BY LUGA PODESTA, M.D.
As we all know, drumming can take its toll on hands, especially if you are a hand percussionist. Over the past few months, I have had an increasing number of drummers consult me for an evaluation of their hands and fingers due to pain. Repetitive gripping or striking a drum with the hands can lead to a number of injuries to the fingers, joints, tendons, and muscles within the hand. Drummers and hand percussionists can develop pain in the palm of their hands or within their fingers, which can be debilitating.
The position with which we hold our sticks, traditional grip versus match grip, can also predispose us to stress across the joints and tendons of the fingers, which can lead to pain, tendonitis, joint capsule laxity, and eventually arthritis. The most common portion of the hand affected is the basal joint of the thumb. When pain becomes severe and there is limited range of motion of the thumb, or pain at the base of the thumb with associated swelling, there is significant risk of developing basal joint arthritis, or arthritis in the metacarpal phalangeal joint of the thumb, which can be quite debilitating. Unfortunately, to grip a stick effectively, either with a match grip or with a traditional grip, stress is applied across the base of the thumb, causing pain. Basal joint arthritis can occur as a result of wear and tear on the joint surface and 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. Most patients with these injuries complain of pain at the lower base of the thumb and have difficulty pinching with the thumb and index finger and grasping and twisting objects with the thumb. Most severe cases will result in swelling and pain, becoming unbearable, causing the drummer to drop objects, including sticks if he or she is not able to grip effectively. When the pain becomes more severe, swelling can occur, restricting thumb motion. When this develops in a drummer, it should not be ignored and requires quick evaluation to prevent further deterioration of the joints and hand. Diagnostically, x-rays are the hallmark of the evaluation process.
Treatment will depend on the severity of the symptoms, as well as the clinical impairment that these symptoms can lead too. Once the diagnosis is made, we begin with nonsurgical treatment, including anti-inflammatory medications, ice, bracing, occupational therapy, and possibly injections with corticosteroid medications. However, when pain becomes very severe or does not respond to conservative measures, surgical treatment may become necessary.
As musicians, we rely on our hands to perform, so it is imperative that we care for them and treat even the most minor of injuries aggressively. When a problem develops or is identified, quick effective evaluation and treatment can help minimize the lasting effects of these injuries.