb (in advanced or long-term cases)

-Weakness in one or both hands

Alexi

My mother, Alexi Hagedorn is a passionate musician and a phenomenal one at that. She picked up the cello when she was only  nine years old, practicing for endless amount of hours, and performing in recitals and orchestra concerts. Today, she still plays on a daily basis, performs in church services, and is asked to play for concerts in our local community. After forty plus years, playing vigorous cello can really put a toll on a musicians fingers, hands, and elbows. My mother has experienced pain in all of these areas due to carpal tunnel syndrome. Although pain caused by carpal tunnel can be excruciating, my mom will not give up her passion of playing the cello.

 My mother (circled in red) playing in her high school orchestra in 1972