Surgery?

j dasinger · Post by **j dasinger** » Fri May 21, 2004 3:11 pm

Let me tell you a sad story. About a year ago, after a bout of practicing 3 hours a day for approx. a month, I ended up with some kind of spinal/nerve problem. I can play the pipes for a bit, but after a few minutes my left hand fingers get stiff and lose their dexterity. Usually I have to put the pipes down after 5-10 minutes. When this all started I was determined to get it fixed and get back to regular playing, so I spared no expense. I've tried physical therapy, anti-inflammatories, muscle relaxants, electro-massage, shiatsu, heat/cold therapy, chiropractic, and probably a couple others I've forgotten about. I went to a neurologist who did a nerve conduction test in my lower forearm and said that I didn't have carpal tunnel. My doctor said that I've basically tried just about every non-invasive thing that I could. His only suggestion was to get an MRI and look into having surgery to correct my problem. Knowing that there are several MD's on the boards, I was wondering if anyone had any opinions on surgery as a method to correct these kinds of problems, what the recovery time was like, could you play as well as before you had the problem? Basically, anyone got any good advice?
Thanks,
James

kkrell · Post by **kkrell** » Fri May 21, 2004 3:25 pm

Surgery to correct what problem - since nothing been identified? So far you don't seem to have found a physical problem, but perhaps instead a problem in usage. I'd suggest first upping your physical therapy approach to seeing a Feldenkrais (movement therapy) practitioner. Their one-on-one approach is called Functional Integration. There may be some parasitic (non-useful) muscle movement that is in conflict with your movement goals, and such a practitioner could re-train you to a better and more comfortable use. The North America organization can be found at http://www.feldenkrais.com/ . I don't know where you are located, but there are practitioners around the world.

Kevin Krell

anima · Post by **anima** » Fri May 21, 2004 3:51 pm

I agree, what kind of surgery for what problem? I'd say you need a diagnosis first. Have you tried going to a hand surgeon? Hand surgeons can be either Plastic surgeons or Orthopedic surgeons.

Short of that, I can't help you until you get pregnant or need hormones or something like that.

Jeff

Dionys · Post by **Dionys** » Fri May 21, 2004 4:07 pm

You may also talk to a person who specializes in PT/ergonomics. It may be a simple matter of how you hold things, where the padding is, or how you move.

Also, if you started practicing 3 hours a day from the beginning, you may have stressed something. People should remember that playing the pipes is like any other exercise: start off slowly, in small amounts and build up. An hour a day (or even less sometimes) split into two 30 minute sessions is enough to get you started, keep you learning and keep you from hurting yourself in the beginning while you build up muscles, muscle memory and good practice habits.

Dionys

No E · Post by **No E** » Fri May 21, 2004 4:24 pm

-Disclaimer- I'm not a doctor nor a medical expert of any sort.
I had an inflammed rotator cuff that just wouldn't get any better until I let it rest for 6 weeks. As awful as it is to say, you may want to put down the pipes for a month or two and let things heal themselves.

I hope you feel better and can get back to piping soon.

No E

j dasinger · Post by **j dasinger** » Fri May 21, 2004 4:30 pm

Well, quite right about the diagnosis problem. None of the doctors or other practitioners I've seen know whats wrong with me. Usually when I go in whining about having problems playing the bagpipes, they give me the same look I would imagine they would give me if I said "Doctor, my right arm hurts when I masturbate." In other words they kind of think that this problem isn't really terribly important. I got that vibe from the two doctors I saw when I was in the military. So that may have been part of the problem (military doctors). In any case, I know that there has been some type of physical injury because I have circulation and numbness problems even when I'm not playing. It's just most noticable when I try to play because of the rapid finger movements involved. I've tried all sorts of posture adjustments and elbow padding real early in this whole escapade. I haven't tried Feldenkrais, although I have heard of it. Probably would have been much easier to find when I was in California than here in Georgia, but I'll certainly look into it. I don't think it would do much good going to a hand doctor because I can tell the root cause is up near the spine, which is in turn affecting circulation in the arm. The doctor that suggested thinking about surgery said I might have a disk out of whack or something. He said that the MRI would show if there was something "surgicable" (is that a word?), but if the MRI didn't show anything, then I was probably SOL. Anyway, keep the suggestions coming, I'm open to anything.
Thanks,
James

P.S. Re: No E's post. I've taken several months off since this started. Essentially, I don't play the pipes anymore. I pick them up once in a blue moon to remind myself why I can't play anymore. But after the 5-10min. I have to put them down.

kkrell · Post by **kkrell** » Fri May 21, 2004 4:51 pm

j dasinger wrote:Well, quite right about the diagnosis problem. None of the doctors or other practitioners I've seen know whats wrong with me. In any case, I know that there has been some type of physical injury because I have circulation and numbness problems even when I'm not playing.

Ah, a real symptom. Here are some things to think about: Perhaps a "funny bone" kind of pain (numbness, maybe a little burning). Maybe in the forearm in front of the elbow. Aggravated by pressure against the finger pads, when gripping, or particularly the thumb, if pressing against something? Aggravated by lifting weights? There can be some tingling through the wrist, also. If anything at all like the above, it could indeed be radiating from the back, often the shoulder rotator cuff on the particular side involved. The above can be relieved through chiropractic, some stretching exercises against a door frame (spreading the chest). Oh well, these may be off the mark for your particular incident.

Again, I think that you'd certainly gain some information from Feldenkrais. I'm a big proponent of body therapy, having avoided having both knees replaced before I was 20 (kneecaps kept trying to get out). I did register for College in a wheelchair. BTW, at the time, artificial knees were pretty crappy, limited to about 90 degree movement. In my case, I underwent a series of 10 Rolfing sessions (deep tissue massage) at age 26, and have never had any problem since (50 next month).

Best of luck to resolving your issues and returning to playing.

Kevin Krell

Tony · Post by **Tony** » Fri May 21, 2004 5:19 pm

Lots of great advice.
Get a proper diagnosis, continue with physical therapy. Don't consider surgery an option.

It's important to improve your overall physical strength with exercises that don't aggravate your condition. You've got nothing to loose from this. Try some vitamin B supplements... someone told me about this (especially B6) and it appears to help me with shoulder/arm pain I get from piping.

djm · Post by **djm** » Fri May 21, 2004 6:42 pm

James, I think you are being far too hard on yourself. It is not your fault. It is the chanter's fault. What an idiot instrument! What moron could ever have designed something so ridiculous? Got a gun? I'd go out and shoot something, just to feel better and let off a bit of tension if I were you. Hey! Why not the chanter?

I second (third, fourth?) the suggestion to go to a chiropractor. As well, you might want to consider an exercise system like tai chi ch'uan to loosen and re-align your spine. It would be better than sitting around moping and staring at your pipes - I mean your UPs.

djm

j dasinger · Post by **j dasinger** » Fri May 21, 2004 7:35 pm

No really, I HAVE tried everything. I went to the Chiropractor long enough that he told me he was stumped and had no idea why it wasn't getting better. I've been doing Yoga and martial arts for years and have always been consciencious about stretching. I've even been supplementing B6 by accident (a weightlifting supplement I take has 300% DV of B6, which doesn't include what is in my multivitamin). Kkrell, my symptoms are similar to what you descibe, except that weightlifting hasn't helped or hurt. The only problem is that the therapies you mentioned haven't had any effect. Believe me, the last thing I want is someone cutting into my spine, but everything else has so far failed miserably.

To DJM... Hey, can you hand me my pipes? There the ones that say "Bad Motha****er on 'em. I'm goin to get a couple hard pipe-hittin' Irishmen to get all Medieval on the brotha that sold me these things....Hey, wait, that's YOU DJM!

Peace,
James

danny · Post by **danny** » Fri May 21, 2004 7:38 pm

maybe your not playin enough,and your seizing up?

glands · Post by **glands** » Fri May 21, 2004 8:43 pm

Just checking in to see if anybody replied about the pipes 4 sale post of my own, caught this, then decided to reply since I know James. He has been playing long enough and is quite accomplished that there has to be something more going on than this being a beginners problemo.

Ask somebody to check to see if you have a cervical rib (an extra rib that is higher than the usual first rib over which the nerves and vessles to and fro the arm must course over and thus get stretched) or something else about your shoulder girdle anatomy that may compress the axillary vessels or nerves when you play and abduct the arm/shoulder girdle. You may have an ulnar nerve tunnel compression that is exacerbated by playing. The location of the bag may have something to do with it if it is compressing the brachial vesssels and nerves on the inside of the arm. Whatever the cause, an interested sports medicine specialist might be sympathetic enough to help out. Check out Emory in Atlanta or even come to Nashville to see somebody who may care....and take your pipes to show them what happens. They should want you to play to the point of discomfort, and you should demand the opportunity, so they can check your pulse to evaluate blood supply or conduct a basic simple upper extremity neurological exam while under duress.

Also, it may be the bag with which you are playing. Try others including fatter and narrower and smaller and bigger to see if it makes a difference. Gotta meet with other pipers or go to a tionol to test this one.

What are you doing in Valdosta of all places? Are you out of the USAF at the moment? Write me at glands@comcast.net

Beehiveman aka Lewis

texasbagpiper · Post by **texasbagpiper** » Fri May 21, 2004 9:06 pm

I had carpal tunnel surgery about 2 1/2 months ago and I was playing my pipes Uilleann and Highland ,again with no pain in about a month and a half. Surgery helped me thank god.

kkrell · Post by **kkrell** » Fri May 21, 2004 9:17 pm

j dasinger wrote:No really, I HAVE tried everything. I went to the Chiropractor long enough that he told me he was stumped and had no idea why it wasn't getting better. I've been doing Yoga and martial arts for years and have always been consciencious about stretching. I've even been supplementing B6 by accident (a weightlifting supplement I take has 300% DV of B6, which doesn't include what is in my multivitamin). Kkrell, my symptoms are similar to what you descibe, except that weightlifting hasn't helped or hurt. The only problem is that the therapies you mentioned haven't had any effect. Believe me, the last thing I want is someone cutting into my spine, but everything else has so far failed miserably.

Get a second opinion on the chiropractic.

Weightlifting (curls, etc.) would be harmful.

Even if something is found radiating from the spine, there are still numerous non-surgical approachs. If it's mainly pain, then epidurals, or endoscopic opening of up areas compressing nerves, facet blocks, & radio-frequency denervation can deal with the sensations. The main thing is for you to go ahead and determine a cause. Put the chainsaw away for now.

Kevin Krell

meir · Post by **meir** » Sat May 22, 2004 7:22 am

1. you are all over the place with your suspicions of what is wrong. if its the circulation it is not a disc, and visa versa.
2. there should be lots of doctors who do not look at you funny becuase you play the pipes. that is what occupational medicine is all about.
3. feldenkries will not hurt. try it until it helps or until it does not.
4. otherwise, you need a full workup. you should know what is wrong without commiting yourself to surgery.
5. if you have a spine problem, there are surgeries and their are surgeries. some should be the last resort, some considered earleir.
6. if you have a circulation problem, which i STRONGLY doubt, it needs to be addressed immediately. there are sometimes solutions which do no involve real surgery.
7. you may have a repetitive stress injury. carpel tunnel is the most common but there are others. 3 hours a day is alot of anything. as has been suggested, a hand surgeon or very good general orthopedic surgeon could evaluate you for that.
8. finally, and this is unlikely, there IS an official entitiy called writers cramp- its not a joke, its a neuro diagnosis. i doubt you have it. however, some neurologists are VERY GOOD diagnostiticians, even if it is not a problem they can solve. they will send you to the one who can.
9. finally, you may want to ignore me, i am one of those military physicians.
10. if you are still entitled to military benefits, pm me i can help. and for the rest of you skeptics. i take home the same salary whether i help him or not. i am just offering to point him in the right direction.

meir