The Doctor is In With Dr. Randy Kertz, DC: DeQuervain’s Syndrome
The Doctor Is In… DeQuervain’s Syndrome
Hello and welcome back. I took a month or so off but am back with a column about DeQuervain’s Syndrome, a condition that presented to my office the other day by a guitarist, but which is equally as detrimental to a bassist.
DeQuervain’s Syndrome is a condition in which inflammation at the base of the thumb causes pain in that area with most thumb movement and is felt most during twisting movements, either with the instrument or in everyday tasks. This includes turning the hand towards the pinky, reaching the thumb under the hand towards the pinky, moving the hand and/or wrist sideways towards the pinky side of the hand (ulnar deviation), or with any forceful gripping, pinching, squeezing or grasping. The idea is that there are two tendon groups (tendons connect muscle to bone), which control the thumb, pulling the thumb outward and away from the hand. These tendons pass through a tunnel on the side of the wrist above the thumb. When overuse causes inflammation of the tendon, you have tendonitis, and this causes pain in that area. Fluid, designed to allow the tendons to slide easily, builds up and causes swelling and irritation, again due to repetitive motion, i.e. repeated picking, plucking, fretting, or extension of the thumb, such as with the left hand reaching the thumb over the neck to fret or just hang there. Signs of this problem are burning, tingling, and numbness on the thumb side of the forearm, which sometimes spreads up the forearm and which can travel down the thumb and into the wrist. This is different from carpal tunnel, which is commonly considered to be the problem because people have heard of it, because you do not feel these sensations in the other fingers of the hand.
Problems in this area can arise from squeezing your thumb excessively. This can be a problem for upright bassists when bowing if the thumb isn’t bent on the bow and able to move freely. A rigid wrist is an indicator of excessive thumb pressure. I preach having the wrist in a neutral position as much as possible, but this doesn’t mean rigid, as in tight and stiff and straight. Allow the thumb and wrist to relax by stretching or shaking them out to remind yourself they are tight. A pressing thumb causes the forearm to tighten up and causes the forearm and wrist to become rigid. Releasing the thumb allows the arm and wrist to move freely. This can be tested by trying this experiment away from your instrument. Move your arm as if bowing while pressing w/your thumb into your forefinger. Then release your thumb and move your arm as if bowing. See how your hand is able to move freely when your thumb is relaxed. For the electric bass guitarist, try to avoid right-hand movement as described previously in the article.
For the left-handed electric bass guitarist, avoid reaching over the top of the neck with the thumb, as keeping the thumb in the middle of the neck in a more classical position is much easier on the thumb and wrist.
Changing up a few things such as previously described and proper stretching and warm-up will help significantly with this problem. If it becomes chronic, ultrasound is a therapeutic modality that will help to reduce pain by reducing inflammation and increasing circulation, and acupuncture is great for pain relief also.
Have a great winter- any questions feel free to contact me anytime in care of the magazine or at firstname.lastname@example.org –
All the best always,
Dr. Randall Kertz is the author or The Bassist’s Guide to Injury Management, Prevention and Better Health – Volumes One & Two. Click here to get your copies today!