Carpal Tunnel syndrome
Carpal Tunnel syndrome
Carpal Tunnel Syndrome is caused by the compression of the median nerve as it passes through the carpal tunnel (in the underside of the wrist when in playing position). There are various reasons why this might happen: for instance, inflammation of the tendons or tendon sheath within the confined space of the carpal tunnel can lead to compression of the nerve. As the median nerve supplies the muscles of the thumb, the second and third finger and part of the fourth, and provides sensation in those digits, CTS can result in numbness or weakness in the thumb side of the hand.
Carpal Tunnel Syndrome is also linked to Thoracic Outlet Syndrome. The median nerve stems from the neck and can also get compressed in the thoracic outlet between the collarbone and the top rib, producing similar symptoms.
The symptoms of CTS usually occur in the thumb and in the second, third (and part of the fourth) fingers and include:
an ache or pain in your fingers, hand or arm
tingling or pins and needles
weakness, particularly in the thumb, or difficulty gripping
Symptoms often start slowly and may be intermittent. They are usually worse at night.
Carpal Tunnel Syndrome can be difficult to diagnose as it is associated with a number of other health conditions and lifestyle factors (it can, for instance, increase during pregnancy). Always consult your doctor who will assess you for any underlying conditions.
The most common diagnostic tests are nerve conduction studies which measure the conduction speed of nerve impulses. If the nerve impulse is slower than normal, you may have carpal tunnel syndrome. However, some pianists experience symptoms of CTS even when test results come up negative (this may be due partly to the musician’s hypersensitivity to sensations): negative test results do not rule out the possibility of Carpal Tunnel Syndrome.
The Phalen test can be done at home (there are demonstrations online).
The most common causes of Carpal Tunnel Syndrome include:
Extreme wrist positions over long periods, such as:
Holding the wrist high when playing piano or typing or flexing the wrist when sleeping.
Over-extending the wrist at the keyboard, or when using crutches.
Leaning on the wrist when typing.
Other awkward hand positions, such as twisting the hand out of alignment.
Repetition, such as prolonged exposure to vibration from power tools, or repeated octaves.
Strong gripping with a tight wrist.
Discuss all pros and cons with your clinician before agreeing to treatment. Your doctor may recommend:
Piano technique retraining - avoiding extreme wrist position
Wrist splint, especially at night, to keep your wrist in neutral position.
Ice during the first 24 hours. Thereafter warmth is preferable.
Mild pain medication and medications to reduce inflammation
Treatment of any underlying conditions you may have, such as diabetes or arthritis
Steroid injections into your carpal tunnel area to reduce inflammation and associated symptoms (normally only lasts a few months)
Surgery is normally only considered after other forms of treatment have been explored.
The most important thing is to cut down on movements that might be causing the CTS. This includes avoiding extreme wrist positions and learning to keep the wrist relaxed while playing. It might be helpful initially and for a limited period, to use a splint when playing the piano, to help you become more aware of any extreme wrist positions.
The technique described throughout ‘The Complete Pianist’ uses a supple wrist, with the neutral position as the midpoint of all movement. Chapters that will be particularly beneficial include:
The Pianist’s wrist
The Roskell Warm-ups (especially shoulder rolls)
The Natural alignment of the arm
The Parachute touch (with minimised movement)
Fundamentals of chord playing
Developing strength naturally
In all movements and techniques involving the wrist, aim for softness in the wrist, with the minimum of movement.
As you recover, it is important not to revert to old playing habits. Keep the wrist supple, working around its neutral position, especially when playing widely spaced chords and when playing forte. Use the ‘cushioning wrist technique’ to minimise the impact of the hand on the keys. Aim to keep within your limits and take regular breaks.