Knuckle Locking: Experiences? Treatments?

[Dan000892]

I'm a tripler (Tenor Sax, Bass Clarinet, Clarinet). Whenever I play clarinet, some of my knuckles lock up. For me, it's the pinky finger and sometimes the ring fingers too, the knuckles you knock with (second from tip or middle knuckle). It doesn't happen on sax or bass clarinet. I'm not totally sure why. Here's what I've narrowed it down to for me:
* stress (I'm not very good at clarinet and perhaps I tighten up)
* the extreme close-movement (it doesn't happen on bass clarinet, even when I play as technical passages as on clarinet)

With my middle knuckle locked (on my left pinky without having done anything except typing), I can rotate my third knuckle (finger - hand) 90 degrees fullmotion and my first knuckle (towards the tip) 45 degrees fullmotion.

Share your experiences with this and provide any insight you can about the origin and treatment. Thank you.

[Bill Mecca]

sounds similar to the "trigger finger" my daughter had. Her thumb used to lock up and she wound up having surgery.

It was a bump in the tendon that slides thru a channel in the bone, the bump gets stuck. the surgeon went in thru a small incision (she's now 9 and you can't see it for looking) and slices the sheathing around the tendon to relieve the constriction.

It's been a couple years and I'm not a doctor so my description might be off in technical terms, but thats the basic idea.

[MS]

I'm not a doctor - so a suggestion perhaps until you can get a doctor's evaluation.

1) if it's practical, try playing clarinet with a neck strap to see if pressure off your right thumb helps.
2) Can you keep your fingers in a gentle curved arc and move them at the knuckle that joins the finger to the hand and still have enough flat part of the tip to cover the holes? (this will work on saxophone and bass clarinet also).
3) Check in a mirror your overall body position for balanced shoulders and straight spine, lungs unimpeaded. Then watch your finger movement on clarinet. See if you can figure any change in finger position that can allow you to cover holes with the flat part of the finger tip joint and keep the rest of your finger curved in an arc.. This may keep your middle joit flexible and not flatten out to where it will lock. Position and finger accuracy in covering holes without excess pressure may help.
4) It is possible for a repairman to move your thumb rest if it causes the tumb on a person with large hand to be bent at an angle that is too acute.
Good lluck to you. :D

[Dan000892]

OK, let's see... first off, thumb pressure has nothing to do with it. I have correct hand position, which I wouldn't change even if it would have an effect. My hands, thumb and posture are correct, not that that would effect this anyway. But thanks anyway MS.

I did some research and I found out that this must indeed be "trigger finger" (not trigger thumb) or tenosynovitis.

Here are the available treatments for it:
(Technically there is no treatment, and these treat the symptoms)

1) Change your lifestyle and take ibuprofen, immobilize your hand... all of which I personally consider unacceptable.

2) Steroid injection in the ligament. Apparently 50% of patients respond to the first shot, and another 25% to the second. This can only be done twice in about 6 months since it makes the skin thin. It thins the ligament to allow it to pass through the channel at the base of the finger.

3) Surgically slit the channel to allow the ligament, even when enlarged to pass through it. It's permanent and nearly 100% effective and it's an outpatient procedure. You just can't use your hands for a couple days and then have to take care and keep them convered for a few weeks til the stitches are removed.

4) Surgically strip the inflammation from the ligament. This seems to be almost completely discontinued except perhaps for the absolute extreme cases where the inflammation has completely seized the knuckles.

I happen to have a physical examination tomorrow so I'll inquire about this and let you know what a medical professional has to say.

Dan

[Bill Mecca]

I had forgotten about #2, the Steroid or Cortisone injection, since my daughter was too young for that option. She had the surgery(#3) and it worked wonderfully, and I don't truly remember her having to not useher hand for allthat long. The toughest part was standing there outside the OR watching her go limp as the drugs took effect. (since she was so youg they had to knock her out, as they couldnt count on her keeping her hand still.)

Also if you are Diabetic, like me, the Steroids may not be an option since they can play havoc with blood sugar.

Best of luck at hte Doc's.

[MS]

Good luck to you Dan! Hope the Dr. can give you some good news. :D

[Dan000892]

Alright, went to the doctor. He's just a general physician so he basically said "yeah, looks like trigger finger. you should see an orthopedist. I don't know what they can do other than surgery." To which, I filled him in about the steroid/cortisone shot treatment. So I'm going to have to make an appointment with an orthopedist - hopefully one near school so I don't have to wait as long. So I guess I'll fill you in when I hear from the orthopedist and til then just focus on tenor sax and bass clarinet (after all I do have a new tenor sax coming tomorrow anyway... hehehe).

Thanks everyone... i'll keep you all informed. :)

[orions_belt27]

gee, i do kinda get worried about stuff like dat. i do get locking fingers as well but i pray they dont get worse. cant imagine having problems with severe locking fingers, nerve tendons gettin inflammed etc etc.. just scares me when i think of how many possible ways my hands and fingers could get into trouble.. makes me treasure them in a whole new way~ :)

all the best dan~ hope the problem goes away for u soon :)

[Dan000892]

Thanks, orions_belt27... you realize that if you fingers are locking to any degree it's due to an inflammed tendon, right? You made it sound like inflammed tendon was only indicitive of severe locking fingers.
If it's not so bad, take ibuprofen before you play. That's what I'm going to have to do in the meantime whenever I play clarinet.

[MJ]

I'm interested in any updates on effective treatment for this condition. I have this problem. Last week, my family practice doc told me to live with arthritis and take Tylenol when needed for pain. On the other hand, this hand is my dominant hand.
Thanks for the information.

[Suds]

Good gracious :) I have the same problem too, especially on clarinet and flute, but I've tried to ignore it over the years. No major pain yet, but just reading all of this is making my fingers sore!! Yes, please keep the updates coming.

My teacher advised me to roll my RH wrist upwards when playing flute, as my RH pinky was always locking and I could only practice for around 10 minutes at a time. This would alleviate a bit of the tension in the fingers. Maybe the same concept could work on sax? I should try it as my pinkies (esp LH) tend to lock up on sax as well.

[bsclrntplyr08]

I play bass clarinet and clarinet and I am learning how to play tenor. I had the same problem when I was playing clarinet. It would happen to my pinky fingers all the time. It goes away after a lot of practice on the intrument it happens on, it worked for me.

[22639]

gee, i do kinda get worried about stuff like dat. i do get locking fingers as well but i pray they dont get worse. cant imagine having problems with severe locking fingers, nerve tendons gettin inflammed etc etc.. just scares me when i think of how many possible ways my hands and fingers could get into trouble.. makes me treasure them in a whole new way~ :)

all the best dan~ hope the problem goes away for u soon :)

I'm not a musician (found this discussion on WebMD) but I have a similar problem. However....contrary to the typical symptoms of Trigger Finger when my index finger or thumb lock up it's always in a hyperextended position (that looks almost deformed) and, although there is pain while locked up, there is no swelling or redness. Does this ring any bells with anyone?