This
begins with pain in the elbow area, along the inner
side of the forearm. The pain can travel downwards
towards the pinky, and can be accompanied by tingling
or numbness sensations to the pinky side of the hand.
The forearm muscles can be painful, and can lead to a
misdiagnosis of tendonitis by an inexperienced
doctor. This syndrome will usually only involve the
ring and pinky fingers, since these fingers receive
their nerve supply from the ulnar nerve. If the
syndrome progresses, it can cause decreased function
of the hand, especially grip strength. Wasting or
atrophy of the pad of muscles on the palm side below
the pinky finger can develop as well. Typically, the
person notices that flexing the forearm tends to
irritate the symptoms.
The
culprit in this syndrome is compression of the ulnar
nerve. Just south of the elbow, the nerve passes
through the flexor carpi ulnaris muscle to travel
down to the hand. A small tunnel forms in this
location, and the nerve becomes surrounded on all
sides. In this tunnel, the ulnar nerve sits on top of
the flexor digitorum profundus muscle. A ligament
forms the top layer of the tunnel. It's important to
understand the function of the muscles in this
tunnel, because they play a major role in the
development of the syndrome. The flexor carpi ulnaris
muscle attaches to the inner part of the elbow, and
its function is to flex the wrist and laterally
deviate the wrist to the pinky side. The flexor
digitorum profundus attaches to the medial elbow and
inserts into the tips of the fingers. This muscle's
function is to flex the fingers (especially the
tips).
This
syndrome typically affects guitarists in the left
hand (for right handed individuals, the opposite
would apply for left handed people). If we dissect
the playing of a simple bar chord, we would notice 1)
contraction of the thumb against the underside of the
neck of the guitar, 2) a counterbalancing contraction
of the opposing fingers on the top fretted side of
the neck, 3) bending of the fingertips to push
against the strings, 4) flattening of one finger
against the neck to form the bar (usually the first
finger), 4) maybe some stretching of the pinky to
reach a higher fret and 5) flexion of the wrist.
Since the
ulnar nerve passes between the muscles that perform
flexion of the wrist, bending of the fingertips, and
lateral deviation of the wrist (used in stretching
the pinky to reach the higher frets), you can see how
a typical bar chord can affect the muscles
surrounding this nerve. With constant overuse of
these muscles, they can become inflammed, or actually
form "microtears" at the attachments to the
elbow. The swelling involved can start squeezing down
on the ulnar nerve, causing the symptoms mentioned
above. This is also why bending the forearm will
worsen the complaints. The ulnar nerve becomes
stretched upon flexion of the elbow. If the nerve
already is being pinched, the stretching is going to
amplify the symptoms.
For those
of you who don't have symptoms and would like to
prevent them from ever occuring, give yourself more
frequent breaks (about a 10 minute break after every
45 minutes of playing) during rehearsing or practice
times. The constant playing for hours upon hours
without resting causes the microtearing of the
muscles and the resulting repetitive strain. Before
you play and during your breaks, increase blood flow
to the forearm and hands by stretching and performing
self-massage to the area.
If you do
have the symptoms mentioned, use heat on the forearm
before practicing, and ice the elbow and forearm area
after playing. The heat will encourage more blood to
the tissues while playing, and the ice will
discourage swelling afterwards. Perform stretching to
the forearm three to four times a day. If you're
experiencing nerve related symptoms like tingling and
numbness, see a health professional immediately who
is experienced in treating musician's injuries. Many
musician's make the mistake of seeing their local
doctor who is not trained in treating repetitive
strain injuries. Ask the doctor or therapist if they
have treated similar cases, and what type of results
they achieved.
Always
try conservative measures first, such as
chiropractic, physical therapy, massage therapy, or
acupuncture and give yourself at least six weeks to
heal. If you notice symptoms worsening, or weakness
occurring in the hands, your health care provider
should refer you to a medical doctor for a
consultation and neurological testing. Nerve-related
conditions are serious because the nerve can actually
die due to compression and decreased blood flow. This
could lead to a permanent disability in your forearm
and hand - not what a guitarist needs!
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