Picking hand joint damage?
Posted 29 October 2010 - 12:46 PM
The joint of my index finger snaps and cracks very loudly every time I bend my finger. It's the joint closest to my fingernail (so not the joint at the knuckle), and it constantly pops, even during every day activities. If I use a mouse, it pops upon every mouse click. If I close my hand, making a fist, it pops. If I re-open my hand (e.g. to point at something), it pops. I've had several colleagues have a look at it, and about half of them think it's arthritis - except that I don't have the number one hallmark of arthritis, i.e. stiffness. The joint isn't swollen either, it just... pops. The cracking is loud enough to be heard across the room - something that occasionally scares the sh!t out of my patients, hah. There's no structural damage to the joint, either. There's no refractory period in the popping, as you have in your knuckles - you can't crack your knuckles twice in a row, within seconds. But my index finger pops every time... and it's gotten to the point where it is affecting my guitar playing. If I fingerpick for 5 minutes, I have to stop and stretch my fingers several times to get 'em cracking, and then I can play for a couple of minutes again.
Now here's the thing: it's making me paranoid, because fingerpicking is pretty much all I do nowadays. I made the switch from "rock" guitar playing to folk, blues and jazz fingerpicking quite some time ago, and I'd be nowhere without my index finger. So the question, in short, is this: do any of you "heavy fingerpickers" have similar issues with joints popping in your picking hand? If so, how does it affect you? Does it hinder your guitarplaying at all? Have you changed your technique to accomodate for the "loss of a finger"?
Thanks in advance for your answers - this is really doing my head in.
Posted 29 October 2010 - 01:45 PM
Edited by madaxeman, 29 October 2010 - 01:47 PM.
Posted 29 October 2010 - 02:40 PM
Posted 29 October 2010 - 04:40 PM
I "crack" my second finger joints every once in a while, but my knuckles do not "crack" . . .
[NOTE: In my numbering system, as explained in more detail below, there is a "knee" looking bit of skin for each finger, which is not actually a knee but it looks a bit like where a knee might go, and it is on top of what I refer to as the second finger joint, where the first finger joint is at the "knuckle", which probably is backward, but so what . . . ]
And I did a quick experiment with the last joint of each finger, which led to discovering that the last joint of my index finger on my right hand will do something similar to what your index finger is doing, but it does not feel like something I want to do more than perhaps 10 to 20 times, ever--noting that I am right-handed and that in great contrast to physicians who like to refer to everything as a "digit", my view is that there is a thumb and four fingers rather than five fingers or five digits on each hand. In my system the thumb is not a finger or digit . . .
My index finger does not make a "popping" nose, but I definitely can feel a tiny pop or motion of ligaments, but only in a very specific instance . . .
Specifically, it occurs when I extend my index finger and curve it in a very low-angle arc, where the segment from the knuckle to the "knee" of the index finger is straight in a parallel line with the top of my forearm. Then, bending at the index finger "knee", the second and third segments go downward at an angle of approximately 5 to 10 degrees . . .
In this particular configuration, if I put the tip of my left-hand thumb directly next to the bottom of the last joint and then use the index finger of my left hand to press downward on the top of the tip of my right-hand index finger, I can feel a tiny "pop", which repeats each time I do this specific movement, at least for 10 to 20 times, which is all I plan to do it, since it is pretty strange and does not feel like something I should be doing . . .
And, after doing it 10 to 20 times, I noticed that I then was able to "crack" the joint, which also is pretty strange . . .
So, a quick test of each finger, led to discovering that I can "crack" the last joint of my index, middle, and little fingers on my right hand but only the ring finger of my left hand, although I can "crack" the middle joint of all my fingers . . .
From this quick series of experiments, I make the following inferences:
(1) I think that the last joint "popping" noise phenomenon is related to playing bass guitar and standard guitar strings with my fingers, which I do primarily when I am playing bass guitar and nearly never do when playing standard guitar, since I do not fingerpick, mostly because it makes not sense to me and appears to be entirely too complicated . . .
(2) I think it is not entirely a coincidence that the ring finger of my left hand exhibits the same last joint "popping" phenomenon, because I bend notes quite often when playing lead guitar solos, and I do this primarily with the ring finger of my left hand (what I call the "third" finger, since I count the index finger as "1", the middle finger as "2", the ring finger as "3" and the little finger as "4") . . .
(3) Intuitively, while it does not hurt or whatever to do the aforementioned strange experiment with the last joint of my right-hand index finger, it makes it feel different in an odd way, so I am not going to do it anymore . . .
(4) And I can "crack" the last joint of my left-hand index finger, as well, but it requires a firmer bit of "cracking", which I suppose is consistent with doing left-hand index finger "pull-offs" . . .
(5) Apparently, when one performs certain rather intense motions with the tips and last segments of fingers, this changes the strength, overall tone, and so forth of the various muscles, ligaments, tendons, lubricating sacks, and all the other stuff that for the most part makes hand surgery the most complex type of surgery, which among other things tends to be a stellar way to select a plastic surgeon, where one looks for a specialization in surgery of the hand . . .
(6) You have even more free time with nothing to do than I do . . .
So, if I were making a guess, then it is that you fingerpick with the tip of your right-hand index finger more curved, as contrasted to more straight position or at least a less curved arc . . .
When I play bass guitar with my right-hand fingers, I keep them mostly straight, which is the way I learned to finger-pick a string bass, but I do this also because I think it looks cool, where the general strategy for looking "cool" is to make as many tiny but rapid motions as possible, which visually makes it appear to be magic or something but also maps to the most efficient and optimal way to play for a variety of reasons, including avoiding problems like carpal tunnel syndrome, bruised or pinched nerves, and so forth and so on, because these are repetitive physical motions, and there are correct ways to do them . . .
[NOTE: One of the reasons that the ladies prefer bass players who are very rapid tiny motion fingerpickers should be obvious if you think about it for a while, being a medical doctor and remembering a few quite important bits of information from your anatomy and physiology courses . . . ]
Regarding an explanation of precisely why the last joint of your index finger is "popping", I have no specific idea, but there is a bit of merit to what in the US is a classic bit of common sense:
PATIENT: It hurts when I do this . . .
DOCTOR: Well, don't do that!
The additional bits of advice that come to mind are to consider asking a plastic surgeon who specializes in surgery of the hand for a diagnosis and to ask a physical therapist who specializes in hand stuff if there are some exercises or strategies that will be beneficial . . .
You also might consider simply giving your index finger a rest for a few days or a week or so, but I also think that you might benefit from watching some of the outstanding Flamenco guitar video lessons that Prof. Díaz makes available, where in particular if you watch Paco de Lucía fingerpicking, you will observe that he does it in a very specific way, noting that Paco de Lucía has extraordinarily long fingers, for sure . . .
Bulería Rhythm (Prof. Díaz) -- YouTube video lesson
"Entre dos Aguas" (Paco de Lucía) -- YouTube music video
[VERY IMPORTANT: If you watch the Paco de Lucía video, you will notice that he bends his picking fingers at the "knee" but keeps the second and last segments primarily in a straight line, which is what I do when fingerpicking bass guitar, so even though I had not noticed this, now that I am focusing on it, I think that it is very important, and it might help you to avoid the particular repetitive stress injury you appear to have, which after pondering it for a while is my diagnosis (specifically, that you have a rather unusual repetitive stress injury of the index finger, which is caused by improper fingerpicking technique) . . . ]
In other words, Paco de Lucía plucks the guitar strings with the tips of his fingernails, and based on watching some of the excellent Flamenco video lessons provided by Prof. Díaz, I think that he also very specifically is plucking the guitar strings primarily with the tips of his fingernails, since Prof. Díaz has a Flamenco lesson devoted entirely to proper fingernail care, filing, and so forth, really . . .
[NOTE: I capitalized "AVOID" for emphasis . . . ]
"Picado: 10 Things to AVOID! (1 to 4)" (Prof. Díaz) -- Part 1 -- YouTube video lesson
"Picado: 10 Things to AVOID! (5 to 10)" (Prof. Díaz) -- Part 2 -- YouTube video lesson
[IMPORTANT: In this reply I numbered the finger segments starting at the knuckle and going toward the fingernail, in part because I play by ear, which basically maps to the first thing that appears in my mind being what I do, which is the reverse of the way Prof. Diaz refers to the finger segments or joints. So in my numbering system, the segment with the fingernail is "3" but in Prof. Diaz' numbering system it is "1" or the "first joint" . . . ]
This is the video on fingernail care, for sure . . .
[NOTE: This is quite brilliant, and it is very logical from the perspective of physics, as well . . . ]
"Fingernail Care" (Prof. Díaz) -- YouTube video lesson
And, of course, I think that you should listen to my fabulous Flamenco song--done in the Surrelería subgenre that I created earlier this year--while sanding your fingernails and avoiding popping your index finger, which is fabulous . . .
"Maríta de la Luna y Pablito el Petardo (No Es Tanto Lo Que Es Como Lo Que No Es)" (The Surf Whammys) -- Windows Media Video (WMV, 6.7MB, approximately 3 minutes and 40 seconds)
P. S. And I strongly encourage not to do these remarkably stupid finger tricks unless you have played string bass and electric bass for several decades, and even then I would not the four gallon bit more than once, since it pushes the limit a bit too far, really . . .
[NOTE: These are US gallon containers filled with water, and each one weighs approximately 8.25 pounds . . . ]
Edited by surfwhammy, 29 October 2010 - 05:25 PM.
Posted 30 October 2010 - 11:26 PM
Posted 31 October 2010 - 01:27 AM
And I started getting a strange sense of the tip of that finger being thicker or something, which was even stranger . . .
So, I do not advise anyone to do what I did, and I am not going to do it again . . .
Whatever makes the clicking or popping does not appear to be something that is good, and the last segment of the index finger continues to feel a bit different today, which is 24 hours later, more or less . . .
I expect it will return to normal if I leave it alone, which is what I am doing, but it was pretty strange . . .
And I notice a tiny bit of tenderness underneath the right-side of the second joint of the index finger, which is the underside next the middle finger, where the tiny bit of tenderness is between the central line of the finger and the outer edge, which tends to suggest to me that the popping thing involves a ligament or perhaps a circular ring type of thing constraining ligament or whatever it is called, all of which maps to suggesting that stabilizing the finger for a week or two with a metal splint or whatever one uses for a broken finger probably is a good idea--not for my finger, but for eulogy's finger . . .
My index finger is fine, but only because I recognized that the particular motion did not feel right and stopped doing it immediately . . .
It was my idea to do the experiment, which was pretty stupid in retrospect, but it will be fine after a few days, so no harm done, really . . .
Posted 31 October 2010 - 02:54 AM
Thanks in advance for your answers - this is really doing my head in.
As a bit of follow-up based on the truly stupid experiment I did with my own index finger, I am convinced that the "popping" noise is the result either of a repetitive stress injury or a tear or break in ligaments or tendon sheaths, or something . . .
I had a copy of "Gray's Anatomy" when I was in high school and for a while in college, and I remembered the names for a lot of stuff, but it has been a while since those days, so for the most part I only remember specific things when I am doing something in a caregiver or patient advocate role and need a quick way to let the doctor know that I did not fall from a turnip truck recently, with one example being an initial visit with an ophthalmologist whose initial impression of me was that I was a bit of a dunce, perhaps because I was wearing Walmart sneakers, white socks, an old pair of pants, a t-shirt, and a baseball hat . . .
[NOTE: The bit about "falling off a turnip" truck is a colloquialism in the Deep South, where for reference a turnip is similar to a potato but more bitter, sour, sweet, and so forth. And when folks want to suggest in a subtle way that someone is not the brightest candle, one way is to suggest that the person "fell off a turnip truck", with the inference being that the person is about as smart as a turnip, which in Australian slang is like being "one stubby short" or "his elevator doesn't go to the top floor", or whatever, where for the folks who have not visited Australia a "stubby" is a can of beer, so the general idea is that instead of being a "six pack" or whatever, the person is missing a can, which I suppose is like having 51 cards rather than a full deck . . .]
I asked a very specific question about glaucoma with respect to where the patient for whom I am the primary caregiver had LASER treatment to relieve some of the intraocular pressure, and the ophthalmologist got a rather large plastic model of the eye and started explaining that the fluid around the lens is a bit like water, while the fluid in the center of the eye is like Jell-O, at which point I replied, "So that must why they call the thinner fluid 'aqueous humor' and the thicker fluid 'vitreous humor'", and the ophthalmologist's response to my observation was to put down the plastic model of the eye, saying "Well, I guess we don't need that", and then he handed me the patient's chart, which was pretty amusing, since I really appreciate subtle humor and quick wit, and he certainly is an outstanding ophthalmologist . . .
So, after refreshing my memory with respect to the anatomy of the hand, one possibility for the "popping" noise is that it is a "mallet finger (dropped finger)" or perhaps something like a "trigger finger" but affecting the last joint and segment rather than the joints and segments more proximal to the knuckle . . .
Mallet Finger (The Electronic Textbook of Hand Surgery)
Trigger Finger (The Electronic Textbook of Hand Surgery)
However, another more likely possibility is that it is a Boutonniere Finger Deformity or a variation of it . . .
Boutonniere Finger Deformity (The Electronic Textbook of Hand Surgery)
My terminology is not so stellar, but my understanding is that tendons connect to muscles, while ligaments connect either to each other or to bones, and there are various bands, rings, and sheet-like things (ligaments, most likely) that act as guides and constraints for the tendons that actually move the bones of the index finger . . .
And from the excellent work of Sir Isaac Newton, we can infer that there is at least one tendon for moving the index finger downward and another tendon for moving it upward after it has been moved downward, which is based on the "equal but opposite" bit . . .
But there also must be an addition pair of tendons for wiggling the index finger sideways, which maps to there being at least four tendons and a bunch of ligaments to keep everything in place and so forth . . .
[NOTE: I reserve judgment on the number of tendons, because I suppose that a single tendon could handle moving forward and backward, which would map to downward and upward, but rotating requires more tendons, so four looks to be a good number, although there might be more than four, albeit for different motions . . . ]
I suppose that some of the "popping" might be due to excess nitrogen gas or perhaps an interaction involving some of the lubricating fluid that is in joints and probably is released from tiny sacs or whatever, and there also are bursa, which I think are different and probably should not leak, but so what . . .
From my perspective, motion of the third phalanx is not supposed to make a loud "popping" noise, hence all things considered with special focus on being a guitar player, I think that consulting a plastic surgeon who specializes in surgery of the hand is the way to go . . .
Doing a finger splint might be a good idea, but one of the things I read indicated that an incorrectly designed and applied splint can make certain finger problems worse rather than better . . .
Basically, if you value your fingers, then when you have a problem with a finger, the best strategy is to consult a plastic surgeon who specializes in surgery of the hand, which based on the best information I have is likely to be the most difficult type of intricate surgery, not because hand injuries are particularly life-threatening but because there is so much stuff in hands and the motions are so remarkably intricate and sensitive in terms of nerves and so forth and so on . . .
And the reason for a plastic surgeon with an additional specialization in surgery of the hand is that most of them have significant architecture and art skills (including drawing and sculpture), which makes them a bit more attuned to the importance of fingers for a musician, for sure . . .
Stated another way, in my sua sponte role as your caregiver or patient advocate, if a doctor tells you that your third phalanx "popping" loudly is not a big deal, then you need to get another opinion from someone who knows more about fingers . . .
If I ponder it for a while longer and do a bit more research, I might be able to diagnose the problem accurately, but do I really need to start practicing medicine over the web in a guitar forum without a license?
Instead, I need to compose more DISCO songs, which is fabulous . . .
Edited by surfwhammy, 31 October 2010 - 03:12 AM.
Posted 01 November 2010 - 01:44 AM
I have talked to a surgeon specializing in elbow and hand surgery before (I had ulnar nerve issues in my left arm for as long as I can remember), and she basically said that unless the condition aggravates to the point where it becomes impossible for me to do everyday tasks (typing, playing guitar, writing, et cetera), she refuses to look into it. She claims (rightfully so, I might add) that surgery on small joints is always traumatic, and often causes bigger problems than what they were trying to fix in the first place. Which is... a bit of a bummer, really.
Finally, regarding the flamenco videos you posted: interestingly, I already pick very "flamenco-like", in that I have a very "high and tight" way of fingerpicking. I use very small, economical movements, and mostly pick from the second joint of my fingers (so not from the knuckle, but the next joint - as illustrated in Diaz's videos). I don't think that it's my playing style that has caused the problem: I think it must've been an inherent problem that somehow got aggravated by me being a guitarist and pianist. I've seen fingerpickers with terrible technique who seem to have no problems after 30-odd years of playing.
(I saw Steve Earle live last year. He played for about 2 hours, with just his thumb and his index finger. And man, he *pulls* on those strings. He doesn't fingerpick, he fingersnaps. The guy has been playing in a very aggressive, very tough-it-out-kind of style for over 35 years, and it doesn't seem to affect him in the least. His son, Justin Townes Earle, strums with a frailing banjo-like technique, using his thumb and index finger, that makes me cringe just looking at him doing it. Again, doesn't seem to affect him too much. Something about being dealt a bad hand when I was born, and all that...)
Posted 01 November 2010 - 08:06 AM
Surf: I appreciate the time you've put into this thread. I had a quick look at some of the videos and medical illustrations you posted, but I reckon that you are over-estimating the severity of the issue. While the popping is very annoying and somewhat painful to me, it is not even close to developing into a mallet finger. Mallet finger has functional implications, which my joint problem does not. So I don't think that that's the problem. (Interestingly enough, I also pondered upon the hypothesis for a while when I first developed the problem - great minds think alike and all that.)
It is an intriguing puzzle . . .
And since there appears to be no immediately obvious injury, trauma, and so forth, the common sense suggestion simply to give your index finger a rest for a while, provided you are comfortable with giving it a rest not aggravating the condition . . .
Initially, I was going to suggest putting a splint on your index finger, but after reading some of the detailed information about various finger problems--only one of which was not entirely a new discovery, since I knew about the trigger finger behavior, although I do not recall how I knew about it, since I never had that problem and for the most part would have no reason to know anything about it--and reading that incorrect splinting could exacerbate at least one type of problem, I continue to hesitate to advise using a splint, but you can decide that yourself, along with whether there is any merit to giving your index finger a rest for a few weeks . . .
In some respects, it is not so easy to avoid using the index finger of your dominant hand, but I had a wart on the side of my index finger, which is another interesting medical story, and after it was zapped with nitrogen gas, I gave it a rest for several days, so there should be a way that you can do it, although I suppose it depends on how much you use it for your medical work . . .
Several years ago, after doing a lot of carpentry work with a very heavy framing hammer, I had a pretty gnarly time with right shoulder to the point that I could not lift an empty cup of coffee, and for a while I had to stop working on the computer, because moving the mouse was too painful, which was around the same time that I basically could not sleep due to the pain, but after asking my sister (who is a medical doctor) about it, she said there were two quite excellent solutions, one of which was excruciatingly painful for about a minute or so but solved the problem instantly and the other of which took about two weeks but was no more painful than it already was, where the first option involved a steroid injection into the shoulder, which she said definitely would be intensely painful, and the second option was to take ibuprofen for two weeks, so I opted for two weeks of ibuprofen, which worked nicely after a few days and then got gradually better and better, although I had to repeat it a few weeks later and another time or two after that, although with periods of no ibuprofen in between, since my view on ibuprofen is that it is not something one wants to take all the time, as contrasted to Bayer aspirin, at least for me . . .
As you know, there is a lot of history on aspirin and its ancient predecessor, which as I recall is willow bark, which was used by the Romans several millennia ago . . .
And so forth and so on . . .
Summarizing, absent reading the bit about an incorrectly configured splint doing more harm than good for certain types of finger problems, I would put a slightly curved splint on the finger and tape it, but in a way that I could continue using the finger for activities like touch-typing, writing notes with a pen or pencil, but not for fingerpicking guitar . . .
And while you specifically mentioned getting a consult from a hand surgeon, which is excellent, you did not mention anything about getting a consult from a physical therapist who specializes in treating musicians . . .
So far, I have had limited experience with physical therapists, but they can do some quite amazing things with respect to devising ways to help with physical activities, although the correct specialty in the US is more along the lines of an occupational therapist, since their focus is on things people do in their work or whatever, as contrasted to more general things like walking and so forth . . .
For example, in the US a physical therapist for example helps a patient with recovering from surgery for an intertrochanteric fracture of the femur, although I think the more standard name is "intertrochanteric fracture of the hip", where "femur" is implied, but regardless of what one calls it, an occupational therapist helps the same patient with such things as putting on socks and reaching stuff on the floor with a mechanical "grabber" device, so based on this understanding it might be more of an occupational therapy as contrasted to physical therapy, although I suppose that a physical therapist can do both if they have the required training and so forth . . .
Intuitively, at one time or another, I think that concert violinists and lots of other musicians have some pretty strange arm, hand, and finger problems, and there probably are physical and occupational therapists who specialize in musical instrument-related stuff in the same way that a voice coach specializes in helping singers with singing problems . . .
Hence, you might give the idea of doing a consult with a physical or occupational therapist who specializes in musical instrument-related problems a bit of consideration, since from what you described the problem appeared to originate with switching from using a guitar pick to fingerpicking . . .
Alternatively, try switching back to using a guitar pick for a while . . .
I switch styles every so often, and what nearly always happens is that later when I switch back, after a few weeks of refreshing my memory I am better at it than I would have been if I had not switched to something else for a while, which as best as I can determine is a plateauing type of phenomenon, where when you get to a plateau and appear to be stuck there, switching to something else for a while tends to result in moving beyond the plateau without actually needing to do much of anything other than not doing whatever you were doing when you were stuck on the plateau . . .
And I think this is based on the principle that people forget bad behaviors but remember good behaviors, so taking a break for a while allows the brain to do a bit of housekeeping during which it resets or initializes all the inefficient neural pathways, which soon makes more neural pathways available for better stuff, which as best as I can determine is the way I taught myself how to play grand piano without actually playing grand piano, which took about 20 years, and certainly was a strange way to learn how to play grand piano, but it worked, and it was a lot easier over the long run than having to mess with doing a lot of piano practicing, really . . .
"Starlight" (The Surf Whammys) -- Kick Drum, Bass Guitar, Grand Piano, Fog Synthesizer -- MP3
My current hypothesis for the way I taught myself how to play grand piano without actually playing grand piano is that I somehow managed to rewire my brain so that I use the frontal eye fields (FEF) region in conjunction with the auditory cortex, which is the only logical explanation for being able to play so rapidly without having any immediately conscious idea what I am doing, since I literally just thought about playing grand piano for about 20 years during which time I only played grand piano anywhere other than in my mind for at most a few hours (total), mostly to determine how much progress I was making, which for the first 19 years in the real world was not a lot, and then last year it started making sense, and soon thereafter it became very easy to do in the real world (as contrasted to the imaginary world) . . .
Basically, I play grand piano as if were a linear drumkit with a lot of melodic drums, cymbals, cowbells, and so forth . . .
And while the grand piano in "Starlight" might sound like a bunch of musical gibberish, there actually is a genre for it, which is called among other things the "Twelve Tone Technique" or "Dodecaphony" and was devised in the 1920s by Arnold Schoenberg . . .
Twelve Tone Technique or Dodecaphony (wikipedia)
This is the 2007 Henry Sanborn Music Competition Winner's Recital, which certainly is a self-esteem booster for me with respect to my grand piano virtuosity, since I not only play this stuff but compose in real-time on the fly, which is fabulous . . .
"Six Little Pieces" (Arnold Schoenberg) -- Performed by Anabelinda de Castro -- YouTube music video
Keep us posted on how everything develops, for sure . . .
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