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Thread: Basal Thumb Arthritis Surgery options for Mandolin Players

  1. #1

    Default Basal Thumb Arthritis Surgery options for Mandolin Players

    I am a mandolinist, and appear to have lost most of the cartilage at the base of my right thumb due to osteoarthritis. Picking and especially tremolo are becoming more and more painful. My hand specialist is suggesting surgery to reconstruct the joint with a piece of a tendon from my forearm which is used to rebuild the joint. This evidently is a very successful surgery that has been practiced since the 80's and I should expect it to last for the rest of my life. The Dr assures me that the tendon taken from my forearm is one that is not used (by whom, the common Joe, or mandolin players?) I don't know how "successful" it has been for musicians, since we work our hands in such different ways. Maybe I won't be in pain anymore, but maybe I won't have the coordination to play, either!! Have any other mandolin players had this surgery, and how successful was it for you? Has anyone else experience another, better option?

  2. #2

    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Last month, my hand surgery doctor took x-rays of my left hand and detected arthritis at the base of the thumb. He assumed that it is also in the right hand, but my left hand hurts more than the right, especially as I press down on the back of the neck. Although he's a hand surgeon, he advised against sugery at the outset and had me fitted with the least immobilizing of 3 available hand splints as a starter, and recommended progressively trying the more immobilizing splints to see how it goes. The least splint helps a bit, but requires changes to how I hold the neck, etc., and even at this early stage, I can tell that I will have to make some significant changes to how I hold the instrument. I already know from playing my other mando that neck profile also makes quite a difference in how the stress of playing is distributed to the hand, so I will probably be more attentive to this as well.

    My take away is that surgery should be the last option. Not saying "never," but as a last resort, perhaps.


    Quote Originally Posted by WaltzingM View Post
    I am a mandolinist, and appear to have lost most of the cartilage at the base of my right thumb due to osteoarthritis. Picking and especially tremolo are becoming more and more painful. My hand specialist is suggesting surgery to reconstruct the joint with a piece of a tendon from my forearm which is used to rebuild the joint. This evidently is a very successful surgery that has been practiced since the 80's and I should expect it to last for the rest of my life. The Dr assures me that the tendon taken from my forearm is one that is not used (by whom, the common Joe, or mandolin players?) I don't know how "successful" it has been for musicians, since we work our hands in such different ways. Maybe I won't be in pain anymore, but maybe I won't have the coordination to play, either!! Have any other mandolin players had this surgery, and how successful was it for you? Has anyone else experience another, better option?

  3. #3

    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    This surgery was suggested to me almost ten years ago. A friend of mine had it at about that time so I followed how it went for him. His opinion is that he wouldn't have done it if he had known how long it would take to get anywhere near back to having "something" like a normal functioning thumb. I opted out----

    What I did. Glucosmine---MSM daily for a long while. Not so much anymore but maybe it would be a good idea to never stop. Exercise -based on a use it or lose theory that I made up myself. And "Rocky" a Chinese acupuncturist who cleared up all kind of messes for me. I suggest that your acupuncturist be actually Chinese 'cause there is some traditional cultural mind set that goes along with the theories and understanding of how we work and how that stuff works on us. I don't think you can learn that in school.
    So ten years later I rarely have any pain at the base of my thumb and as this condition was supposed to get progressively worse I must have done something right. Not to knock Western medicine ---nah,scratch that---to knock Western medicine--all they have are drugs that cure nothing but maybe make you not notice the problem (and then destroy your liver or something, or force you into a lifetime of AA meetings) and knives --they get big money for those knives and oh,by the way the drugs as well.

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Thanks for the advice. I am going to pursue all non-surgical avenues first. I will check back in with MandolinCafe and report in 6 months. I think we need more information on health issues re mandolin playing, both positive (lowering blood pressure?) and negative, and I would like to contribute to that knowledge. I also think this may warrant its own 'thread', if MandolinCafe would consider that idea.

  6. #5
    plectrist Ryk Loske's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Another Basal Joint Arthritis diagnosis here. I got an appointment with the best "hand man" i could find. His advice ... given that i was a musician .... was to stay away from him and let time work it all out. I'll add to barney59's apothecary: Glucosamine-Chondroiton-MSM, Zyflamend (A natural anti-inflamatory available over the net and in health food stores) and fish oil especially Salmon which is good for arthritis. I have some painful instances periodically but still play for hours on end a couple of times a week and a couple of hours every day. (Archtop guitar with highish action and heavy gauge strings.) Throw in some mandolin and banjo as well.

    Good luck staying away from the knife.

    Ryk
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    "I'm convinced that playing well is not so much a technique as it is a decision. It's a commitment to do the work, strive for concentration, get strategic about advancing by steps, and push patiently forward toward the goal." Dan Crary

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    In 2002 my right thumb became so painful at that joint I could barely hold a pencil. I went to a local ortho doc who told me he would never ecommend hand surgery, period! He prescribed celebrex and gave me a brace which prohibited playing the mando. After 2 months of drugs and the brace I was no better....maybe worse. Doc referred me to the 'best hand surgeon' in Washington County (Maryland). This guy recommended the surgery you are considering, and offered to schedule the surgery right away.
    I got on the web and then called the Curtis Hand Center at Union Memorial Hospital in Baltimore. I saw Dr. Raymond Wittstadt (he specializes in musician hands), a second opinion hand doc, 2 'fellows', a retired chief of hand surgery and a physical therapist all together in one visit. They had already read my notes from the Hagerstown 'best.' Dr. Wittstadt spoke, "you have 2 choices, 1)you can visit our therapist for 6 weeks and see if that helps or 2)we can operate; we would slice your thumb open and tighten up the ligaments and tendons and repair it." I asked, "what about taking a ligament out of my forearm and attaching it?" He and the other doctors laughed. The retired chief of surgery said, 'we haven't done anything like that since the 1960's. The success rate is very low." I asked about the success rate of the surgery he wanted to do....he said 95%. They call all patients one year after surgery and ask if they would have it done again if they had it to do over. 95% said yes. It is a common hand surgery, especially for cops......they get in street fights and fall on concrete and mess up that joint.

    I got the surgery. Totally successful. I am a terrible patient. I told the Doc before the surgery, 'I need to be able to pick for 3 hrs, run a chain saw, weeder, push mower, play tennis and have 0 pain.' Well, I got all that.

    See an experienced hand surgeon!

    PM me if you want more details.

    Bob

    Bob
    re simmers

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Another potential candidate here.. appointment made for Sept for further analysis. Mine is left thumb but compounded by a butchered surgery in 1984 for a shattered left wrist.

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    Full Grown and Cussin' brunello97's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    This has been a helpful conversation for me. Thank you all for sharing your experiences. I've been experiencing pain in this area of my left thumb and have wondered about its cause.

    I didn't really consider arthritis as a possibility figuring I was too young for that. But I did I broke the thumb some 20+ years ago in a bike accident (dog related, and not unlike the accident that Leo Posch suffered that is being discussed--and supported--in another thread) and the doctor did warn me about winding up with arthritis in my AC joint where the major damage was sustained.

    I'm up for trying the herbal 'cocktail' that barney prescribed, though I don't share his singular skepticism of Western medicine. I'm skeptical of all medicine eastern or western. In my experience the inflated promises of alternative medicine have been as problematic as the slash and burn technique I've sometimes run into with 'traditional' western medicine. (Had a kidney stone a couple summers ago and both east and west failed me miserably.....) In my view we need to be alert and engaged with whatever anyone asks us to take or do in regards to our health.

    Surgery sounds really scary to me. I had severe carpal tunnel in both wrists when I just began my career as an architect--was on the computer ten hours a day for months and months at a time. The sports medicine group here in Austin recommended surgery but I opted for a slow conservative approach which paid off in the end. Not to say that it wouldn't be an option for the thumb if things get really bad (they are not, now) and I'm glad it worked out for Bob (and maybe others here.)

    This is a serious topic. The option of not playing the mandolin is unthinkable.

    Great conversation. I hope some others weigh in.

    Mick
    Ever tried, ever failed? No matter. Try again, fail again. Fail better.--Samuel Beckett
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    Market Man Barry Wilson's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Call it odd, but people see my mangle left pinky finger and cringe. I first broke it auto detailing, wind blew a car door shut as I was wiping the jam and bent it 45 degrees. Broke it many more times wiping off wax hitting mirrors and door handles (I closed the doors on my business 2 years ago)...

    I tried braces and stuff and found a thin strip of good old hockey tape around the knuckle provides enough support and has some give that I can play for hours. If I don't tape up, I can only play a few songs and the pain is too much to use the pinky any more

    I am so anti doctor. I have needed surgery for years and have learned my limitations to avoid the problems. I don't want to be laid up for some undisclosed amount of time healing. I have a rib on my back dislocates when I work with my hands above my head. So sorry honey I can't paint and cut in the top lines anymore... I will pay someone and play an instrument and watch haha
    Kala tenor ukulele, Mandobird, Godin A8, Dobro Mandolin, Gold Tone mandola, Gold Tone OM, S'oarsey mandocello, Gold Tone Irish tenor banjo, Gold Tone M bass, Taylor 214 CE Koa, La Patrie Concert CW, Fender Strat powered by Roland, Yamaha TRBX174 bass, Epiphone ES-339 with GK1

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    Registered User David Rambo's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    My surgeon has suggested the same operation, but he wants me to wait until the cortisone no longer works. I have it injected every 3-4 months, and I can play for a while again. I'm not good enough to play fast, anyway, but this way I can hold the pick. As someone else said, it's sometimes hurts too much to hold even a pencil.
    "Put your hands to the wood
    Touch the music put there by the summer sun and wind
    The rhythms of the rain, locked within the rings
    And let your fingers find The Music in the Wood."
    Joe Grant and Al Parrish (chorus from The Music in the Wood)

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    Registered User belbein's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    I just had major surgery—a full knee replacement. I’ll share a few thoughts.

    There are always people who claim that they would never have done the surgery if they knew how hard etc etc etc. The ones that I’ve run into, when I’ve probed a little, are people who had absurd expectations, or—more often—didn’t do the physical therapy or the continued exercises. Rarely, there’s someone with a bad result or a bad doc. Mostly, it’s the failure to live up to their end of the bargain.

    As for chondroitin and herbs … There’s no science behind it. There’s no disproof, and no proof. I don’t have a problem with anecdotal evidence (I believe in Santy Clause, Saskwatch and Bigfoot—oh, and Nessie), but when anecdotal evidence is all there is, you have to wonder. (I know, I know, “Big Pharma” “doesn’t want us to know.”)

    The thing is, all those herbal remedies are also drugs, and they also have secondary effects and effects upon effects of other drugs. Unlike Big Pharma drugs, the herbals are completely unregulated. Did you know that? Completely. Unregulated. By. Anyone. Including the FDA. You may not trust Big Pharma or The Government, but do you trust a completely unregulated industry?

    I did the cortisone injections, and tried the other high-tech injections where they inject lime jello or something. The thing is, these are not without cost. Beyond the $ cost, there’s also some indication of a systemic reaction to even local cortisone. Cataracts, for example, might be caused or exacerbated. I’m not a doctor, and I haven’t explored this, but I’ve seen it mentioned.

    I think it’s a good idea to put off surgery and try everything else first. Just one other factor to think about. None of us are getting any younger. The older we are when we have surgery, the older our bodies are when we try to recover. Older is better in a lot of ways, but not for recovery. So trying other things is one thing. Getting to the point that we’re old enough that it’s too hard to do the things we need to do to recover: something else. You have to balance them.

    Just my thoughts. FWIW.
    belbein

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    There is also the point where we get old enough that all those bones rubbing together just turn to dust. Much less problematic when that happens.......

    I had surgery a couple of years ago as a result of a broken arm. My experience was much different than the above post. Doctors,hospitals etc. just did a crumby job, charged an astonishing amount of money and left me with all kinds of complications. The PT people on the other hand were terrific and the recovery took a long time but they did save the day.

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Do 10 times the amount of research that you would do when selecting a luthier to build the mandolin of your dreams. Google, speak to doctors, find musicians who have had hand surgery, ask for references from patients, nurses, etc. Find a hand surgeon who has done a lot of hand surgery (as opposed to a general ortho surgeon who mainly does knee and hip replacements). Do not settle on a surgeon just because he is close by, or because his brochure looks good. After all that, go to see the surgeon with a list of prepared questions. Then get a second opinion, and a third if necessary.

    This is the thumb! You're a musician. You must have it!

    Do all of the above BEFORE 'trying medication and supplements first.' A good hand surgeon will tell you the pros and cons of the drugs and supplements. These days, good doctors are schooled on supplements and alternative treatments. Also, when it comes to medications and supplements......no matter what you read in the puritan's pride catalog, or what you hear from the herb lady at church.......ask a young pharmacist. They are well-schooled in long term and short term side effects of all of it - more than doctors, who are usually schooled by the pharmaceutical rep who gives them free samples.

    My thumb surgery was 2 hours away from my home. It was same day surgery. I made just 4 follow up visits. Therapy was done locally, and my surgeon stayed in contact with the therapist.

    My experience was very good with surgery, but it was not a fluke. I did not settle for the "well, some people do OK, and some don't". I did research. There are never any guarantees, but your chances are better if you find out that the surgeon has done the same surgery successfully 38 out of 40 times.

    Good luck.

    Bob
    re simmers

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    I am dealing with the same issue in both thumb joints, and have chosen to treat the condition with prolotherapy, where the joints are injected with what are basically inert liquids. One doctor used a B vitamin liquid; I then found another doctor who was 6 hours closer, and she uses what she described as "little more than sugar water." It is my understanding that it just opens the joint, and creates some inflammation, which the body then reacts to with its healing processes. My right thumb is considerably better, and the left has improved a bit. They are not normal again, but at least the pain is far less and far less frequent. I also had the first joint on my left hand middle finger treated; it had been injured in an accident some years before, and would bend only slightly, with a great deal of pain. After one treatment, it has returned to normal function with no pain, and has remained that way for over two years. My present doctor, who is an MD also trained in alternative therapies, has said that we can take the prolotherapy one step farther by harvesting stem cells from my body and injecting the thumb joints with them. There have been some positive results using stem cells to treat arthritic joints, as they are capable of regenerating tissue, of all kinds, including cartilage. At present, prolotherapy is considered experimental, (as far as health insurance is concerned) but the positive part is that if it doesn't work, it does no harm, in contrast to repeated cortisone injections and surgery.

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    plectrist Ryk Loske's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    I'm sorry .... and i do not want to get into a war with anyone ...... but belbein's opinions are based on ... what? Opinions are like rectums ... everybody's got one. Referrals to top physicians in Boston and Dartmouth Hitchcock have all produced a positive response to Chondroiton-Glucosamine&MSM. "We don't know why .. but ...." Skepticism has its merits .. but flaming doesn't when it comes to helping other afflicted with something so important to an aspect of their lives they deem crucial.

    Ryk
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    "I'm convinced that playing well is not so much a technique as it is a decision. It's a commitment to do the work, strive for concentration, get strategic about advancing by steps, and push patiently forward toward the goal." Dan Crary

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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    Yep. Opinions are like toilets. Everyone thinks their's is special, but they are serve the same purpose.


    Bob
    re simmers

  20. #17
    Registered User belbein's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    I agree that everyone has an opinion. And I think your skepticism about mine—asking what it’s based on—is legitimate. I’ll share the basis with you in a minute. But for the record, I didn’t flame anyone. Nor did I imply that your opinions, Mr. Ryk and Mr. Simmers, belonged in the toilet. I think that’s a little much. Usually, on the Café, we are not quite so rude.

    Now, as for what my opinion is based on: (1) research and (2) experience.

    As far as the research, chondroitin in its various compounds has been pushed at me by every chiropractor, alternative medical professional, and well-meaning individual who has seen fit to insert themselves into my knee problems. So I researched it. And what I found—whether relying on MedLine or the Internet or my doctors—is that there are a lot of claims but absolutely no proof of efficacy. "Proof" here means something very specific, and it does not equate to "belief," or "SWA guesses." I don’t mean to be rude, but I simply don't believe that all the best doctors in Massachussets recommend chondroitin. They may say “It helps some people,” and apparently it does. But if they’re recommending it you need to run like hell, because they’re doing it in spite of there being no proof of efficacy. None. (And if you have some, I hope you will share, because I haven’t seen it. I am willing to be educated, even down here in my toilet.)

    As for experience: I’ve prosecuted a bunch of dietary supplement cases, and I’m knowledgeable for professional reasons about alternative health claims (magnets etc etc) They all fit the same pattern. Universal claims are made, including claims that “clinical studies prove…” When you read the clinical studies—and I read every word of every clinical study in my cases--you find that they are either bogus, or laboratory (not clinical), or presented falsely. Consumers who believe these claims generally believe the claims because they believe that claims about the existence of evidence actually constitute evidence, and also that “they wouldn’t let them print it if it wasn’t true” (whoever THEY are). And there’s always the conspiracy belief that Big Pharma doesn’t want you to know about all these miracle drugs. In not a single case that I’ve been involved in or researched have I found that these supplements are efficacious. Which doesn’t mean that some miracle cure isn’t out there, but no evidence is no evidence. QED. (But then, Big Pharma is hiding it, of course.)

    Will chondroitin work for you? I don’t know. I hope it does. I’ll just say again: these are drugs, and they have effects on your body and interactions with other drugs you’re taking. They’re not risk free. You take them at your peril. But if you choose to, it’s your God-given right, and I wish you all the best results in the world.
    belbein

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  21. #18
    plectrist Ryk Loske's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    I now know i am dealing with an attorney .. so i'll be careful.

    "but I simply don't believe that all the best doctors in Massachussets recommend chondroitin. " A careful reading of my post will reveal that that was not what i wrote. The orthopedic specialists WITH WHOM I HAD REFERRALS in Boston and other Boston area hospitals and at the Dartmouth Hitchcock medical center in Hanover, NH all spoke to the efficacy, in most patients, of the use of Chondroitin-Glucosamine and MSM. "We don't know why .... THERE's no Proof that will allay the concerns of an attorney ... but our patients have had relief through their use." Please accept that the is not a direct quote but the clear sense of the information conveyed by physicians.

    To tie your knickers in a tighter knot .... those who had patients who had used the non-prescription anti inflammatory Zyflamend were enthusiastic about the response patients had experienced.

    I am done with this thread. If there's anything of aid or interest here for folks dealing with these types of problems i am glad to have been a part of it. I would refer those interested back to re simmers post #6. Should you be a fellow sufferer of Basal Joint Arthritis ... or any other hand problem ... i find his experience to be enlightening and an addition to the research i had done when scared at the thought of surgery.

    Ryk
    mandolin ~ guitar ~ banjo

    "I'm convinced that playing well is not so much a technique as it is a decision. It's a commitment to do the work, strive for concentration, get strategic about advancing by steps, and push patiently forward toward the goal." Dan Crary

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    Registered User Jim Ferguson's Avatar
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    Default Re: Basal Thumb Arthritis Surgery options for Mandolin Players

    WaltzingM.......I recommend:
    CAUTION when trying to relate many of the above comments to your own situation.......some of the comments above sound similar to your diagnosis but at least one comment sounded like "game keepers thumb" aka ulnar collateral ligament tear of the thumb.........you don't want to be basing any decisions on our offerings on this site as it really is only our best opinion or guess & is NOT BASED on all the facts plus we are not your medical provider...:-) obviously ponder the advice but......Get a 2nd opinion from another hand specialist & make a decision based on the best medical advice available to you.
    Hope all goes well.
    Peace,
    Jim Ferguson

    Kentucky KM1000

    ~Give Blood-Play Hockey

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