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Just to reiterate what others have said, please refrain from diagnosing yourself.

I would find either an orthopedist who specializes in the hand or a neurologist with neuromuscular training. This is one of those things that overlaps a couple of different medial areas, so it may take a bit of research to find the right person.

My guess is that you'll get some kind of EMG testing along with a complete history and physical to help rule out other things. You'd be amazed at how many little things, some serious, some not, can cause neuromuscular problems. Everybody tends to self-diagnose Focal Dystonia and Carpal Tunnel rather quickly because they're well-known in the musical community, but there are lots of other things out there. (My wife works in neuromuscular medicine, and there are a lot of things that have very similar symptoms or unusual presentations.)


"If we continually try to force a child to do what he is afraid to do, he will become more timid, and will use his brains and energy, not to explore the unknown, but to find ways to avoid the pressures we put on him." (John Holt)

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NikkiPiano,
since you seem to live in Britain, you might find some help here
They specialize in performing arts medicine.
Good luck and speedy recovery!


"The creative process is nothing but a series of crises."
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Hi Nikki,

Sorry to hear about your issue. Not to take away from the good advice already posted, especially the caution to seek the opinion of a professional, but I found a short article online which touches on the subject with some interesting insights. You can read it here:

https://www.scientificamerican.com/...ddenly-develop-yips-choke-under-pressure

Best of luck in your recovery!


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Wow, you guys are insanely helpful. I didn't expect so much wonderful advice. I'm looking at all the options.

I saw my GP who said would refer me to anyone of my choosing. She's aware of focal dystonia, but wasn't quite sure who to refer me to other than a hand surgeon. There isn't a quick fix and recovery is going to take some time, so I need to think carefully about my next move.

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I was not going to, but I'm now getting my GP to refer me to a hand surgeon or neurologist. Last night, after a few hours practice I started feeling tingling in my 5th finger. That's a new phenomenon. My 5th finger coordination was taking a nose dive at that point, no longer holding any curve, with my finger flat and bending only at the knuckle whilst stabbing at keys. I'd like to rule out any carpal tunnel syndrome or compression of the nerves elsewhere and then take it from there.

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Very glad to hear you are doing this!! Please keep us posted on what happens.


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Hi Nikki,

If you need to go see somebody right away and you can't get to a music med specialist, you could ask to be referred to an occupational or industrial medicine specialist. Typically, they see hundreds of cases of occupational upper extremity injuries and won't think you're crazy. They'll be able to do all the preliminary assessments, and start any immediate first-aid right away. If what you have is an entrapment issue, they'll be able to find that out PDQ. They'll also test you, as Kreisler said, for type II diabetes, and osteoarthritis, and rheumatoid/autoimmune conditions, et cet., just to make sure those things aren't causing your problem.

In the meantime, stop practicing. Seriously. My mom always said, "Does that hurt? Then stop doing it!" So does every doctor and physical therapist I ever met.

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Originally Posted by Praeludium
Hmmm.. I never understood why finger articulation was supposed to be so bad....


Salut Prae!

It's not that finger "articulation" is bad per se. It's the way it's traditionally taught that can cause problems.

I just wrote a digest of Taubman's technical approach for wikipedia. It briefly explains the issue seen from the standpoint of best practice as opposed to injury, but I think you'll understand what Taubman meant. You can find it here:

http://en.wikipedia.org/wiki/Dorothy_Taubman

bon weekend, et a la prochaine!

Last edited by laguna_greg; 04/27/13 08:06 PM. Reason: showing off
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ClasscLib,

Thanks so much for the kind words!

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Could this be caused by lack of independence of the fingers, and then constant usage of those fingers in awkward practicing..the likes of playing pieces or passages over and over instead of picking them apart to attempt to develop independence?? The symptoms that I am seeing from this forum could point to some kind of overuse of the nerve which controls our 3-4-5 fingers when it doesn't develop enough independence between the fingers to handle the rigorous duress of autonomous practicing..? It could be a factor maybe..??

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When it comes to dystonia it's anybody's guess. I've had discussions with some of the top European researchers. They can't point to a cause - not with much confidence anyhow.

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This is not an orthopedic or "neuromuscular" problem. It is a Movement Disorder, which expresses itself by simultaneous contraction of agonist and antagonist muscles, thereby causing distortion of the posture of the hand and fingers. The cause is not known, but there are Movement Disorder specialists in Neurology Departments throughout the world who are expert in treating this condition. Treatment for this condition is very complicated and critical. Not to be tried at home.

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The thought I had was more directed towards the possible avoidance of this terrifying disorder. What causes a movement disorder? Is it possible that through long hours of strain with hands and fingers that are not trained to act independently (and with the common exertion of unnecessary muscle groups in movements that would require less, and which we think would require less but our body cannot keep up)? So we want to move one thing, but muscle memory has developed and causes us to move a whole group? Or that if we even start to think about moving the single unit we want, the whole group tenses up? It's a thought to spur practicing avoidance of this disorder while practicing..
How do we practice? Do we train mastery of the keyboard, or are we trying to work from piece to piece, passage to passage, hurting ourselves in the process?

Last edited by hujidong; 05/02/13 09:54 AM.
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My guess, and it's only that, is that it is indeed the simultaneous contraction of agonist and antagonist muscles that are the problem, but not in an obvious way. My work with sEMG has shown me that the antagonist of the finger flexors, the finger extensors, always contract simultaneous with the flexors, but it's an eccentric contraction - they smooth the movement. Otherwise the fingers would instantly snap curled on command - and what condition does that sound like? The finger extensors are only about 1/10 the strength of the flexors according to Prof Earl Owen. I think that makes them more vulnerable.

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But what I'm talking about here is not about the groups that must work together, but the groups that are pulled into a movement when they shouldn't be. It's a fun thought to humor, that our axon firings are becoming disjunct and confused through bad repetition, and of course unconscious axons are firing to tense the muscle groups that are not necessary. But when we want to lift up our fourth finger, that is the initial action, a conscious thought that fires off axons to the nerve to lift the fourth finger with the usage of the tendon sheaths, which are smooth muscles. If the axon is not well developed enough, other muscle groups would unconsciously kick in. And so we develop a habit of unconsciously starting a whole bunch of chains when we really only want one. Then could whatever possible muddling of nerves and energy and muscle contribute to this disorder? Would it be possible that smooth muscles rely on unconscious axon firing to keep the movement up? It certainly makes sense for our organs, especially ones that also share usage with skeletal muscles. Could it be something like the difference between breathing 'shallowly' and breathing 'deeply'?

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Originally Posted by hujidong
a conscious thought that fires off axons to the nerve to lift the fourth finger with the usage of the tendon sheaths, which are smooth muscles.
Sorry, don't get the above.

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In the hand the third fourth and pinky fingers are controlled by one nerve, but so many different tendon sheaths which control the fingers, under one nerve!

On an interesting side note, I've found that the more I practice the smoother I can very slowly lift a single finger and place it back down.

Last edited by hujidong; 05/02/13 04:28 PM.
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While we do not know the cause, there is reasonably good evidence that the abnormal movements of focal dystonia are mediated by the central nervous system (brain and/or spinal cord) rather than the peripheral nerves. It is similar to "writer's cramp". For many years, many types of dystonia (writer's cramp, torticollis) were thought to be of hysterical origin. That notion has been discredited.
Some have blamed "overuse". It is likely much more complicated; perhaps "overuse" in susceptible individuals.
The good news is that several world-renowned pianists whose right hand had been rendered useless due to dystonia have been able to regain the use of the right hand as a result of expert treatment.

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Hello and sorry to hear about your condition.

One of my former professor taught Taubman Technique. "Rotation is the key" according to the prof. He was a very good friend of Dorothy Taubman, the founder but sadly passed away very recently.

I wondered if contacting Taubman Center was something I can recommend.

Wish you the best.


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That Taubman Technique looks really interesting. I had never come across it before and it seems really high level. But what kind of practice mentality is needed to gain the most from a method such as this? Schubert do you have more to share about this wonderful looking technique? The wiki is a little too vague.

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