thumb pain that initiated bilaterally?

[fizixx]

Hi, I've had two clients who developed thumb pain simultaneously in both hands. In one it seems more like de Quervain's (doc diagnosed it as arthritis and suggested a wrist brace which didn't help; with massage and hydration she seems to have eliminated the pain except if she bangs the area, but she still has weakness in her hands; she is not great about stretching and strengthening).

The other client is new, a professional piano player, and his pain is in the carpometacarpal joint and would probably be diagnosed as arthritis. i'm massaging all the muscles around the joint, am also thinking structurally, and am suggesting stretches. (Not sure yet how much strengthening he needs!)

What surprises me is that in both cases they remember the pain has happening simultaneously in both joints. The first client said it came on after a friend "massaged her hands too roughly" (!). The other remembers nothing that would have brought it on. I assume some nutritional or other imbalance might be a factor, but I'm not well-versed in nutrition and am not sure what to suggest besides a low-inflammation diet (sugar and white flour is a big problem for both of them). Any suggestions? I realize nutrition is outside my scope of practice but would at least like to point them in a helpful direction, or to get any other ideas you might have.

Thank you!

 

[MDNova1]

thumb pain that initiated bilaterally?

If your second client is a pianist, then there's automatically not "nothing that would have brought it on." If you're secure enough in your knowledge of body mechanics, I suggest observing the client as he/she plays, especially a particularly virtuosic piece with lots of octaves and other large intervals. You didn't mention whether this person played classical or another style of piano, but both can involve a ton of strain on the fingers and wrists, and most musicians unfortunately don't have the education needed to keep themselves safe from injury. I've seen several pianists end their careers this way.

If this isn't something you feel comfortable with, I suggest referring the client to a specialist in sports/performance massage, and having an experienced mentor (pianist) observe their playing for awkward hand and finger positioning, unnecessarily heavy pressure on the keys, and stiffness in the arms, wrists, hands, and fingers while playing. My father (a piano professor) often has to videotape his students playing, because they describe their style as "natural" or "fluent," all the while having no idea they look like hunchbacked robots when they play!

Kat

 

[Sariel]

thumb pain that initiated bilaterally?

anything that presents bilaterally in the arms/hands I always do a thorough going-over of the neck, even if the pain is very distal. There could be some impingement/compression of nerves in the neck. Honestly, I don't have much knowledge of the precise location of the nerves, but I have had success with this when bilateral shoulder pain presented. Whenever a client claims they don't know why they have pain, I always looks for a non-local source. Even when they know exactly how they got it, involving all of the muscles and structures that are involved in any way always helps the issue to correct faster than simply spot treating. For instance, a therapist who blew out their thumb doing bodywork would always benefit from proximal arm work and neck work because if they were using their thumb that much, it's likely (though not always the case) they were over-using the rest of the arm/neck muscles as well.

 

[tatiana ooh ahh]

thumb pain that initiated bilaterally?

I'm sorry Kat, I didn't mean his ergonomics at the piano couldn't have contributed, just that it was strange to me that, by his memory, pain (that didn't seem to be nerve pain) presented in both hands simultaneously without any obvious change in his behavior. I should have added that in both cases the dominant hand, the right, is worse. He plays 8 hours a week, relaxed gigs at malls and parties, but yes, his posture is very hunched---his shoulders are up and over the keys---enough to create or contribute to dysfunction over time. In both cases forward head posture and tight, rounded shoulders are present; and Shivashiva thank you so much, I agree that working with the neck is a good idea. I think of nerve pain as achey or tingly and fairly constant so long as the nerve is being pinched, rather than pain in a specific joint that increases with use and decreases with rest. Am I wrong about that?
Thank you!!

 

[al-in-chgo]

thumb pain that initiated bilaterally?

I think of nerve pain as achey or tingly and fairly constant so long as the nerve is being pinched, rather than pain in a specific joint that increases with use and decreases with rest. Am I wrong about that?
Thank you!!

Well, hunched shoulders and tight neck could be the cause of nerve pain, or simply referred pain. If you look up the referral patterns for some of the neck and shoulder muscles, they sometimes go all the way down into the arms and hands. And the referral patterns are not always exact. A person can have a different referral pattern than the book shows. I have worked on scalenes to relieve dorsal forearm pain that felt like burning/throbbing. I'm not sure if any book shows that, but I haven't looked it up so it may very well.

Basically, pain that is distant from the site of the cause may be nerve pain, or it may be referred pain. I can't tell you how many times I've seen specific thumb joint pain relieved by working on anconeous (near the elbow) with sustained trigger point work.

But, the fact that it decreases with rest is key. Rest and ice is what I would recommend, but he sounds like someone who probably won't or can't rest.

 

[~ Floridian``]

thumb pain that initiated bilaterally?

Thank you so much shivashiva (I love writing that name). It's true, I talk myself out of referred pain when the pain seems to be deep in the joint, so it was eye-opening to hear that. I shall proceed :0). Thank you again!!!

 

[Lisa W]

thumb pain that initiated bilaterally?

I agree with working upstream before doing more direct work on the areas of discomfort. When you do get back to the hands, also check the interossei and the proximal metacarpal joints. I often find issues in those tissues when clients present with thumb pain.