A very specific left hand pain question
 

Ok, I know there have been many other hand pain question threads, and I've read most of them, but I have a very specific pain I'm trying to identify.

I met with my phys therapist y'day and it perplexed her; she's doing some more research to figure out what's up. I'll also make an appointment with my GP, but that will take over a month and will no doubt lead to another month or so of waiting to have specialists run tests, etc etc, so in the meantime....

Any of you other players ever develop a shooting/stabbing pain in your fretting hand, at or around the "dime" spot in my picture? Usually the hand feels alright *unless I touch this spot*, and then it's like a toothache: just blindingly painful.

There's no bump there.

It's been slowly developing for years but in the last few months it's become chronic.

For years I assumed it was because the wide (1 3/4"), somewhat "sharp" neck of my Larrivee sits *exactly right there*, and that may indeed be the cause, but now I get it playing thinner necked guitars as well.

I'm pushing 51 (a week from today!), have been playing the acoustic tons the last few years, and I also rock climb... and so, you know, it's no great surprise I'm wearing out, but, still, like I said, this seemed to mystify my PT and the issue failed the normal left hand, tendon-issue tests.

Also, do you think I can use this to justify buying a short-scale, narrower-necked guitar, like, say, a 50s J45? ;)

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Hand pain
 

Is that the part of your hand that gets the most pressure pressing against the back of the neck? Could it be neck shape?

ganglion cyst?
 

Could it be a ganglion cyst? I had one years ago , on my left hand on the first joint under the little finger that just disappeared over time . . .

My father is a family practitioner, and he'd tell you see an orthopedic surgeon(that's what he tells me). If it was something that just began, he might inject it, but that's not your situation. A month to get an appt with your family doc? Find another. ;)

I'd skip the therapist. If she has to research it, you're not getting an experienced opinion. About 20 years ago, my father had a patient who went to a chiropractor for lower back pain. He was given some manipulation, and sent home. When the pain persisted, the guy came to my dad, and it was discovered he had severe kidney problems. I was in his office when he called the chiropractor and freaked about playing around with his (my dad's) patients. The chiropractor knew this guy had a primary care physician, but told him not to bother(!!!). That's why specialists ask who your PCP is when you fill out forms.

I'm a year older than you, and have spent many years beating my hands up with cycling, sailing, fly fishing, etc. I have aches and pains, and backing off usually helps. I've never had work done on my hands or feet, and my father is always warning patients (and me) about doctors who are quick to operate. I have decades of stories regarding surgeons who wanted to operate on everything. My father takes a very conservative approach to ailments like yours, assuming there's nothing too serious involved. He did inject my wife's shoulder with cortisone about 7 years ago, and even though he had to give her another shot a few months later, she's been fine since. She fly fishes quite a bit as well, and no problems since. My dad doesn't get paid much more for an extended visit, or injecting a site, but surgeons make their money from surgery. Fortunately for me, his partner's brother is an excellent orthopedic surgeon.

I'd look to your technique and playing position. With "good" left hand technique, no part of the palm of your hand touches the neck. Raising the head of the guitar to shoulder height will reduce the bend in your left wrist and change how your left hand relates to the neck.

As you point out, this has been in the making for a while, not a sudden injury. As one ages, ergonomics become increasingly important to avoid injury.

The indicated spot is where the main index finger muscle runs towards the wrist. I can clearly feel that muscle move when I move my index finger.
To me it sounds like you may have something like RSI or an inflamation of that muscle which has been ignored for a long time.
I'm not a Phd but I've dealt with many of such problems, many induced by playing guitar or computer gaming. It always went away after giving it attention and allowing it to heal, but sometimes it would take weeks.
Hardest part was always to not engage in such activaty which caused the injury in the first place.
Ignoring pain can only lead to worse situations, I just hope something can still be done about it without interfering with your skills or the use of permanent medication.
Best wishes,

Ludwig

Are you sure? :D

http://celebrityrockstarguitars.com/...781-slarge.jpg


http://theselvedgeyard.files.wordpre...esley-army.jpg

Thanks for the feedback, all. I have one more show on Saturday and then am determined to lay off playing for awhile...which sounds terrifying, to tell the truth, because I get jiggy if I don't play every night.

And I'm definitely swearing off of climbing for a bit.

...which leaves...what...drinking and tv? Or reading, I reckon.

Frank B2: it's a small town and we are truly pressed for GPs...great access to emergency care, but access to specialists is usually 90 miles away and requires cancelling a full day's work. The PT clearly agrees we'll need to up the ante if the cure isn't obvious or out of her league; she has 25 years experience so was as surprised as I that it wasn't something obvious. But I hear what you're saying; I've lost a few family members to sloppy diagnoses.

PTC Bernie: yeah, it's exactly where the neck binding sits, and on the Larrivee that's a really sharp angle-break...I just can't figure out whether that's the cause or simply exacerbating the underlying cause. In the best of all scenarios I'll find a doctor to prescribe a short scale, narrow necked 1963 birth year J45. :) ...and you all know that honestly is what I'm hoping: a new guitar will fix everything.

Charles Tauber: sorry for the ironic reply above; I know you are right, but only for certain styles of music; my fingerpicking style is pretty good, but I'm mainly a hard-driving rhythm player and use my thumb a lot on the low E. You may indeed be right that that's the underlying cause, tho, and that would crush me because playing like that is my whole thing!

Van Beerhoven: that's gotta be it: stress and a pressure point on a nerve or tendon...?

And I guess all this is what I expected the PT to say, and it was the fact that she'd never encountered anything similar that has me so perplexed.

And I don't want to waste hundreds of dollars and days of driving to docs just to hear some specialist say "oh, yeah, stop playing for a month and see what happens."

Right?

if i were you, besides seeing a specialist, i would study various hand anatomy diagrams (available online) and try and figure out if it's related to bone, joints, tendons, nerves, and/or muscles.

that might tell you something. i would also rest it. so if you have to play, warm up, take frequent breaks, etc.

The dime spot is right over the pulley for the tendon. I know because that is where they cut to correct my trigger finger a couple weeks ago. Are you experiencing locking on the index finger?

Could be a cyst on the tendon - had one of those below my ring finger and it cleared up by itself after about a year. Definitely see an orthopedic surgeon.

Two of the all-time great guitar virtuosi there, to be sure . . .

I'm a singer-songwriter; I make no claim to nor aspire toward virtuosity. Works for me.

Seems to have worked for them.

Yeah, after looking at some online anatomy stuff (gotta avoid the actual cut up hand pics, tho! zoinks!) I'm convinced you both are right -- the only odd thing was that the condition failed the normal tests she ran on the hand tendons. It's definitely not trigger finger, but I suspect it's similar.

As its worsened I feel it more in the index finger itself, and up the arm, where she certainly located all kinds of stressed tendons.

It also occurred to me that in the past couple months I've worked on playing/singing without a capo on quite a few songs, and on new songs I've been playing repeatedly. As you all know playing chords in the first/open position vs capoed at the second or fourth fret pretty radically shifts left arm and hand position, not to mention the added strain from fretting. That probably has amped up the technique issues.

We're headed to Hawaii for two weeks on Christmas day (and not taking a guitar as I normally do); if that doesn't cure it, nothing will ;) and I'll look into specialists; even if it's not like it's cancer, though -- it's not like it's going to spread, so while entering the time consuming maze of specialists may indeed offer a faster solution (but only maybe, and in my experience never yet), there's no actual larger threat to trying the simpler solutions first.

Works for you? I'd say not, if your left hand technique causes the pain in your hand. Just a thought.

This kind of non-specific/use-related pain can have a root cause of any number of reactions...but the symptom (pain) is certainly telling you something is wrong. It could be a nerve, it could be a tendon inflammation...and even a doctor may not be able to give a specific answer to this.

Once an irritation gets to the point that you've brought it (again, pain), it can be variable as to how long it takes to resolve, and also in what kind of activity (therapy) or inactivity might be your best possible course of action. A simple change in guitar neck-profile, nut width, and/or scale length is unlikely to be something that brings actual relief at this point.

First you have to calm the irritation.

I recommend finding an orthopedic hand-specialist that might that work with other musicians, perhaps someone that could be recommended by a local symphony.