The Rhythmic Physician: Don't Cry CTS!
Pain, numbness and weakness in a drummer’s hand or wrist can arise from many different sources. These complaints are most commonly due to carpal tunnel syndrome. However, not all symptoms in the hand are due to this common nerve compression at the wrist.
The ulnar nerve is another nerve that can affect the hand and wrist. It originates in the spinal neck and passes through the arm, forearm, and wrist into the hand. Due to its superficial position at the elbow, it is often injured by excessive pressure either by leaning on the inside part of the elbow or by repetitive bending and straightening of the elbow. A second common area of compression of the ulnar nerve is in the wrist as it passes through a tunnel on the pinky side of the wrist called Guyon’s Canal. Injury can be due to direct repetitive pressure over the palm of the hand (hand percussion) or after a fracture of the wrist. Whether an injury of the ulnar nerve occurs at the elbow or wrist, the results can severely affect your drumming life.
The ulnar nerve functions to provide sensation to the pinky finger and half (pinky side) of the ring finger. It controls most of the small or intrinsic muscles in the hand that provide fine movements, in addition to some of the larger forearm muscles that provide a strong grip. Symptoms of ulnar nerve entrapment or compression frequently begin with a sensation of the hand ring finger and pinky finger “falling asleep,” which worsens when the elbow and/or wrist are bent. Carpal tunnel syndrome has similar symptoms, but involves a different nerve and typically causes numbness and tingling in the thumb, index finger, and middle fingers.
The diagnosis of ulnar nerve compression is suspected when a number of clinical findings are found by your physician, such as a positive Tinel’s sign, an electrical shock sensation over the inside part the elbow (funny bone area) or over the pinky side of the wrist, numbness and tingling in the pinky side of the ring finger, or in the pinky finger with wrist or elbow flexion. However, the definitive diagnosis is made by performing a nerve conduction/electromyography test (NCV/EMG), which is an electrical test to evaluate nerve and muscle function.
Treatment of ulnar nerve injuries begins with identification and elimination of the cause of the injury. Anti-inflammatory medicine can help reduce swelling around the nerve. Therapy with exercises to help the nerve slide through the tunnels can also help to improve symptoms. Bracing to prevent the elbow from bending at night (night extension splints) and an elbow pad worn during the day to minimize direct pressure on the nerve has also been helpful in diminishing symptoms. In severe cases however, surgical treatment to relieve compression from the nerve around the elbow and/or wrist is necessary.
Drummers are not immune to nerve injuries. It is imperative that we take proper precautions such as warming up and cooling down before and after playing, avoiding leaning on the elbow, maintaining an ergonomic setup of our drum kits that limits excessive degrees of elbow flexion for prolonged periods of time. An ounce of prevention is worth a pound of cure.