Bow string effect
I am a 65 year old amateur double bass player and I have had a condition in my left hand diagnosed as CTS for about 2 years (including nerve conduction tests). I used a splint for a while with some benefit, but have avoided other treatment because it is interfering with the natural design of my hand. I am worried that the lack of a ligament designed to hold my wrist together will affect my double bass playing irreversibly. The left hand has to grip the neck of the instrument, the fingers are moved rapidly and need considerable strength and speed, and the thumb moves with the arm over a range of a couple of feet or so up and down the neck. In upper positions (low down over the body of the instrument) the thumb is on top of the fingerboard with the other fingers and all are pressed down very firmly. In addition to pins and needles and related discomfort I sometimes get a sharp stabbing pain when my hand goes for a particular position, although I can't predict when or what is likely to cause it. Of course it doesn't do my playing any good.
However I would rather put up with it than end up with worse side effects such as loss of strength or flexibility in my hand and wrist. The thought of the muscles not having a proper hinge to work over and as result getting the 'bow string' effect I have read about is enough to put me off altogether. I have not noticed that more frequent practice makes the CTS symptoms worse, but this could be because I have got used to it. Alternatively, maybe it is a useful form of physiotherapy and I should just play more. There must be other musicians with the same worries. Has anyone got any useful evidence?
Thank you for your reply. I live in Dorchester, Dorset. I didn't know about the BAPAM - very useful, and maybe I will go for a free consultation in due course. Their factsheets are interesting, especially the warm-up exercise physio, and it is reassuring to know that others must have similar problems, even though I am beginning to think that there will not be any way to return to a 'perfect' state of health.
I haven't got the results of my nerve conduction tests, but at the time (2009) it was confirmed that I had CTS in my left hand, possible LH ulnar nerve problems and slight CTS problems in my right hand also. I expect I could get the details, as in the first instance I will soon go to my GP about this (a different one from the last time, as I have moved).
Re steroids, I don't like the fact that it is not a permanent cure, and as you say on your website there is no research on the effect of multiple injections over time. In the last sentence of your reply, did you leave out the word 'if' (you are lucky) by mistake, or were you implying that I am lucky compared with less fortunate people? What if I am not lucky?
Missed out the ;if' ... sorry! I've corrected it now. Occasionally steroid injection can be remarkably successful and it is such a low risk intervention that there is little to lose in trying it - you would be very unlucky indeed to suffer any serious complication from one injection if it is done by someone competent. I have met individuals who presented with their first relapse of symptoms 48 years after a carpal tunnel injection and a couple of weeks ago I met a lady who has so far been free of symptoms for 23 years after one injection and continues so. There are thus a few people for whom steroid injection is effectively a 'cure'. Unfortunately for most it does turn out to be a temporary measure.
2 year old nerve coduction studies are pretty much out of date and if you still have symptoms they ought to be repeated really, in an ideal world by the same laboratory so that a comparison can be made. JB
Encouraged by your responses I posted a message on a double bass internet forum called Talkbass and got a whole range of comments back from all over the world - some saying go for the operation, some saying try the steroid injection, some saying don't trust anything. A fairly intelligent cross section, from which I deduced that my concerns are shared by lots of people, it is quite a common problem with bassists, and there is no single magic bullet. The response I liked best (from a professional American bassist and teacher about my age) was a recommendation for a book of stretching exercises by Sharon Butler - Conquering Carpal Tunnel Syndrome and other Repetitive Strain Injuries. The reviews on Amazon were also very good, so I got it. Provided you follow it carefully and are prepared to be patient and spend the time on the exercises it seems very plausible. It gives lots of useful backgound to make you better able to become aware of how your body is working. I am slowly refining what I do (in conjunction with the BAPAM warm ups) and although I am not really any better yet, I feel it will help me eventually.
Do you know this book and what are your views?
I haven't read that particular book - I tend to rely on primary research and systematic reviews as my evidence base and the main purpose of most consumer books is to make money for the authors/publishers. There is a Cochrane collaboration review of non-surgical treatments which covers exercises and manipulations (amongst other things) and concludes that there is no real evidence that they are effective. I cannot quickly trace any useful information about Sharron J Butler, other than the fact that she is described somewhere as a 'Certified Hellerwork Practitioner' which I suspect means that she has no formal qualifications in medicine or physiotherapy - no qualifications appear on the cover of the book so far as I can see on Amazon - what does it say in the book?. The reviews seem to be largely from people who may well not have had CTS and do not really tell you much. Having said all that - it is very unlikely that a moderate exercise program of any kind will do you any harm so one might as well give it a go - as you have already splashed out for the book. I would by interested to hear if it works and whether it does or does not you should post a furhter review on Amazon. JB
If you are in the UK then the British Association for Performing Arts Medicine (BAPAM) can be a useful resource. I would tend to agree on being wary of surgery but a lot depends on how bad the nerve danage is and whether it is progressing - do you have your nerve conduction study results? Local steroid injection is often a good tactic when there are reasons to try and avoid surgery - it is comparatively safe and can be very effective if you are lucky. JB