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#1236778 - 07/24/09 06:12 PM Thumb tendonitis (De Quervain's)
wtc48 Offline
Junior Member

Registered: 02/10/08
Posts: 4
Loc: Gold Hill, OR
I posted about my thumb problems about a year ago. At that time it was diagnosed as arthritis of the base and first joint of my right thumb. I had a cortisone shot about a year and a half ago, which brought temporary relief. I have also had some temporary relief from acupuncture.

This was an overuse injury, from painting an apartment, mostly with a brush. There may be arthritis present, but I think the symptoms correspond more with De Quervain's tenosynovitis: tenderness and swelling at the base of the thumb, restricted range of motion, pain from pinching or grasping movements, and an audible crackling when the thumb is moved in a rotary fashion.

I can play somewhat without pain, as long as I avoid wide-ranging arpeggios, heavy octave passages, and basically the technical requirements of 90% of the post-Beethoven repertory. The Well-Tempered Clavier works pretty well, with a little assistance from the pedal, which is good, because I really like playing Bach.

I wonder if anyone else has had experience with this condition, and found any treatment that works. I don't rule out surgery, as long as it doesn't make my thumb shorter than it already is. The ortho docs have focussed on the arthritis, and are not too encouraging in this respect.

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#1236780 - 07/24/09 06:17 PM Re: Thumb tendonitis (De Quervain's) [Re: wtc48]
Horowitzian Offline
8000 Post Club Member

Registered: 09/18/08
Posts: 8453
Hi, it might be better to post in Pianist Corner or Adult Beginner's Forum. There will be more responses to a question of this nature in those fora. smile

_________________________
Close only counts in horseshoes, hand grenades, and nuclear weapons.

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#1236831 - 07/24/09 08:12 PM Re: Thumb tendonitis (De Quervain's) [Re: wtc48]
Nikalette Offline
1000 Post Club Member

Registered: 12/22/08
Posts: 1081
Loc: California
Originally Posted By: wtc48
I posted about my thumb problems about a year ago. At that time it was diagnosed as arthritis of the base and first joint of my right thumb. I had a cortisone shot about a year and a half ago, which brought temporary relief. I have also had some temporary relief from acupuncture.

This was an overuse injury, from painting an apartment, mostly with a brush. There may be arthritis present, but I think the symptoms correspond more with De Quervain's tenosynovitis: tenderness and swelling at the base of the thumb, restricted range of motion, pain from pinching or grasping movements, and an audible crackling when the thumb is moved in a rotary fashion.

I can play somewhat without pain, as long as I avoid wide-ranging arpeggios, heavy octave passages, and basically the technical requirements of 90% of the post-Beethoven repertory. The Well-Tempered Clavier works pretty well, with a little assistance from the pedal, which is good, because I really like playing Bach.

I wonder if anyone else has had experience with this condition, and found any treatment that works. I don't rule out surgery, as long as it doesn't make my thumb shorter than it already is. The ortho docs have focussed on the arthritis, and are not too encouraging in this respect.


I had a problem with both of my thumbs at the base joint. It happened about 5 years ago, after a bunch of long sessions of playing a very repetitive blues chord progression. I still have a look of arthritis in thumb joints.

My thumbs were sore for at least 6 months maybe a year. I actually just stopped playing piano...I wasn't doing that much on the piano at the time anyway. Eventually it went away, and I rarely get thumb pain now. When I was taking my class piano at the college, if I tried to do extended rolled chords, my thumb would hurt in my left hand. Any sustained stretching, like trying to play 9ths, will lead to pain.

All I can say is, since you probably don't want to stop playing piano for 6 months....to do the usual rest, ice or heat, elevation, perhaps some massage at the base of the thumbs. You might check with a physical therapist or hand doctor for some gentle exercises.

I think once you have a problem like that you have to avoid certain pieces of music that would be aggravating. I'm also very careful with doing too many scales or arpeggios...I avoid passing the thumb under whenever possible, instead trying to move my hand quickly.

Hand surgery is a big deal...there are no guarantees with any surgery and the hand is very complex. I would get several 2nd opinions from hand specialists.

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#1236832 - 07/24/09 08:13 PM Re: Thumb tendonitis (De Quervain's) [Re: Nikalette]
Nikalette Offline
1000 Post Club Member

Registered: 12/22/08
Posts: 1081
Loc: California
I wouldn't count on the opinion of orthopods, unless they have undergone extensive training in the hand. I think a lot of hand specialists are plastic surgeons.

Even the back is now the province of the neurologist, not the orthopod...give them the hips, knees, shoulders, etc...

Go elsewhere for the hand.

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#1236847 - 07/24/09 08:58 PM Re: Thumb tendonitis (De Quervain's) [Re: wtc48]
dmc092657 Offline
Full Member

Registered: 02/02/08
Posts: 277
I have been down this road for the last two years. I was misdiagnosed first with Carpal Tunnel & then DeQuervain's. My pain is in the exact same joint (Carpal-Meta-Carpal joint at the base of the thumb). I also received two cortisone injections which didn't really help. It took 3 or 4 doctors before one finally told me it was Osteoarthritis.

Here is a simple test you can perform to determine if you have DeQuervain (i.e. teno-synovitis):

Finkelstein test

If this causes EXCRUCIATING pain (not a mild discomfort), then you may have DeQuervain's.

Hand specialists are NOT plastic surgeons, but actually orthopedic surgeons with additional specialized training.

A word of advice - I would start by seeing a rheumatology physician. This area is a sub-speciality of Internal Medicine. Hand injuries can be very tricky to identify because there's a great deal of symptom-overlap. Rheumatologists are intimately familiar with joints of all kinds (and the surrounding soft tissue). They can pin it down. Internal medicine physicians in general are diagnosticians (i.e. problem-solvers) whose strength & training centers around making the right diagnosis based on a clinical picture that you provide as well as other tests. From there, they can refer you to a surgeon to fix the problem (if that is what is needed).

Hope this helps. Good luck !

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#1236872 - 07/24/09 09:51 PM Re: Thumb tendonitis (De Quervain's) [Re: dmc092657]
wtc48 Offline
Junior Member

Registered: 02/10/08
Posts: 4
Loc: Gold Hill, OR
Thanks for all the replies. Actually, I get through Finkelstein's test pretty well, but in all other respects (especially the crackling of the tendons) it corresponds to De Quervain's. I know a rheumatologist, who is also a musician, and I think I will try to see her. Also, I had hand surgery for trigger finger (middle digit, RH) 25 years ago by a plastic surgeon, which was totally successful.

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#1236877 - 07/24/09 10:07 PM Re: Thumb tendonitis (De Quervain's) [Re: wtc48]
josh3355 Offline
Junior Member

Registered: 07/09/09
Posts: 12
i wouldn't suggest cortizon shots they are really bad for you. have you tried some sort of SLOW strech therapy and or message therapy it it's De Q's then i think thats just tendonitis in the base thumb joint. also don't push yourself ice your whole hand (in icy water in a sink) when it flares.

what is trigger finger exactly i never thought it was real i though it was something to do with someone who shoots at people alot or something

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#1236919 - 07/25/09 12:01 AM Re: Thumb tendonitis (De Quervain's) [Re: josh3355]
Bob in WA Offline
Junior Member

Registered: 11/27/07
Posts: 15
Loc: Walla Walla, WA
Greetings,

I would suggest "Topricin" creme. It's a topical cream that seems to work very will with these sort of "overuse" injuries. My wife is a rehab therapist and starting using this several years ago on her patients with very good success. I've used it too. It seemed to work pretty well.

A friend of mine who is a trombone player had such pain in his elbow he could hardly play. My wife gave him a tube of Topricin to try and a couple of weeks later he called to say that, "whatever that stuff was, it worked."

Google Topricin. At about 13 bucks a tube it would at least be inexpensive to try.

Good luck,

Bob

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#1237171 - 07/25/09 03:15 PM Re: Thumb tendonitis (De Quervain's) [Re: Bob in WA]
dmc092657 Offline
Full Member

Registered: 02/02/08
Posts: 277
Quote:
i wouldn't suggest cortizon shots they are really bad for you.


Oh good grief....You should educate yourself before posting such nonsense.

Cortisone injections (like most things in life) are only "bad for you" if you have too many of them (in the same area) in too short of a time span. Kind of like ingesting 100 Advil at a time instead of just taking two. Doctors monitor these very carefully and won't administer more than one in the same area within about 4-6 months of each other. They may not always be effective. But as long as you don't get them more frequently than 2-3/year in the same joint, cortisone shots are fine.

Dequervain's is a type of teno-synovitis that is centered at the base of the thumb. It is NOT an inflammation of the actual tendon (i.e. tendonitis) but a swelling of the sheath or tunnel that surrounds & lubricates the tendon which eases its movement. This is what causes the clicking sound often associated with it. As the tendon tries to move, it becomes caught in the tunnel. The clicking sound is caused by the tendon being freed up.

Trigger finger is basically teno-synovitis that is centered in a thumb or finger. The label "trigger finger" is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun.

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#1237252 - 07/25/09 05:24 PM Re: Thumb tendonitis (De Quervain's) [Re: dmc092657]
Jeff Clef Offline
4000 Post Club Member

Registered: 10/05/08
Posts: 4457
Loc: San Jose, CA
Cortisone injections are not only for pain relief, but also to put the brakes on the runaway inflammatory process (which becomes a problem of its own, on top of the original injury), so the joint can heal; same story with ice. NSAIDS are somewhat anti-inflammatory and may help a bit that way, as well as relieving the discomfort.

The joints are not very forgiving, but they do heal themselves in time, given rest and appropriate treatment. There are studies that have shown that glucosamine-chondroitin tablets can be helpful with osteo-arthritis. Rheumatoid is a whole different story.

I had to stop playing for about four or five months--- like it or not--- then resume very cautiously. I also found PT to be helpful. But, my injury, while somewhat similar to yours, was not like what you're describing.

I'll hope for a good outcome for you, wtc48. It sounds like you're getting good care with reasonable recommendations, trying the easiest and safest things first. I think I, too, would want a second opinion before a hand surgery, but I didn't hear you saying the doc is rushing you into it. Patience, persistence, and good luck!
_________________________
Clef


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#1237254 - 07/25/09 05:27 PM Re: Thumb tendonitis (De Quervain's) [Re: dmc092657]
Jeff Clef Offline
4000 Post Club Member

Registered: 10/05/08
Posts: 4457
Loc: San Jose, CA
Cortisone injections are not only for pain relief, but also to put the brakes on the runaway inflammatory process (which becomes a problem of its own, on top of the original injury), so the joint can heal; same story with ice. NSAIDS are somewhat anti-inflammatory and may help a bit that way, as well as relieving the discomfort.

The joints are not very forgiving, but they do heal themselves in time, given rest and appropriate treatment. There are studies that have shown that glucosamine-chondroitin tablets can be helpful with osteo-arthritis. Rheumatoid is a whole different story.

I had to stop playing for about four or five months--- like it or not--- then resume very cautiously. I also found PT to be helpful. But, my injury, while somewhat similar to yours, was not like what you're describing.

I'll hope for a good outcome for you, wtc48. It sounds like you're getting good care with reasonable recommendations, trying the easiest and safest things first. I think I, too, would want a second opinion before a hand surgery, but I didn't hear you saying the doc is rushing you into it. Patience, persistence, and good luck!
_________________________
Clef


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