Drumming can take its toll on hands, especially the thumbs. Recently a number of drummers have asked me to evaluate their left hands for pain at the base of the thumb that was limiting their ability to grip the stick. The patients had two things in common: 1) They all played predominantly with a traditional grip and 2) their pain was localized in the joint at the base of the thumb, commonly referred to as the basal joint or CMC (carpometacarpal) joint.
The basal joint allows for the swivel and pivoting motions of the thumb. Because of its design, it tends to wear out and develop arthritis early in life. To hold a stick effectively, either with a matched or a traditional grip, significant stress is applied across the base of the thumb. The position of the joint when the stress is applied may lead to increased torques and pressures predisposing the basal joint to articular-cartilage injury and early onset of arthritis. Playing with a traditional grip can apply even greater shear and rotational stress across the base of the thumb resulting in premature arthritic changes in the joint. Basal joint arthritis is most likely to occur at a younger age if a fracture or an injury to the thumb has previously occurred. Repeated gripping and twisting of the thumb as seen with drumming can also worsen early arthritis in the thumb, allowing it to progress more rapidly than would normally be expected.
Pain at the base of the thumb is usually the first sign of injury. Trouble pinching a stick between the thumb and index finger or difficulty with grasping, twisting, or leveraging the stick with the thumb can also commonly occur. Most severe cases will result in swelling and pain at the base of the thumb, which can become unbearable, causing the drummer to drop objects, including the stick if unable to grip effectively. When the pain becomes more severe, swelling can occur, restricting thumb motion. These signs and symptoms in a drummer’s hand should not be ignored and require quick evaluation to prevent further deterioration and disability. Simple X-rays of the hand and thumb can easily help make the diagnosis.
Treatment depends on the severity of the symptoms, in addition to the clinical impairment that is occurring at the time of diagnosis. Once the diagnosis is made, non-surgical treatments include anti-inflammatory medications, topical anti-inflammatory/analgesic medications, ice application, bracing, occupational therapy, orthobiologic treatments with PRP (platelet rich plasma), or corticosteroid injections. However, when pain becomes severe or does not respond to conservative measures, surgical treatment may become necessary.
As drummers we rely on our hands to perform, therefore it is imperative that we care for our hands and treat even the most minor of injuries aggressively. Early evaluation and effective treatment can minimize the lasting affects of these debilitating injuries.