Carpal Tunnel Surgery - help please

[justharmony]

New here - hope I'm in right place.  I'm a skilled almost-middle-aged pianist desperate to hang onto my ability to play.  Have had carpal tunnel for over 2 years (sudden onset- definitive cause never determined) and have failed all therapies trying to avoid surgery.  Can't avoid it any more, as am losing dexterity, strength, etc. 

Want to find medical practitioners who appreciate the needs of a pianist, particularly in helping me recover post-surgery, and have been stunned by the collective blank stare I've gotten.  Have called local universities, music schools, prof. orchestras, hand clinics, you name it.  Th most I've found is one local member of PAMA, who doens't have experience with pianists (but is willing to try with greater openness and awareness than others), someone who teaches Alexander technique, and a dr who plays piano but hasn't worked on pianists.   

Maybe worse than the blank stare response are those who simply dismiss that my needs could be any different than anyone else's needs.  It seems to me that it's pretty important for someone who's helping me get back to playing post-surgery understands the different requirements, say, in playing  a Chopin Nocturne vs. a Scherzo, or even Mozart vs. Rachmaninoff. Am I just nuts???

Please help.  Advice, direction, suggestions- general, or anyone (surgeon, physical therapist, etc?) specific to Denver metro area or surrounding states - would be most appreciated. 

Currently have messages into Performing Arts Clinic in Boston and Medical Program for performing artists at the Rehab Institution of Chicago, btw.  Don't know how practical that is, but thought it couldn't hurt to get whatever info they might be willing to give.

Please help.

Thanks in advance.
M.

[oxy60]

Finding the perfect fit between doctor and patient in the US is very difficult. You're on the right track, just don't give up. Doctors tend to be classically minded and you will find a lot of them who play piano. You will also find a certain level of arrogance.

You will want the least invasive procedure. If they open up everything and then try to hook it all back up, you won't get back 100% of what you had before. There is a procedure going through the palm, cutting the fewest nerves on the way to relieve the tight tunnel. Other procedures, going through the wrist or the lower arm will cut a lot of nerves.

I'm no doctor but my wife and her girl friends, all 10 finger typists, have had some sort of hand surgery. That thumb banging on the space bar on non-electric machines caused a lot of stress. 

[drazh]

Dear justharmony
Don't waste time
Find an experienced plastic surgeon  who works on endoscopic hand surgery.
Do whatever he recommend
In CTS no nerve will be cut .only fibrous adhesion bands which compress median nerve should be cut
Don't worry but hurry up
Thank you

[justharmony]

Thanks for the replies.  Does anyone have any references/articles, etc. that support the idea that endoscopic has better recovery rates for musicians than open (or anything else related, for that matter)?  I've heard advocates for both (tho none who worked with musicians, to be fair).

The surgeon I was going to go see today on a referral from a doc I trust I found out was sanctioned because he did the WRONG SURGERY on someone.  Not just the same surgery on the wrong side which is heinous enough, but the WRONG SURGERY, as it was the wrong side (and therefore different anatomy) of an afllicted elbow, apparently.  He's not touching my hands. 

While this is an extreme example, this is the sort of thing I'm running into over and over - referrals, if any given at all, turn out to be people I would never want touching my hands.  But waiting is becoming scarier by the day, too.  I'm absolutely on board with not pussy-footing around, but I don't know where to turn when I have no one giving me any good direction in terms of referrals.... ?  HELP!

No word from Boston or Chicago yet, btw....

M.

[oxy60]

I sympathize with you! I change doctors and specialists every two or three years. They are on their good behavior at the start, then start advising needless tests, procedures and referrals. As soon as they see that medicare card they know which charges the patient sees and which threy don't. My most recent doctor to be fired went a little too far and switched me for someone else. The two tests I get are really cheap and the other patient got everything the lab offered billed to my account. Medicare informed me that they didn't think that I "knew" these tests were being run and that next time they wouldn't cover the costs.

Don't give up! Your doctor is out there!

[justharmony]

Was talking with someone at the international foundation for performing arts medicine today who said that endoscopic surgery was most definitely NOT the way to go - that open offered the best chance of recovery without recurring symptoms.  Again, any references (I also asked her) that document anything in regards to these things woudl be most helpful!  I've been told so many conflicting things I don't know which way  is up anymore!  She didn't have any articles, but said that she'd only seen one person come in who'd had endoscopic surgery - that in her area of the country the docs had pretty much rejected the endoscopic version long ago. 

Thoughts?

[keyboardclass]

Have you actually worked with a piano teacher who understands the problem?  A change in technique where a relaxed wrist is more pronounced may solve the problem, but it often takes time.

[justharmony]

No, I have not had a formal lesson in years. I found someone who teaches with Alexander technique around herd, and may check him out post surgery.  Unfortunately, I don't think I have the luxury of time to try anything else - I need to release the pressure on the nerves as quickly as possible I think. 
I also strongly suspect that it is not my playing alone that has caused this, and that just doing this, like other therapies/techniques I've tried, would not be effective.  After all, I've played fo years, with hours of practice a day at times, and never developed carpal tunnel syndrome until recently.  Something else is going on (pitting edema I strongly suspect is a major contributor if not the culprit,  tho no one can figure this one out either - only what it's NOT - NOT heart issues.  NOT hormones.  NOT nutritional defiiciency. Not an underlying nerve issue even though I do have these also, etc. etc.), I think. though no one has any idea what to do, including, except to try to give my nerves some relief and pray that I can recover to some degree...
JH. 

[keyboardclass]

Presumably you've tried giving up the piano to see if the symptoms go away?

[pianoplayjl]

Instead of giving up the piano why not just take a break? don't practice too much or even don't practice at all for some period of time?

JL

[justharmony]

I did try, once, to not play for a period of time (among other things). No noticable effect, really.  AFter that, I never stopped playing entirely, until recently.  I actually think that my continuing to play (under an hour a day, often less than 30 minutes) may have helped me to not completely atrophy, etc., especially as I suspect that piano is not the main culprit here.  Perhaps if I were back in time 6 months or a year I'd try Taubmann or Alexander etc PRIOR To surgery, but I don't think I have any more time.  I am not playing at all now (and it's killing me) - because I lost the dexterity and strength (rather suddenly, I might add) to play much of anything not long ago. 

Then I had an entirely unrelated accident which cut a nerve in my left hand (a sensory one, not a motor one, so I have hope there), and that hand has been virtually imobilized now for a few weeks as the nerve (post micro-surgery) heals - hopefully.  So I have not played now at all for weeks, and have not used my left hand at all, really (save for a bit of typing, and using some fingers for stabilization, but no grabbing, no real use of any kind).  Hard to assess what effect that's had on my left side until I actually am able to use that hand again.  I'll know more tomorrow, I think.

Thanks for your suggestions.  I don't mean to shoot everyone down, but I'm feeling like I really have few options at this point - trying to make the best of the option that's left - surgery - to let me get back to some kind of playing again asap!  If anyone has any direct experience with surgery - having it or not, or any experience similar to my own, I'd especially welcome hearing from you!!!
Thank you!

JH

[sparkette14]

Hello,

I don't know if you have had your surgery yet. I do have advice to give on this subject. I was an electrician and musician and found myself in need of surgery for carpal tunnel. The person who advised you NOT to do the endoscopic said the exact things my surgeon said to me. he felt the best chance for my recovery was to do the traditional release. He does the mini open procedure. It is still the typical release but a smaller 1 inch incision is made on the palm. I had my surgery about 5 years ago. I am glad I did it. I didn't loose anything after recovery. Recovery is scary and painful, but I still play piano daily for hours without pain. I also play trumpet without pain. I am no longer an electrician because I feel that is what caused the carpal tunnel and I don't under any circumstance want music to be taken away from me. The key to recovery has a lot to do with your surgeon but lots to do with your therapist afterwards. It is important, i mean important to do the exercises given by your therapist daily and as directed. The point of the therapy is to keep the tendons moving to prevent scar tissue from forming which would cause loss of function and pain. I went to McBride Clinic in Oklahoma City. My surgeon was Thomas P. Janssen. I don't know if he has worked on pianists but he has worked on many athletes and everyone I talked to had a good experience with him. He didn't treat me like I was stupid and explained the surgery to me, took time to answer my questions and even told me the risks between endoscopic and traditional. He said he knew how to do the endoscopic but doesn't do it because he feels the risks are too great. I had very severe symptoms before surgery and my nerve conduction study was immeasurable. If yours is not as severe as mine your outlook is much better. I still play piano and without pain. Even though I live in California now I would travel back to Dr. Janssen if I needed another orthopedic surgeon for anything. He was so good to me. Email with questions if you like.

[jesc]

All the best to the OP. I hope that you give us an update should things turns out for the better.

This thread made me aware of the seriousness of Carpal tunnel. I'm a lot careful now since weeks ago some symptoms seemed to manifest on my left hand. I stopped everything stressing my hand. After a few days I did the Phalen maneuver, and nothing significant came up (ok I'm not a medical doctor but I felt no unusual pain).

Still it's good awareness to everyone playing the piano and visiting this forum. BTW I have a good physical therapist I consult with when I feel extreme pain on my hands. It's acts as a preventive measure as well in addition to the recovery as stated above.   

[justharmony]

Thanks everyone for your replies.  Here's an update:  I had surgery about 2 weeks ago on my left wrist - done at Mayo clinic.  I didn't go there for that, but was able to get a referral while there for something else, and was able to get the surgery done before leaving, which I felt ok about.

He did the endoscopic version, which apparently he's had great success with  (done literally thousands of them). The numbness and tingling went away right away, though I am still having pain at my wrist.  Been told to use it, despite some pain, though still hurts enough to be disinclined to do much.  Supposed to be healed enough to fully use in 4-6 weeks, with nerve recovery - to the degree that will happen - possibly taking several months to a year.

Still getting conflicting info on what I should (have)/should not (have) be doing (have done) - and still have the right wrist to do too.  We'll see.  I've heard the figure thrown about that 30 percent of people who have more than "mild" CTS (which I did/do) have recurring symptoms if surgery's done endoscopically, to the point having to have it redone, yet I found no reason to NOT trust the folks at Mayo. 

Both Mayo docs and a local doc I went to for the nerve surgery on my thumb say specific piano-based therapy unnecessary, but still going to pursue that anyway.  Have two names and not sure either is quite right for this stage of recovery.  Suggestions, thoughts, etc. about this (or any of this, really) as always, are welcome.
   
Thanks.
JH

[drazh]

Hi
You did it in one of the best centers in the world
What is the name and specialty of your surgeon?
Where is the scar of incision?
Thanks

[viridian]

The website of the American Society for Surgery of the Hand may have information that will be helpful. You can find out a lot about carpal tunnel syndrome and find an orthopedic hand surgeon in your area.    The URL is www.assh.org. Good luck!

Viidian

[drazh]

Dear viridian
I know but I want to help him for post op recovery
Thanks

[justharmony]

Dr. Elhassan.  See below for info on him:
https://www.mayoclinic.org/bio/13315528.html
Endoscopic surgery, so two small incisions (but the one over my wrist is where it hurts like crazy).  The other is about 2 inches above it in the line in my palm.  2 stitches each (now removed, of course)

It's hard trying to sift through a bunch of information, some of which is conflicting, but I think I'm back to placing my trust in the Mayo folks both on gut instinct and general reputation, and also because if a particular doctor was doing things "wrong" and not having success, I would think they would no longer be working at Mayo, or that they'd adjust to doing things differently. (Besides I couldn't find anything negative about any of the 5 of the docs that were on that day that I happened to get called in by this one.  All 5 stars on public forums where anyone could say anything (and usually the cheesed off folks are the first to express themselves), and that says something to me!)

I'm still looking for a good local complement to the care they began, though.  Have several leads, now. We shall see.

[drazh]

dear justharmony
use silicone base cream and sheet on the scars for at least 6 months to make them softer.
use your hand in usual daily piano practice .
avoid excessive flexion and extension of the wrist . 
find a good physical therapist .s/he can be very helpful post operatively
if scar become larger ask for intralesional corticosteroid injection and laser therapy
thanks

[keyboardkat]

No one is mentioning vitamin B6.   Large doses of it.  If your doctor pooh-poohs that, then get another doctor.   Some doctors never learn a new thing after they graduate med school.   And as the late Dr. Carlton Fredericks said, "It's easy to put down what we're not up on."

B6 in sufficient doses can prevent the inflammation of the carpal tunnel that compresses the nerve.   Most doctors do not receive more than perfunctory training in nutrition.   They say to eat a "well balanced diet," but no one knows really what that is.   Remember, as human beings, we are not mass-produced.   We are all different.   I may require ten times as much B6 or B12 as you do.  I may not absorb it well from food, while another person may absorb it very well.   You should take this by injection.

And remember, playing the piano should feel delicious.   It should NEVER hurt.   If it does, your body is telling you you're doing something wrong!

[drazh]

Dear justharmony
How much did it cost for you ?
Thanks