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#535189 - 12/20/06 03:34 PM Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
Hey a couple years ago I worked ina butcher shop and got a really bad case of "trigger finger" in my right hand that ruined my ability to play/practice for a while. However, ever since then I've been experiencing a decrease in finger independence in my right hand in regards to the middle finger.
It's difficult to explain but basically when I use my 4th/ring finger, my middle finger now automatically wants to raise up and often it's similar when I use the pinky as well. There's other small problems but none are as big as this which has caused me to stop playing for a while out of frustration.
Basically when I play fast passages my middle finger ends up invariably rising up higher and higher whenever the 4th finger is used and then if the middle finger has to be played right after afterwards it's impossible to make it come down quick enough for a smooth passage and that's where this problem hinders me.
If I place all my fingers on the keys and play really slowly some exercises I can press down the 4th finger or any finger usually without the middle coming up but only like I said if I am playing slowly and concentrating hard but in faster passages when I can't help it this problem continues to occur.
Even now as I type fast in the qwerty position if I have to type LOL really fast for example and with my 3rd middle finger on the letter "K" I hit "L" "O" "L" really fast with my 4th/ring finger, my middle finger cannot help but to rise really high in the air and give me a tensed feel throughout the hand whereas if I do this identical exercise in the left hand on "S" "W" "S" my left hand 3rd finger barely moves at all.
Since I know that supposedly the 2nd, 3rd, and 4th fingers are connected by one tendon into the forearm for mobility I fear some sort of tendon damage from the ravages of that inhospitable butcher shop environment that I suffered for 5 or 6 months back in early 2005. However, at other times I'm almost convinced that it is at least mostly mental and that with exercise I can restore and fix this severe independence issue that disables me from playing many fast passages in the right hand at this point.
Does anyone with or without medical or physiological knowledge have ANY opinions or ideas for 1. what the problem might be and 2. how I can fix it, what sorts of finger independence exercises etc?

This has sidetracked my entire pianistical pursuits so I appreciate any help or advice at all, thanks guys.
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"He who turns himself into a beast, gets rid of the pain of being a man."

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#535190 - 12/20/06 03:36 PM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
By the way when I put all my fingertips on a flat surface and 'trill' with the 4th and 5th fingers, the 3rd invariably also rises and I have a much harder time of doing this in the right hand whereas in the left I feel no sensation or desire of the 3rd finger to rise as the 4th and 5th trill
_________________________
"He who turns himself into a beast, gets rid of the pain of being a man."

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#535191 - 12/20/06 05:54 PM Re: Finger Independence/Tendon Injury HELP
signa Offline
8000 Post Club Member

Registered: 06/06/04
Posts: 8482
Loc: Ohio, USA
it would probably be healed after a while if it's temporarily strained somehow. but in any case, you might want to try to rotate/circle (horizontally) your hand a bit more so that you could rely on your arm weight being distributed more to that finger. such a movement will definitely help with touch and therefore the sound produced even if you don't have any finger problem. it's a tip from my teacher btw.

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#535192 - 12/21/06 09:36 AM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
thanks signa I have been trying that somewhat as well.
_________________________
"He who turns himself into a beast, gets rid of the pain of being a man."

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#535193 - 12/21/06 10:18 AM Re: Finger Independence/Tendon Injury HELP
playliszt Offline
Full Member

Registered: 05/01/06
Posts: 449
Loc: Oh/Fla
-
Did you try doing Chopin op10-2 Really Slowly (and just the RH) as a therapeutic exercise to see if may get you some finger independence restored?

Sorry I have nothing else to help you out of the problem.

A Butcher shop seems like the last place a piano player should work!

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#535194 - 12/21/06 11:16 AM Re: Finger Independence/Tendon Injury HELP
Jim Frazee Offline
Full Member

Registered: 01/31/06
Posts: 392
Loc: Westchester County, New York
Try this, an exercise I call the "spider":

With your hand in playing position on any flat surface, keep all your fingers down, then lift thumb and three ONLY keeping two, four and five down, then two and four ONLY keeping one, three and five down and three and five ONLY keeping one, two and four down. Kind of like playing thirds but you can do this anywhere. Do this slowly, slowly at first, then gradually build up speed, making sure that three fingers are down while two are lifted.
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PianoPerfection
Teacher, performer, technician
Westchester County, NY

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#535195 - 12/21/06 11:59 AM Re: Finger Independence/Tendon Injury HELP
Pathbreaker Offline
500 Post Club Member

Registered: 09/18/04
Posts: 996
Loc: Massachusetts
Dohnanyi deals with finger independence including holding fingers down etc. Must take special care also not to overdo it.

Maybe some balance between very limited use and simple relaxed exercise could work as therapy for you.

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#535196 - 12/22/06 07:28 AM Re: Finger Independence/Tendon Injury HELP
virtuoso418 Offline
500 Post Club Member

Registered: 10/29/03
Posts: 645
Considering the general nature of your job, it seems to be a case of repetitive strain injuries.

You are correct with the fact that specific muscles are located in the forearm. When describing the physiology of finger movement, it involves the contraction of muscles in the forearm but the tendon is required to physically move the finger. The tendons, in this case, are an elaborate system called Flexor tendons, which travels from the muscles in the forearms, to the wrist, and finally to the fingers.

Each tendon MUST be securely attached to the finger bone and the muscle on each end. At the same time, you have a neural network that is involved. Your brain receives sensory input from your fingers and joints, and each of these nerves run into each hand. The nerves use the exact same route through the wrist as the tendons, so you can think of it as a co-route in which serves both functions.

Having said that, there are three primary nerves that run through your hand: radial, median, and ulnar nerves. The median nerve reaches the hand through the carpal tunnel and provides sensation to your middle, pointer, lower thumb, and thumb side of the ring finger. It's a very asymmetric arrangement when you think about it, because there is an unequal distribution of nerves to each finger. The radial provides the same sensation to the digits on the backside. The ulnar primarily provides to the pinkie.

My 1st guess is that there may be an obstruction of nerve(s) that doesn't allow you to differentiate between your 4th and 3rd intricately. It may be another specific nerve that i may have not mentioned to be affected. It could possibly be nerve damage and/or muscle/tendon damage also.

Again, more specific insights can narrow possibilities and knowing more specific conditions of your workplace can lead to better inferences.

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#535197 - 12/22/06 07:29 AM Re: Finger Independence/Tendon Injury HELP
virtuoso418 Offline
500 Post Club Member

Registered: 10/29/03
Posts: 645
And of course, always seek professional opinions near you so they can physically have a look.

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#535198 - 12/22/06 08:32 AM Re: Finger Independence/Tendon Injury HELP
CC2 and Chopin lover Offline
1000 Post Club Member

Registered: 01/12/06
Posts: 1981
RA,
As a Physical Therapist and pianist, I will give you some likely possibilities, although with the caveat that a musculoskeletal problem such as you describe cannot, and should not, be diagnosed without a thorough examination and history taken of the patient. The "trigger finger" you describe can be caused by repetitive strain, and a swelling/scarring/thickening of the tendon sheaths (tunnels) that the tendon slides through as it moves the bone of the finger. One thing that you said is incorrect...there is not one tendon that controls the last three digits, but individual tendons emanating from muscles in the forearms. The lifting of the 3rd digit, that you describe, can be the result of scar tissue that has formed from the 3rd digit's tendon adhering it to the adjacent 4th tendon. Or, it could be the result of inherent muscle weakness in the 3rd digit from having been unable to use it through its full range of motion for so long. If you go to see a Physical Therapist who is certified in Hand Therapy, specifically, they can make an accurate assessment of the cause of your problem and recommend a series of home exercises for you to follow. In addition, they will probably use ultrasound and a topical ointment, as well as "hands on techniques", to attempt to break up scar tissue and regain mobility. You can manually hold down the middle finger while lifting the ring finger for 10 or 15 repetitions at a time. If you require assistance to get the ring finger all the way up, provide whatever level you may need with the left hand, while continuing to hold down the middle finger. Additionally, you can work on lifting the middle finger while holding down all the others, in order to strengthen it. But, by all means, seek the assistance of a Certified Hand Physical Therapist. If this conservative approach does not work for you, then your physician will probably recommend cortisone injection, and, if all else fails, surgery. These conditions are complicated if you are a diabetic or have rheumatoid arthritis, by the way. Hope this helps you. Good luck.
Dan
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Piano Technician/Tuner

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#535199 - 12/22/06 12:12 PM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
Everyone, thanks for your input. Jim I have been trying this "spider" exercise of yours and I seem to be able to do it with little problem other than perhaps a feeling of tightness.

However, let me address the two most important posts from cc2 and virtuoso418 at length since it seems you two have great knowledge of this and may be able to help me.

First allow me to describe what it is I think that damaged my hand thus:

The main culprit in that meat room was daily usage of the meat hooks to grab heavy hunks of meat and throw them on the table for cutting. We had barrels upon barrels, or rather giant garbage cans full of heavy sections of meat and daily I would grab a meat hook with my right hand tightly and hookonto htese heavy chunks and throw them on the table. The meat hook is basically a wooden cylinder with a metal hook protruding out of it. You grab the wooden cylindre part with your palm and grab it tight s othat the metal hook part protrudes from between your 2nd and 3rd or 3rd and 4th fingers. After the first few days on that job I felt immense strain and pain in my forearm and my hand felt really tight. Eventually I got a really bad case of trigger finger where mostly my 2nd, 3rd, 4th, and 5th fingers would all lock into my palm if I close them. This would normally occur in the morning and upon loosening up for a few hours or what have you it would mostly go away.

After I left that job eventually the trigger finger disappeared however to this day, which is almost 2 years afterwards now I can FEEL a difference in my right hand. For example sometimes after a lot of typing or playing if I close my fingers of my right hand into the palm I can still feel a very SUBTLE tightening and or "clicking" (don't know any other way to explain it) as I raise my fingers back into outstretched positoin. It's very hard to describe but it almost feels as if the tendon(s) connecting my fingers to my forearm is tight and I can feel a tightness. When I do things like trills on a flat surface with my 4 and 5 or 3 and 4 fingers I often feel a slight pain or tightness eventually enter my UNDER forearm, i.e. the opposite side of the top of the forearm.
Other anomalies persist that do not exist in my left hand. For example I've often woken up at night or in the morning with my right hand feeling numb as if there is some sort of nerve or blood flow damage though this hasn't happened in a few months I THINK. Secondly, my right hand fingers are now more wont to crack if I attempt to crack them whereas the left hand the fingers always feel very limber and enegetic and don't crack if I pull them back or forward. The riht hand on the other hand I experienced something a few months ago where my middle finger kept going up when playing as I described before and then upon closing the finger tightly into the palm and pushing it down with my left hand sharply to crack it, it would pop and suddenly afterwards for a while at least the 'lifting' of it whilst playing was less pronounced and I simply felt more in control somehow of the finger whereas otherwise it would feel weak and somehow slightly beyond my control. In general after typing/playing I feel a tightness in the right HAND that just doesn't exist in the left but this could be natural I suppose as I am righty and perhaps everyone feels similarly.
That's all I can think of to say for now, and alhtough I know a true diagnosis is impossible over the internet, I greatly appreciate and look forward to any insight I can get at all so feel free to ask me more questions because honestly I haven't touched the piano in 2 months now and am greatly depressed over this because I've had this problem now continually in lesser form for 2 years now BUT only in the past 2 or 3 months inexplicably the right hand has deteriorated even more and now I just simply cannot play with it at all due to this problem, even scales are impossible to play with any evenness or comfort because it just feels uncomfortable to even play anything at all as I constantly feel either tightness or pressure or just an overwhelming sense of not being in control of my fingers in the right hand anymore. Like I said any help is greatly appreciated as I am at my wit's end.
_________________________
"He who turns himself into a beast, gets rid of the pain of being a man."

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#535200 - 12/22/06 01:10 PM Re: Finger Independence/Tendon Injury HELP
CC2 and Chopin lover Offline
1000 Post Club Member

Registered: 01/12/06
Posts: 1981
RA,
I will reiterate what I had mentioned earlier. The "tightness" you perceive is coming from the swelling, due to chronic inflammation, of the tendon sheath, which is a "tunnel" that each tendon slides through as the muscle attached to it contracts and relaxes. The "click" or "pop" that you feel occurs when the tendon gets stuck, and then releases from the tight, swollen, entrance to this tunnel. The muscles involved are the finger flexor muscles located in the bottom side of the forearm. The reason your hand goes numb is because these chronically inflammed structures in your hands sit adjacent to the motor and sensory nerves that feed the muscles and sensory organs. When they are pressed on by swollen, inflammed tissue, it is like putting a kink in a fast running water hose, so the neural signals are being prevented from all getting through. You need to go see a Hand Specialist......that is the bottom line here.
_________________________
Piano Technician/Tuner

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#535201 - 12/23/06 10:52 AM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
Holy crap guys, I feel thanks to you I have just had a break through of sorts. Now, it could be temporary we'll see but let me explain:


When cc2 lover said that a hand therapist might be able to give me exercises and use a hands on technique to 'break up scar tissue' this was a revelation to me because not only was I ignorant of the fact that there was even such a thing as a hand therapist but also of the fact that simple exercises I could do myself may be able to solve what I considered to be an incurable problem. This got me to thinking...now I know you would strongly recommend a professional hand therapist and although I may have to try that route eventually but believe me I would have long ago if I had the means to do so but my financial situation presently is such that it precludes me from being able to do so as much as I would like to. So anyhow, armed with this new knowledge I attempted to devise some new exercises myself based on my own theory of what is wrong with my hand which subsequently is based partially on some of the things you guys have said here about tendons and injuries. But anyhow for a while yesterday I began to do all sorts of stretches and exercises for my rght hand, such as gently pulling my fingers backward or lifting each finger multiple times etc I did this for a bloody hour or two and I felt whne I was stretching hte fingers backwards something started to feel better and miraculously as if some of that "scar tissue" was broken instantly my middle finger began to feel much better almost instantaneously. Now like I said this is probably temporary but I can tell you even as I type right now my middle finger is NOT lifting up, or barely so, when I use my 4th and I just played on the piano a bit for only the second time in months (yesterday being the first) and suddenly I can almost play a few of my old pieces. Granted, the finger still doesn't feel 100% but I wonder if I continue a course of such exercises if it will rehabilitate completely. I'm excited and although at the moment where I'm staying I have nothing but a keyboard with unweighted keys, I should be getting my digital weighted keyed p120 in a few days and I'm excited to try it out IF this lasts...thanks again for the help so far guys...
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"He who turns himself into a beast, gets rid of the pain of being a man."

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#535202 - 12/23/06 12:47 PM Re: Finger Independence/Tendon Injury HELP
playliszt Offline
Full Member

Registered: 05/01/06
Posts: 449
Loc: Oh/Fla
Ladies and Gents, I believe we found our "in-house" hand-mechanic-and-advisor: CC2 and Chopin lover[/b].
Lots of info there, thanks.

...And best of luck to Req.A [/b] recovery attempts.

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#535203 - 12/23/06 10:01 PM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
thanks playliszt. During the day after I wrote that my hand gradually deteriorated again but not as worse as before and through continued use of those exercises it has seemingly been gradually improving and feeling much better than the past few months so I am being optimistic right now and will keep you updated on what happens over the course of the next few days or week or two to see if it truly does improve dramatically.
The only other question I have right now is if cc2 or virtuoso can recommend any of the exercises that a hand therapist might use were I to go to one, I am wondering if they are the same or similar to the ones I've devised myself and am practicing now? Anyhow thanks again for the help and encouraging words to everyone.
_________________________
"He who turns himself into a beast, gets rid of the pain of being a man."

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#535204 - 12/24/06 02:40 AM Re: Finger Independence/Tendon Injury HELP
virtuoso418 Offline
500 Post Club Member

Registered: 10/29/03
Posts: 645
 Quote:
Originally posted by Requiem Aeternam:
thanks playliszt. During the day after I wrote that my hand gradually deteriorated again but not as worse as before and through continued use of those exercises it has seemingly been gradually improving and feeling much better than the past few months so I am being optimistic right now and will keep you updated on what happens over the course of the next few days or week or two to see if it truly does improve dramatically.
The only other question I have right now is if cc2 or virtuoso can recommend any of the exercises that a hand therapist might use were I to go to one, I am wondering if they are the same or similar to the ones I've devised myself and am practicing now? Anyhow thanks again for the help and encouraging words to everyone. [/b]
Req, glad to see some improvement.

I apologize if i can't provide any help with therapeutic techniques as i only have a competent knowledge of your situation through my rotational studies. I can provide some insight into physiological functionality, however my applications are limited. cc2 gives some pretty good advice and considering the fact that he specializes in this field, perhaps he can tell you which exercises to perform. But more importantly, as him and I have seem to reach a general consensus, seek certified medical help around you. Best of luck

P.S. Let me know if you have any questions on pathological conditions, that is my specialty.

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#535205 - 12/24/06 10:19 AM Re: Finger Independence/Tendon Injury HELP
CC2 and Chopin lover Offline
1000 Post Club Member

Registered: 01/12/06
Posts: 1981
RA,
here are the exercises I recommended in my post at the beginning of the thread:

 Quote:
You can manually hold down the middle finger while lifting the ring finger for 10 or 15 repetitions at a time. If you require assistance to get the ring finger all the way up, provide whatever level you may need with the left hand, while continuing to hold down the middle finger. Additionally, you can work on lifting the middle finger while holding down all the others, in order to strengthen it[/b]
Sounds like you are doing some things that are similar and likely to have similar effects. I would caution you to not overdo these exercises, however, as you could potentially create a whole new set of repetitive injury problems by doing so. As far as your inability to seek out a PT Certified in Hand Therapy, all health insurance that I know of will cover it, and, in the absence of that, I would allocate the money that I would otherwise be spending on any "non-essentials" so that you get a professional assessment and guidance as to how and what to do. You could accomplish this in two or three sessions, at a cost out of pocket of around $200.00 to $300.00. Hard to imagine your ability to return to the piano is not worth that to you.
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Piano Technician/Tuner

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#535206 - 12/24/06 10:49 AM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
CC2, didn't know htat about the insurance, it is definitely worth it to me. Seeing as how you live in NYC too (I'm in Brooklyn) would you happen to have any recommendations off hand for hand therapists or a source where I can locate one?
_________________________
"He who turns himself into a beast, gets rid of the pain of being a man."

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#535207 - 12/24/06 12:09 PM Re: Finger Independence/Tendon Injury HELP
CC2 and Chopin lover Offline
1000 Post Club Member

Registered: 01/12/06
Posts: 1981
Go to the APTA, (American Physical Therapy Association), website and do a search for Certified Hand Therapist.
_________________________
Piano Technician/Tuner

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#535208 - 12/24/06 03:46 PM Re: Finger Independence/Tendon Injury HELP
Requiem Aeternam Offline
1000 Post Club Member

Registered: 07/28/04
Posts: 1395
Loc: Brooklyn, NY
I forgot to mention that I'm also entertaining the possiblity that this problem could be FOCAL DYSTONIA for whoever's heard of it, read this I just found almost an identical situation to myself:


Thank you for your posting on dystonia in musicians. I had studied piano since age 5, and played all of my life. After obtaining a Bachelor of Music Performance, I went on to graduate school. By age 23, my right hand wasn't what it used to be, and I blamed myself for not being able to play up to par. I decided that I should seek a new vocation, and obtained a Bachelor of Science in physics. I continued to play well for some years, but by the time I was thirty, my right hand (fingers 3, 4 and 5) would not function properly. I fell into a deep depression. I was finally diagnosed with focal dystonia, and I tried everything from Klonopin to Botox. Nothing worked.


Similarly I am 24 and it's my 3 and 4 finger that seem to not be responding correctly. The reason I am thinking this to possibly be a mild case of focal dystonia is that although I did injure my right hand 2 years ago, it never had such a problem until only recently when my hand began as if by magic to mysteriously deteriorate. How is that possible if the hand was more or less fine after the actual time I worked in the butcher shop? Furthermore, after doing various finger exercises and trills for hours every single day for the past few days I am convinced that my right hand does almost everything as well if not better than the left and seems to feel fine and is able to do all the exercises but when it co;mes to actual playing for some reason my 3rd finger seems to be misfiring and has a mind of its own.
_________________________
"He who turns himself into a beast, gets rid of the pain of being a man."

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#535209 - 12/24/06 08:00 PM Re: Finger Independence/Tendon Injury HELP
mmmmaestro007 Offline
Full Member

Registered: 02/15/06
Posts: 420
Loc: australia
i have 'trigger thumb' in my left hand - i am working at a place which requires lifting of small but very heavy objects

one day if i felt a stretching of the tendons in both thumbs but the sensation soon disappeared

a week or so later i had a few days off work and practiced piano quite a lot and next morning woke with the left trigger thumb

i also sometimes have slight pain in my right thumb but never the extent of trigger

you NEED to see your doctor and have your hands scanned to determine whether you need surgery
THIS IS VERY IMPORTANT!!!

i was told if you do not receive the correct treatment there can be long term complications which would not be pleasant for a pianist

yes the scans are not cheap but would pale into comparison of being not being able to play piano years from now
BTW, my Hand Therapist advised AGAINST forcing the thumb past the trigger
all the best!
_________________________
"musical training is a more potent instrument than any other because rhythym and harmony find their way into the inner places of the soul" -Plato

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