bad news for me today

[BillWelcome Home Studios]

A few months ago I had some hand pain, so I went to the doctor who told me that I injured it and it would take four months to heal. Still have pain, so I saw a specialist today.

 

He says that I have worn out my fingers. The cartillage is gone. I never heard of such a thing. The pain and tenderness never goes away, and I can't play. He says that he can fuse the bones together and the pain will go away, and he can fuse them in such a way that I'll be somewhat able to play.

 

hmmm.... think I'll live with the pain for a while.

 

I know that a lot of fellow forumites have far worse health problems, and this seems almost trivial in comparison. But it breaks my heart to consider giving up the guitar.

 

Bill

[Bluesape]

Really sorry to hear that, Bill! Hopefully there are exercises or physio that'll help. I've never heard of anything like that either. Hopefully Don knows someone who can help.

[Rampdog]

That sucks Bill... Doc might have an answer but all is not lost. You could still play slide. Is it in both hands or just your left hand?

[Caevan O’Shite]

Wow, that's rough, Bill. And no, it's NOT trivial, not even almost. I am very sorry that you're facing this.

 

I've always figured that no matter what, I'd always find a way to play- although I've considered the possibility of having to completely change the way that I play in "worst case scenarios" (I wish YOURS was imaginary!!). Y'know, playing slide only, or with a (God forbid) hook-held pick, stuff like that. Pain and discomfort is a sort of a different ball of wax, but no less serious, in some ways worse, perhaps harder to work around!

 

Maybe, maybe, hopefully, there's some way to replace, replenish, or substitute the cartilage... I really, really hope so...

[Gruupi]

That sounds awefull. I've never heard of finger cartilage being gone either, but I guess its just like any other cartilage and can be worn out. In my opinion its one more case where stem cell research might have an answer but we will never know.

[Kramer Ferrington III.]

Well, I'd DEFINITELY get a second opinion.

 

I've suffered from rheumatoid arthritis ever since I was 26 and when I was living in Argentina, they actually gave some injections that contained cow's cartilage (they waste no part of the animal!) and that solved the pain problem for quite a few months. Maybe there's something like that on the market in the US, perhaps synthetic or something?

 

But I'd definitely get a second opinion. Hell, we talk about hand and muscle problems here all the time and this hasn't ever come up, IIRC. And you never hear of any of those old blues guys who've played professionally for sixty odd years wearing out their cartilage and retiring.

 

So... get a second opinion, willya?

 

[Gifthorse]

Dude, that sux. I would get a third opinion on it. I would second that 1 more case for stem cell research thing. You know cuz everyone else in the world is going to do it before us. My Dad also has something similar to Altzheimers. I would have loved if there was some knid of treatment for it a few years back before he became senile, and I don't give a flying F about some 3 day old cell compared to my Dad.

[jbote]

A second opinion is definitely in your best interest, Bill. Don't get too down yet - its still early in the process. (Easy for me to say, I know.) Stay positive, and get a referral to another specialist.

 

All the best.

[S. Yeti Bigfoot, Esq.]

Bill,

I'm really sorry to hear that, man. I certainly wouldn't give up guitar yet, though. Get more opinions.

[mdrs]

Bill, I am so sorry to hear this. It totally sucks, and is in no way trivial.

 

First and foremost....take it one step at a time....all is not lost just yet!

 

You can wear out cartilage in any joint. In fact, with normal age, we all wear out cartilage in all of our joints. Your situation is not all that uncommon, especially in a guitarist. Playing guitar puts a lot of major force on your finger joints, and while they are in very ackward, unnatural positions.

 

A great friend who's about 60, and is a jazz guitarist (played in the army jazz band a long time ago, and has played out for ever, as well as gives lessons, and is a guitar instructor/teacher at a really nice local liberal arts college) has the same problem as you. He has pain, but still plays out, if less frequent than he used to. He's a smart guy, and has been seeing a really good local hand surgeon for a couple of years. I'll speak to Dave when I can, and see if he's got any info for you.

 

What kind of "specialist" did you see? A hand surgeon? Or, a regular orthopedic surgeon? You live in Pittsburg, right? I'm quite sure that there are some excellent hand surgeons in Pittsburg. If you wanted to see world famous hand guys, let me know. I can get some info for you.

 

Have you tried not playing at all for any period of time, to see if things improve? With any hand injury, playing the guitar becomes a "repetative injury" thing, where you are constantly doing more damage, and making things worse, without really allowing for any significant healing.

 

I'd suggest an extended period of not playing AT ALL. During that time, consider taking non steroidal antiinflammatories...like Aleve, Motrin, or the like. If you take over the counter Aleve, double the recommended dose that's printed on the bottle, to get you to the level that we prescribed for patients when Aleve was still a prescription drug. I'd consider not playing for several months...two or, better yet, three, if you can stand it.

 

I had a serious bout with a trigger finger to my index finger on my fretting left hand. I tried several steroid injections, none of which did a thing. The only thing that worked was not playing for slightly over three months....one of the toughest things I've ever done. But, it worked. The rest from playing stopped the incremental injury I was doing by playing, and allowed me to heal.

 

There are suppliments that are SUPPOSED TO aid in repair of cartilage. I know little about them...condroitan sulfate, and others. I'm not much of a proponent of most vitamins and suppliments, because there is little real science to prove that any of them actually do anything to help you!!

 

There are injections into some joints (i.e. knees) where they inject an artificial "gel" to try to help suppliment the cushioning in the joint. I'm not certain that these are done for finger joints....it may be that it is being done, I just don't know.

 

Finally I'm pretty sure that artificial finger joints are being done.....I have no experience with this, but if, at some future time, all else has failed, it could be a option.

 

I'll fish around for any other info I can come up with. Feel free to PM me. The light is always on here, and I'm on call 24/7.

[desertbluesman]

But it breaks my heart to consider giving up the guitar.

 

Bad news, and I am sorry to read it, being a lifelong player myself, I can relate to the pain of giving up your passion. But you don't have to give up guitar altogether, there is always the option of playing slide guitar. There are no fingers being bent and pounding on the fretboard. In a few months (if you can't already) you can be a very impressive slide player knowing all you know about music after all these years. Don't give it up just flow with the changes. I hope you can find a way to keep on going.

[Fumblyfingers]

Bill I am extremely sorry to hear you are having this hand trouble.

 

I cannot tell you anything near what Doc has said other than the fusion should be a very last resort as you know and only to really prevent things getting worse.

 

Doc mentioned the injections, you may as well at least try them to see if they help the pain. A friend of mine had them in his neck for a similar problem and they give relief for months. If you can get the pain under control perhaps you can do some hand therapy with an occupational therapist. A good one can do wonders.

 

I have heard that the cartilage is continually regenerating. Perhaps immobilizing the hand for a while so it can heal...therapy in the meantime...and NSAID's to control the inflammation.

 

I really hope your hand guy will have you go non-surgical for a while......I am going to hold it in my head that your hands are going to respond to conservative treatment.

 

And yes, get a second opinion...hopefully Doc can suggest a good hand guy or point you in the right direction if you are not sure of your current guy.

 

All the best...I know it sounds trite, but keep a positive attitude going and see this thing getting better.

[mdrs]

Just an addendum.....cartilage is avascular (i.e. has no blood supply), similiar to liagments, and bone. This is why they are so slow to heal. You just can't do much that will quicken their snail's pace on the recovery highway!

 

So, patience is gonna be important.

[MILLO]

But I'd definitely get a second opinion. Hell, we talk about hand and muscle problems here all the time and this hasn't ever come up, IIRC. And you never hear of any of those old blues guys who've played professionally for sixty odd years wearing out their cartilage and retiring.

 

So... get a second opinion, willya?

+1

 

A second the motion about getting second opinions.

[Dr. Ellwood]

I'm SO sorry to hear this Bill! lots of good positive advice here from the guys and great comments from our resident MD too! this may very well turn out good for you in the end Bill!!!

[s mel gibson1642606968]

Maybe glucosamine might help. It couldn't hurt to try.http://en.wikipedia.org/wiki/Glucosamine

[trader56]

Sorry to hear this, too, Bill.

 

I think Don has some really good things to say regarding yuor situation.

 

Wishing yuo all the best,

Dave

[Boggs]

So sorry to hear of this, Bill... I would think that there would be a couple of options for a hand specialist... Cadavre cartilage or injections of this derivative actually from chickens that promote growth of cartilage with quite a high rate of success. My brother-in-law is going to be getting this treatment for his knees. Don't give up hope, man...

[mdrs]

Maybe glucosamine might help. It couldn't hurt to try.http://en.wikipedia.org/wiki/Glucosamine

 

Oh YES IT COULD HURT!! There are all sorts of anectdotal reports of reactions to supplements, such as glusosamine. Things like aplastic anemia (your bone marrow dies, and stops making blood and imune cells and you croak) have been reported. Also, many "suppliments", that are marketed to make you think that they couldn't hurt, thin the blood. Many documented cases exist of patients undergoing routine surgery, and having severe problems with bleeding caused by suppliments.

 

So, beware the suppliments. Not to mention, there is no proof that they work.

 

And, Boggs.....those injections put an artificial lubrication into the joint space to cushion the joint (it's like re packing your bearings!), but I do not believe that they promote regeneration of cartlige.

[Guitarzan]

man that is bad news but hang in there and take it easy. sounds like you have gotten some good advice allready.

sorry to hear about your pain.

[BillWelcome Home Studios]

Guys, thanks for the support.

 

To answer a few questions:

 

The fellow that I went to is the Chief of the Division of Hand Surgery, Hand and Wrist Surgery, and Reconstructive Microsurgery at UPMC. So you can see that I started out pretty much at the top. He is, of course, a surgeon, so maybe his natural inclination is to cutting, but he is no hack. He is also a guitar player.

 

In terms of injecting cortozone ($10), or the serum that they make from rooster combs (at $3k!) in the first place the joint is too small, the doctor says that it is rare that anyone gets relief, and he just doesn't recommend it. In the second place, I've had cortozone shot into my leg (about 25 years ago), and I promised myself that I would never let anyone intentionally hurt me like that ever again.

 

Doctors are never in a hurry to operate on fingers, because of the possibility of nerve damage. The area is just too small and the nerves are just to many concentrated in to small a space. Things that they might consider for larger joints like knees are non-starters in hands.

 

Will I get a second opinion? If I can find someone equally qualified. But UPMC sits prettyy much atop of the field around here, and the top guy at the top place... well, it's going to be hard to beat.

 

Don:

 

I've got the xrays in DICOM format if you want to see them, but the damage is pretty clear, plus the smallest little finger bone is growing a hood or hook out the side/top going up the finger. I've laid off playign for about 4 months, doing maybe 3 minutes a week, getting pain and stopping.

 

My knee surgeon told me last week that there is only one study that shows anything about condroitin/glucosimine; amd that was negative. But he also said that people have strong feelings about this, one study is not enough to base a decision, and if it helps me I should take it. I've been taking Solgars multivitamin and Lipotroic Factors, alog with 1g Salmon Oil and a glu/condr combo pill.... but I'll be the first to admit that I'm terrible at taking medicine. I've been trying to be more consiencious about it. I also have 800 mg motrins on script that I should be taking. (sigh...) They are sending me in for ENG/NCS for the upper extremities to hopefully diagnose and then be able to address other hand issues.

 

Fum: no, no chance of regeneration. The DR said that I had a "good life" with my hands. Done. Worn out. I had the same reaction from the Dr who takes care of my knees. I look younger than I am, I do more than I should, I've always been athletic, and one would think that this would make me stronger and keep me healthy (as promised to me by all the media for my entire life...) but as it turns out all I did was accelerate the wearing-out process. The knee guy likened it to brakes on a car...you get so many miles, if you use them in one year or 10 years.

 

Thanks for your support guys, I've been a little bummed since I got the news at about 5 yesterday afternoon. I'll process it a little more, and I'm sure that I will find a work-around. I am just one of the guys who always used his little finger, I play a lot of six-finger chords, and always use the little finger in runs and stuff, so this will be quite an adjustment.... particularly as I was leaning towards learning finger-style guitar, a la Lawrence Juber, Michael Hedges, Ed Gerhard, Muriel Anderson, etc. There are also quite a few of my compositions that will now likely never get recorded. But I'm just feeling sorry for myself now. I can still walk, talk, and earn a living. So I should shut up and be grateful for what I have. I'm sure I'll get my head on straight ina day or two.

 

Meanwhile, you guys are great!

 

Bill

[miroslav]

 

He says that I have worn out my fingers. The cartilage is gone. I never heard of such a thing.

 

Yeah...it is possible to wear/grind away the cartilage. I have that exact same problem in my right hip, pretty bad...from many years of hard skiing.

My left hip is catching up...but I stopped skiing 3 years ago so as not to speed up that process.

It really sucks! Skiing was a big thing in my life.

 

Anyway...I think your options are heat therapy and some decent pain pills when it flares up.

I don't think you will be able to do much to reverse the cartilage decay when it comes to the smaller finger joints/ & cartilage. I dont believe they are doing joint replacement for fingers like they do for hips and kneesyet.

 

I bet if you slow downor just pick you playing moments more discriminatelyyou will be able to play for a long time with the help of some therapy and pain pills.

 

[miroslav]

I also have 800 mg motrins on script that I should be taking. (sigh...)

 

 

Ooooooow...that's a potent dose that can eat a hole in your stomach over time if you have to take it constantly.

 

Oh...I've using glucosimine/condtroitin for a good 10 years now...and no issues from it. I feel that it helps lube the joints a bit, but it certainly is no "miracle" like some ads claim.

But thenIve been a big vitamin/mineral/herb user for over 25 years nowand now real issues to speak of.

I know many of the supplements HAVE been a benefityou just have to tailor them per person.

[BillWelcome Home Studios]

Yeah, I haveproblems in the last three fingers on both hands, but most critically in the lttle finger of the left hand, where I get serious pain in the first joint between the bones from any pressure to the end of the finger (like pressing down a string...) and shooting pains running up to the second joint.

 

Bill

[Boggs]

...and cadaver cartilage is not an option either?

[BillWelcome Home Studios]

...and cadaver cartilage is not an option either?

 

That gets into the whole operating thing, that they don't want to do and cannot say will not cause nerve damage if they do. It was not mentioned as an option, but there would be little point in putting in old cartilage only to have the nerves severed and not be able to play, anyway.

 

Bill

[LeftyBlues]

Bill there's no such thing as "trivial" health problems. See a specialist who deals with this type of thing, regular every day doc won't cut it. Good luck man.

L.B.

[Billster]

I cede to Doctor Don on medical issues, but I think a second opinin is crucial, and with a hand specialist.

 

I don't want this to sound harsh, but what level of pain are you experiencing?

 

Is it in the moment, gotta stop what you're doing pain?

Annoying discomfort that limits, but doesn't halt you in your tracks?

Not so bad in the moment, but you pay the price later?

 

Really analyzing what you are experiencing will make it possible to find solutions, accommodations, and work-arounds. Best of luck.

 

[BillWelcome Home Studios]

I don't want this to sound harsh, but what level of pain are you experiencing?

 

 

Cannot press down the strings with the little finger at all. First press, pain. After that it is less than a minute before the pain between the bones and the shooting pain up the finger stops all playing with the little finger. The others aren't so bad. I just don't know how to play without my little finger. Serious retraining will be required (g)!

 

Bill

[mdrs]

Hey Bill.....I figured that you'd have seen a quality hand guy...Pitts. is a mecca of excellence in health care. If you did want second opinion, PM me. I went to med school at U. of Lousiville, where they have one of the best hand programs in the world...

 

I'm 51. You and I seem alike, in that I keep fairly fit. But, now I'm worried about this pain in my hip. I do some running to keep in shape....I'm no marathon man!!! LOL. But, our bodies do wear out....sucks, but it's part of life. So, I, for one, am with you. Hang in. The news always hits hardest at first. You'll figure out a way to effectively deal with all this.

 

I'll speak with my Jazz bud, and see what his hand guy is up to. Also, I'd be glad to take a look at those x rays. If you want to send them, PM me. I'll give you my e mail contact info, etc..