Anyone have experience playing with the DIP joint (the joint at the fingertip) of the right index finger fused (meaning permanently stiffened)? How much does this affect piano playing?

Here's the background. I'm a 50-year old amateur pianist. Used to be pretty good as a youngster ... had a lot of Chopin, Rachmaninoff, Brahms under my belt; used to show off with things like the Bach/Busoni chaconne, Rach Corelli variations, full set of Chopin etudes, or Brahms/Handel variations. But in the last 30 years, I've only practiced occasionally. Enough to do chamber music here and there, and amuse myself (in spite of slowly getting worse). I don't play the piano to make my living.

About 2 months ago, I had a serious accident, and very badly damaged my right index finger; the rest of the hand and body are fine. The proximal and intermediate phalanx bones were broken into many pieces each, the soft tissue was torn all over. Thanks to the a fabulous reconstructive surgeon, and a few medical miracles, the finger is all attached, it has blood circulation, and the nerves are mostly working. The MCP joint (a.k.a. knuckle) is only slightly damaged (the end of the proximal phalanx was broken lengthwise, but was reassembled with plates and screws), and already has most of the range of motion back. The PIP joint (the joint in the middle of the finger) is doing pretty well, the going itself has about 45 degrees of passive motion, and it is expected that it will also recover nearly completely, although it will require more surgery to free the tendons that are currently bound up with scar tissue. All tendons in the finger are present and repaired, even if many or most are somewhat or completely stuck right now.

The issue is the DIP joint (the joint that holds the fingertip). The fingertip itself is fine (bone, fingernail, and soft tissue), but the bones in the middle phalanx were crushed instead of broken, right at the DIP joint. And the crushed bone pieces first moved to the wrong place (a mal-union), and the two biggest fragments that form the DIP joint are not healing back together (a non-union). This means that the proximal part of the DIP joint is ruined. Right now I have a "false joint" or pseudoarthrosis: the motion that seems to be the DIP joint is actually mostly bone fragments moving in the middle phalanx. Oops, not fun. The only sensible solution (other than amputation, which I don't like) is to do a bone-graft: replace the damaged bone fragments and the whole DIP joint with a solid piece of bone. This means that my fingertip will be permanently and non-flexibly attached to the middle phalanx of the finger, with a 15 degree down bend.

The good news: I'll be able to mostly make a fist, pick things up with this finger, type on a computer keyboard, and not have permanently loose pieces in my finger. For everyday stuff, my finger will be mostly functional. With many months or years of therapy and practice, I'll get most or all of the strength and range of motion back, except with a permanently fused joint at the fingertip.

But how about piano playing? Obviously, for new repertoire, and for simple or improvised stuff (for example accompanying my kid when he practices brass instruments), I can just avoid the right index finger completely, and play with 4 fingers on that hand. That's what I've been doing in the last month, and it works surprisingly well. It's the chords in the right hand that make this hard; either large chords or chord progressions are impossible. A few examples of popular pieces that seem impossible to me with 4 fingers are Rach op.3#2, and the Chopin etudes in sixths and in thirds. If all I'm doing is accompanying someone, I just leave notes out.

How is this going to work with a stiff fingertip on the right index finger though? My hand position varies all over, from nearly completely flat and spread out, to a narrow and tall ball above the keys, depending on need. One thing that particularly worries me is playing white keys with the hand above the black keys. Already today, getting the fat fingertip of my middle finger accidentally between the black keys is a cause of literally fat-fingering notes. With the index finger being less flexible, is this going to get worse? How much do we actually rely on bending the DIP joint?

If anyone has any experience with such a disability, or knows about any literature, I'd be very interested. Or if you know a hand physical therapist or hand surgeon with series piano experience, in particular in California or even better the S.F. bay area. Web searched didn't bring up anything yet.

Treelogger: Very sorry to hear about your accident. Your great posts on the 'voodoo' thread got me curious to see what else you've posted, and that's how I found this.

Of course probably few if any of us have had experience with anything quite like what you've got. As to how much we rely on flexing of the DIP joint....I've never had occasion to think about it before, but now that I do (and look at what I actually do), I'm surprised at how little that joint flexes when I play. But, as you might gather from the kinds of things I'm saying on that other thread I think tiny differences can mean a lot, and I think every extra thing we can do with the finger, however tiny, can contribute to the nuances of our playing. In this case I'd say it's especially in relation to nuances of touch and tone. (Negligible? Sure, maybe.)

YET....I realize that what I'm talking about is eliminating the flexing of the DIP joint and not doing anything else differently to compensate. And I'd guess that actually there's a good chance that you will be able to compensate by changes in what you do with the other joints of that finger, and possibly also by hand positions. And I'd guess further that you won't need to be thinking in terms of any of those specifics; they'll happen sort of by themselves.

It seems you're having a great recovery in view of what happened, and that you won't know for quite a while exactly how it'll sort out in terms of piano -- but that it has a very decent chance to be quite OK.

Heard secondhand today: there is a hand physical therapist who plays the piano, and has treated patients who play the piano. Supposedly he or she is "on the peninsula" (meaning somewhere between Palo Alto and South San Francisco or such). I'll make inquiries to try to locate that person.

And to comment on what Mark C wrote: Clearly, I'll have to change how I play the piano ... in the sense of using a different method or technique. I might actually have to study methods or techniques (for the first time in my life), to see what works best. It's probably better to attack this question analytically and by reading, instead of just trying things out and see what sticks.

I think the opposite.

Dunno, maybe do some of both.

I would definitely go with the latter first -- I trust our brain and body and 'unconscious' to enable us adapt to almost anything, especially if it's something on which we have a lot of prior knowledge and some 'instinct,' which you do -- and only focus on the former if that didn't seem to be working. One big reason I'd definitely do it in this order is that every injury-and-healing like yours, with all the intricacies, must be different, and I would doubt that the same things would apply -- all in addition to the basic differences that exist between people besides. I think our own bodies give us better indications about such a thing than any 'method' would. But of course I know that other people might be inclined in the opposite direction, and I guess you are.

To me there's only one standard thing at all that would apply: Don't do anything at any point that causes more than minimal pain or strain, if any. I imagine we'll agree at least on that.

Good luck. I'm sure a lot of us will be interested to hear how it goes.

During undergrad my teacher complained that sometimes my DIP joints on my index fingers collapsed a little at times, so I tried to learn from my other fingers to see why the same didn't happen to them. I found that my 4th finger DIP joints are extremely tight, and essentially don't move at all when I play, regardless of my hand position. There might be other issues as you are healing, but I don't think a fused DIP joint should affect your playing very much.

That's my own 2c.

I suspect that you won't be affected as badly as you might fear in terms of anatomical shape of the finger. Most things that you do on a keyboard involve a modest curve in that joint. The part that is hard to quantify is how much force this fused joint will be able to withstand without re-fracturing or causing pain.

Assuming you still have functional tendons all the way to the fused joint, I suspect that if you play as though those tendons are still useful. ie. activate them as though they are still holding the shape of the finger tip. you will probably help to reinforce this fused joint and avoid future re-injury. Don't use such a joint in a blunt way assuming that it will keep its structural integrity. Treat it like it's a working finger and try to activate your muscles that way. That way it's more likely to slot in with your other working fingers and less likely to sustain an injury that is based on lack of awareness and stressing the fused part with no muscle/tendon support.

I think it will take a while before you really know how it will hold up. Take it gently and softly and see how it develops. Best of luck.

That's my hope.


After complete healing (which will take many months, finger bones heal slowly, in particular in older people, in particular if circulation is already compromised), the joint will have to be enormously strong. Here's why: Any stiff joint will be in the way. Say I fall, or hit my hand. All my other fingers will know how to get out of the way, by balling into a fist, or by stretching out flat. A stiff finger won't be able to do that, so it will be hit with blunt force way more often. One of the things my surgeon said is: be careful with everyday activities while the joints are temporarily somewhat stiff, so as to not damage them while healing. Once completely healed, the joints need to either be flexible enough to get out of the way, or stiff enough to survive what life throws at them. If that can't be accomplished, he actually recommends amputating the distal phalanx (the fingertip), because having a useless appendage that always gets hurt is worse. But he thinks a sturdy bone graft can be built there.

Consider the inside of a finger. The bone in the tip is tiny, tapering from a little over a 1/4" at the end down to very little. The tendons that attach to that bone are about 1-2mm. Yet that small hardware is capable of handling Brahms2, Rach3, Prokofiev sonatas, and Liszt etudes. I think a nice solid piece of bone connecting the fingertip to the middle of the finger will mechanically survive the pounding that the piano keyboard can dish out. BTW, I'm not good enough to play any of the above pieces seriously.


This sounds like very sensible advice. In particular with bones: by the time you feel pain, something is busted. Joints and tendons are different: you will feel pain when you get them out of their comfort zone, but during rehabilitation, you have to expand that comfort zone. My hand therapist keeps looking at my face when bending the finger, and she says that if I'm not grimacing and gritting my teeth, she has to try harder. She tries to not have to scrape me off the ceiling though.


I look at it as a very long-term investment. If I had had the whole finger amputated, I would have barely had a band aid after a month. Now I'm looking at 1/2 year of occasional surgeries, and probably a year of therapy. But after that, I'll have 10 fingers, of which one is less flexible but mostly movable. And I have lots of time to be patient and careful. It's not like I have a date with the Carnegie Hall stage soon; matter-of-fact, I will never play there in earnest.

You're right, a big part of the piano retraining will be just trial-and-error. But I also might want to study how real experts recommend one should play the piano (if you ask N teachers or books, you'll get at least N+1 opinions), and see what can be adapted to an unusual finger.


Including the ears. I've always found that the most important part in practicing is trying to listen to yourself. What you wrote reminds me that I must look for more than just a technique that doesn't hurt and allows me to hit keys, it must also make good music. Focusing solely on the mechanical and anatomical aspects is tempting, and wrong.

Yes indeed. I think that was about 90% of what I meant by "body."