Coordination Loss/3rd and 4th Fingers

[tom123]

Hello,  I hope I’m not wasting Forum space but I just had a quick question I wanted to get some feedback on if possible.  I’m a guitarist and I’ve had ongoing issues with my left (fretting) hand for a little over a year now (I’ve posted on this forum before).  I had basically been experiencing tingling and weakness (with mild numbness) throughout my whole hand (mostly in my 3rd and 4th fingers).  I did have an EMG done awhile back and it was determined that there was some entrapment at my elbow and wrist.  I went through a couple months of Physical Therapy and for the most part did not play the instrument for the past year.   Within the past 3 or 4 months things have really started to look up.  While my problem did not completely disappear I was able to start practicing regularly and resume guitar lessons.  I also noticed strength and muscle bulk returning to my hand.   Within the past week however I’ve been noticing (or dreaming up in my mind) some new problems.  It is rather hard to describe but it’s almost like it’s harder for my 3rd and 4th fingers to perform the tasks I tell them to do while playing.  It doesn’t quite seem like they are functioning at the level they were a couple of weeks ago.  A lot of the strength has come back and the tingling has subsided a great deal but it’s like the 3rd and 4th fingers just “Hang” there aimlessly as I navigate my hand around the fingerboard.  They seem harder to control.  Anyway, I realize there is probably not too much you can say regarding this.  My question is could it be possible that the nerve has yet again become more compressed which is giving me only limited ability to control my 3rd and 4th fingers  or does this sound like nothing more than some ridiculous scenario I have dreamt up in my ever so paranoid mind?  I will admit I’ve been very paranoid about this whole thing over the past year.   I’d appreciate any input you could give.  If you need more info. on anything please ask and I’ll respond ASAP.  Thanks for your time!  

Greg M.

[CCF Neuro[P] MD, RPS]

Dear Greg:

It sounds like it might be that your neuropathy is returning.  I would revisit with your neurologist and he/she may want to redo the EMG.

Sincerely,

CCF Neuro MD

[comment from fellow guitarist]

I have similiar symptoms and found this article that may or may not be appropriate to post here.  Just more information for guitarists with ring and pinky finger problems.
_____________________________

Cubital Tunnel Syndrome in Guitarists
by:Timothy J. Jameson, D.C., C.C.S.P.
© Timothy J. Jameson

A common problem among both acoustic and electric guitar players is the development of left forearm pain. This column will expand upon a specific type of injury, cubital tunnel syndrome, which affects mostly the inner side of the forearm and the pinky side of the hand. This syndrome is probably not familiar to most guitarists, so I'll discuss the typical pain patterns associated with it.

Cubital Tunnel Syndrome 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 is important to understand the function of the muscles in this tunnel, because they have 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).

Now that you've survived the anatomy lesson, lets discuss in real life how these anatomical structures are affected with guitar playing. As I stated earlier, this syndrome typically affects guitarists in the left hand (for right handed individuals - the opposite would apply for left handed people). Why? Because the guitarist uses the left hand for playing the fret board. 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.

So what's a guitarist to do? For those of you who do not have symptoms and would like to prevent them from ever occuring, there's a few simple steps to take:
1) 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.
2) before you play and during your breaks, increase blood flow to the forearm and hands by stretching and performing self-massage to the area. (You may want to visit your library or bookstore and look into some massage techniques - these help to increase the blood flow to your arms and flush out toxins.)
3) For complete prevention, invest in an occasional massage by a professional massage therapist. Also, check with a doctor of chiropractic to make sure the alignment of your neck, shoulders, and elbows is correct to allow proper nerve flow to the muscles and skin.

If you do have the symptoms mentioned in this article:
1) 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 daily.
2) If you are 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 general practictioner who is not trained about treating repetitive strain injuries. Ask the doctor or therapist if they have treated similar cases, and what type of results they achieved.
3) Always try conservative measures first, such as chiropractic, physical therapy, massage therapy, or acupuncture. Give yourself at least six to eight weeks to heal.
4) 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.
5) 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!


Dr. Jameson is the owner and director of Bayshore Chiropractic Holistic Health Center located in Castro Valley, CA, USA. This center incorporates all of the health care disciplines mentioned above and specializes in the treatment of injuries suffered by musicians. You can reach Dr. Jameson by e-mail at ***@****, or by phone at 510-582-5454.

[Greg]

Thanks for the comment and article!  I had actually seen this in the past and it's a great article on Cubital Tunnel Syndrome.  How has your playing been lately?  Have you noticed improvement since the onset of your 3rd and 4th finger problems?  Thanks again!  

[Lady Jay]

Greg,

I've been playing guitar for over 25 years.  In the beginning, I would jam with my friends off and on all day long til the cows came home.  My arm ached, my hand ached, my fingers used to feel like they were molded in the grip.  I'd get so tired I couldn't choke or hammer-on the strings with my ring and pinky fingers.  Then one day... Charlie came buzzing in the door and said, "Lady?  You gotta hear this guy play!"  So he slapped an LP on my turntable and the sound of Leo Kotke (Cot-key) filled the room.  Then Charlie asked if my strings were old?  I said they were... and he started cranking my strings.  "Open tune in E, Lady!  It's so far out!  Check it out!" he said.

Well, hon... it was another world, and I got into it pretty heavy for a while because I could bar all the majors... E, F, G, A with my first finger alone and slide (ooh it was so slick!) with a cylinder.  The grip was different, so it was ease and rest, yet cool and sedative.  A word of advice from one guitarist to another is to change styles every now and then.  (Get into some blues for a spell)  I also play keyboards and the ease of the velocity keys on my Roland also serves as a way to exercise, but from a different angle.

What I'm saying is that all this isn't a cure-all for your problems, but it is a way to appease the insatiable appetite so you can continue to play through it all for satisfaction.

Yours,

Lady Jay

[CCF Neuro[P] MD, RPS]

Thanks for all your comments.  I love to learn and you all taught me alittle.  If I could play the guitar like Leo Kotke I would trade my practice in.  There is also another way to have ulnar nerve problems and that is compression from trauma.  If you have little in the way of fat in you arms and you also put weight on your elbow in particular ways then you can compress the nerve and cause the same syndrome.  

Thanks again.

Sincerely,

CCF Neuro MD

[Lady Jay]

Dear CCF Neuro RPS,

I'm considered a skinny-minny so remind me not to stress-out my elbows.  I like to learn, you like to learn, everybody has a turn in likin to learn... (lyric ?) Thought so!!!  You must be as old as me, if you recognized Kotke's name and his ability.  Turntables and LP's?  Now I know you're aged!  Ha!

If you play, tune all the strings to the E chord and start barring.  You can't go wrong and pretty soon you'll be a different kind of "Patch Adams" around the clinic and singing songs you made up!  I can hear you now...

"Hypo-hypo-hypo
oh laud oh laud-
it's hypocondria!
I say I say
What chew got
is hypocondria!" (in moderate 4/4) ha!

Just don't trade in your practice.  Musicians are a dime a dozen.  Good neurologists aren't!  But that doesn't mean you can't "practice" both worlds.

Have a good one,

Lady Jay

[CCF Neuro[P] MD, RPS]

Thanks, but we are a dime a dozen.

CCF Neuro MD

[Lady Jay]

Through your eyes, not so through ours.  "Practice" doesn't make perfect... it makes "better".

LJ

[CCF Neuro[P] MD, RPS]

Indeed!

CCF Neuro MD