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Carpal Tunnel Syndrome and the Bass Player : The Doctor is In, Dr. Randy Kertz, D.C.

Hi and welcome back.

Last time I introduced myself and encouraged you to pay attention to your body and your playing, and talked briefly about repetitive stress injuries, which is the core of most of the problems bassists will be facing. This time around let’s talk about one of the most common and commonly misdiagnosed repetitive stress injuries, the dreaded carpal tunnel syndrome.

What is carpal tunnel syndrome? For one, it is what everybody at work, home, the rehearsal studio and the dog groomers says you have when you have any hand or wrist problem, because they heard the term before, and because their neighbor’s brother’s Aunt Sally had it. Sometimes the doctor will tell you that too, incorrectly. Carpal tunnel syndrome will usually present itself with some or all of the following symptoms:

Numbness and tingling starting from the wrist and extending into any part or all of the thumb, first two fingers, and half of the ring finger of either hand or both. It can be noticed anytime, but particularly when the hands are in flexion, which is the angle the wrists will make when one is picking or plucking with the right hand, or fretting with the left (assuming the player is right handed).
Pain in the wrist or hand that wakes one up at night (this is a biggie)

Let me just interject folks that this is for informational purposes only, I haven’t examined you so I don’t know what you do or don’t have, so see a health care professional to get a proper diagnosis, dig?

The above description is pretty on target, so if one has discomfort coming down from the neck or in the little finger it is likely there is something else going on additionally or it isn’t CTS at all.

What the heck is a carpal tunnel? It is a narrow area formed by the bones of the hand, which are called carpal bones. These bones are directly above the crease in the wrist, and a couple of them can be found easily if one feels just above the crease on the pinkie side and the thumb side in line with the index finger. Bony prominences should be felt on both sides just above the wrist crease, towards the fingers, not up the arm. About a thumb width above this area is the carpal tunnel itself, bordered by the bones and a ligament, which is located at the wrist crease. If one taps on this area and it elicits pain, this can be an indicator of CTS.

There is a nerve called the median nerve, which goes through this tunnel and which controls sensation and motion of the thumb, second, and third fingers and half of the ring finger. It can be aggravated or inflamed in the tunnel, due to the fact that it shares this space with nine other structures, tendons, and tissue. Overuse in flexion at the wrist (bending as in playing or fretting position, remember?) can cause inflammation, crowding in the tunnel, and one feels discomfort. If the ligament at the crease of the wrist tightens up due to overuse, it presses down on the nerve and one feels discomfort.

True CTS will be present at night and can wake one up due to discomfort. It will usually hurt more at night because during the day one is in frequent motion, which provides a massage like action and diverts fluid away that would otherwise build up in inflamed tissues. At night, no motion, fluid accumulates; inflammation aggravates the nerve and wakes one up.

What to do? Since I haven’t examined you and don’t know if you have it or not I can’t tell you for sure, but I know the following can be of help for true CTS that has been diagnosed by a health care professional (am I making my point?).

Chiropractic adjustment of the wrist can lift the ligament off the nerve
Acupuncture can relax local musculature and relieve nerve pressure
Ultrasound, electric stim, cold laser, active release technique, splinting at night, all can help and may be appropriate for this condition.
Surgery has a sizeable failure rate, due to patient’s repetition of offending activity and scar tissue build up.
There are great stretches to warm up and cool down with to help this condition, and taking frequent breaks when playing (or ProTooling) and shaking out one’s hands can be helpful.

Remember you can always email me with questions, and I can expand upon this and try to help as best I can, but a lot of my answers will say, ” I haven’t examined you and therefore cannot give you a diagnosis.” Even I am annoyed by this disclaimer at this point, but by now you are well and truly notified.

Any comments are most welcome.

Peace,

Randy

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