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Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912422 11/15/19 01:11 PM
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Re: NEED HELP. My finger's fallen, and it can't get up [Re: chopin_r_us] #2912434 11/15/19 02:00 PM
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Originally Posted by chopin_r_us
Are you aware you fit the classic 'dystonic' type? Shouting it, in fact, all over this thread!

A) Thanks for the input. I'd say that after enough years of evaluative experience, most practitioners learn not to get bit by the shark of believing that a diagnosis was "shouting" its obviousness after merely an anecdotal description which doesn't even include other medical factors, or a physical assessment. Too many a time, such a preliminary educated guess turns out to be way off base. Even "if" a focal dystonia were a contributing factor in my case, I definitely would not be one to call it classic, since it presents in no 'classic' typical manner as most cases of dystonia. [See item "B" below.]

B) While I have not crossed dystonia or any other neuropathologies off of the possibilities list, the problem with an assessment of a dystonia is that dystonia typically tends to be a contraction disorder, which is the literal opposite of paresis or atony which are indicative of lack of ability to fully contract, as in my case. There has not been any indication in my case of any antagonist muscle group anomaly. Said more succinctly, pianist dystonia tends to be fingers curling under from the flexors contracting, whereas my condition appears to be from the opposite muscle - the extensor - not contracting to raise the finger.

But again, I'll keep your theory on my list. Now that I am restarting this process to try to resolve this issue (after somewhat giving up on it for a year or two), I'll hopefully have more answers as this moves forward.

Thanks.

Last edited by johnishere; 11/15/19 02:01 PM.
Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912442 11/15/19 02:26 PM
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Originally Posted by johnishere
Originally Posted by Jethro
Hi Johnishere,
These kind of problems can be result in these types of medical wild goose chases. They are looking at the level of the musculoskeletal system- the fascia, adhesions, joint mobility, etc.- possibly in all the wrong places. I'm assuming you don't have numbness or tingling (paresthesias) shooting down your arm or would have reported that by now. So I think it's coming from a peripheral nerve.

You most likely have posterior interosseous nerve entrapment.

Perhaps a branch of the posterior interosseous nerve is involved in your case only. Normal treatment is too rest, wear a brace, perform radial nerve glides, and in some cases inject cortisone proximal to the supinator muscle. Yours may be long term and might have caused permanent nerve damage (not serious overall but affecting your piano playing). Perhaps the EMG missed this.


Thank you a million times for your time and insights, those are excellent assessments.
I have a question for you at the end of this post. I'm posting the next few paragraphs for posterity, but you can skip to the question at the end if you like.
-----------------------------------------------------------------

1) You're correct, Jethro - no numbness/tingling or any other indication of total nerve compromise.

2) Correct again, that very often a practitioner is looking superficially. Albeit, the human body is a fantastically complex machine - so I can cut 'some' slack in 'some' cases to a practitioner who is trying to figure out what the heck is going on. (I do tend to be, however, somewhat critical of western medicine approaches which too often are premised upon 'treat the symptoms', and not enough time spent understanding the 'root cause'.)

3) As you can imagine, I've replayed in my mind the entire time period as far back as an entire year before these symptoms started - analyzing for any clues. The interosseous muscle/nerve complex 'is' on my mental list of potential suspects for the reason that near the time that the symptoms started, I was spending quite a bit of time working on certain passages that involve reasonably wide finger spreads (wide and moving arpeggios). So, yes - you're are on track with that possibility also.

Spending much time working those passages means somewhat significant amounts of time that the interosseous muscles are being worked; that the fingers are continuously spread wide. Trying from memory, I wasn't able to recall that I had any particular fatigue from that specific work (I'm pretty certain that there wasn't any fatigue) - but, 'no presence of fatigue' doesn't rule out the possibility.

4) I agree that the EMG may have missed something. I've always had a low confidence in electro studies for 'this' type of paresis (though they are otherwise generally useful). If the whole of your hand is not moving, logically it would be very easy to assess if there is zero nerve conduction. But, with a slight paresis, or a fine motor control issue, or nerve 'branch' issue - you would need an 'extremely' high-resolution, or 'extremely' narrow-band filter, or 'extremely' precise probe placement to get an accurate assessment. Otherwise, as long as any reasonable amount of conduction is present a practitioner will likely assess the readings as relatively normal nerve conduction.

5) Lastly, I am sad-nervous that after this much time has passed (4 years now) without any change, that this may be a permanent affliction; that there may have been permanent damage. I did include neural glides (r,u & m just to be complete), along with (in progressive order):

a) cold/heat
b) massage
c) physical therapy (stretching, exercises, neural glides, etc.)
d) 3rd finger splint with 10 - 20 degree positive deflection (for stretching purposes to reduce the antagonist tension of the flexors, and to traction the extensor)
e) accupressure
f) myofascial release
g) active release*
h) IASTM (Graston)*
i) Most aggresive of all: Jedi mind meditation to gain Jedi control of the finger. (or let's just call it "meditation"; mind-body connection exercises.
[Coincidentally, I also ran a course of prednisone during this time period (asthma), which would've helped at least somewhat to determine if there was any hand improvement from the reduction of systemic inflammation, 'if' any was present. There was no perceptible improvement with the finger.]
[* Note: Due to the extremely intricate layout of the forearm musclulature, it is very difficult (in some regards not possible) to fully manipulate individual muscles/tendons.]
---------------------------------------------------------------

QUESTION: Jethro, you sound like you may have some clinical experience. As rare as this may be, have you ever run across a situation of "short-circuited" nerve conduction? (I believe I recall running across that scenario in the textbooks way back when, but I personally have not ever come across an actual case of this.) As mentioned in one of my previous posts, this would be a situation of an adhesion within the muscle or fascia which short-circuits the nerve conduction. This short-circuiting could either a) cause nerve signals to go to an adjacent muscle or muscle area, b) could shunt the intended muscle target (cause it to not activate), c) or both.

Here's the back history: The way that my condition manifested firstly, I was noticing that my 4th finger was raising pretty high as I pressed down my 3rd finger on a certain passage (of arpeggios). I've always had excellent finger independence, so I figured I had just gotten into a bad habit of some sort over time without realizing it. Figured I just needed to "focus" and practice better. However, from the first time I noticed that anomaly, it was over the course of about the next 4 months that the 3rd finger slowly got to the point of full compromise where it still is today - and it was then obvious that the 3rd finger extensor paresis was the main problem, not 'bad technique'.

BUT, I wouldn't confidently make that a conclusively assessment, because as it turns out "anytime" you strain to lift one of your fingers, the adjacent fingers may engage (raise up)/overcompensate [the whole sensorimotor/biofeedback mechanism].
[I eventually realized that my 2nd finger was also raising too high (when playing passages in the other direction) because it was also overcompensating and raising too high when the 3rd finger wouldn't raise.]

Determination of short-circuiting:
Initially this seemed at least somewhat as a plausible, though exotic, possibility. But, due to the fact that the 2nd finger 'also' (just like the 4th finger) exhibits the same sensorimotor peripheral finger activation when the 3rd finger won't raise , I am ranking this possibility as "low" on the list of likely causes.

Thanks a million again for your time and input.

Yes you were on the right track and treatments with a lot of things I would have tried. My only question would be did they address the supinator muscle which is at the proximal aspect of the forearm. Soft tissue mobilization there, neural glides, cortisone injections or even surgery at times is tried to either bring down inflammation and/or release the entrapment.

As for adhesions causing short circuits, I've not heard of that before and I couldn't explain the physiology of why that would happen. I can see how adhesions could slow nerve conduction velocity much as if a piece of furniture was pinching a phone cord would impede the signal but cross talk (short circuit) is something different. It usually implies damage to the axon or competing signals in the central nervous system such as with epilepsy. For example in multiple sclerosis there are plaques that impede the signal down the nerve cell's axon. In a healthy nerve cell the nerve signal is accelerated down the axon by a physiological event called saltatory conduction whereby the electrical signal "skips" down the the axon along something like switch stations called "nodes of ranvier". This conduction is interrupted when plaque damages the myelin (fatty) sheaths that cover the axon and the signal is impeded or slowed. In epilepsy there is cross talk or competing signals sometimes between the left and right sides of the brain and the only way to sometimes stop this short circuit is to do a commissurotomy basically splitting the left and right side of the brain in extreme cases.

As for the loss of independence of the fingers, I think you are indeed utilizing overflow by activating the 2nd and 4th fingers to compensate for a possible signal loss to the 3rd finger. Overflow happens when you try to engage muscles that share the same nerve enervation. In this case fingers 2 and 4 are over excited because they share the same muscle group and enervation by the posterior interrosseous nerve,

Last edited by Jethro; 11/15/19 02:30 PM.

Working on:

Bach/Busoni Chaconne in D minor BWV 1004
Chopin: G Minor Ballade
Schumann/Liszt Widmung

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Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912450 11/15/19 02:47 PM
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If you do want to consult a Taubman teacher, the place to go is the Golandsky Institute. They can do online consultation, I believe, if there isn't a teacher in your area. They've had a lot of success with dystonias and other injuries.


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Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912477 11/15/19 03:58 PM
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I'm just saying how well your character fits the profile of a dystonia prone individual. That's what shouts out.

Re: NEED HELP. My finger's fallen, and it can't get up [Re: Jethro] #2912480 11/15/19 04:18 PM
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Originally Posted by Jethro

My only question would be did they address the supinator muscle which is at the proximal aspect of the forearm. Soft tissue mobilization there, neural glides, cortisone injections or even surgery at times is tried to either bring down inflammation and/or release the entrapment.

Yep, did quite a bit or work on both ends of the arm: fingers to elbow. This was for the obvious reasons, but also because in 2015, about a year after the finger issue began, I was starting to feel a very minor amount of lateral epicondylitis (tennis elbow). This is believed to be from working out, and it later became bilateral (in the left arm also) [those symptoms are gone now], along also with some tendonitis/tendonosis at the quadriceps (patella) a few months after that [I was 49 years old at that point, so those minor ailments alone aren't highly suspicious. But of course I made note of them for possible correlation.]

Since it was at least possible that there may have been some correlation between those two issues, I spent a good amount of focus on trying to :

a) 'Dig in' to get some manipulation/separation between all of the extensors, the supinator, pronator. Get those things moved around to make sure there were no trapped nerves in between the many muscles of the forearm, or irritated nerve pathways.

b) Some focus on active release to try to manipulate the tendon sheaths in case there were any adhesions there.

c) Work done (exercises, ice/heat) to ensure there was no impingement/compromise at the carpal tunnel.

d) Work/massage to the hand to make sure the interossei (both palmar and dorsal) and everything else wasn't getting 'stuck' together in some way, or being compromised there. [The interossei do act on the finger flexion/extension in a complex kinda way, so anything's possible as a cause.]
Also hand stretching and massage to make sure that the palmar fascia is loose and pliable - and not pulling against finger extension efforts.

Last edited by johnishere; 11/15/19 04:21 PM.
Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912488 11/15/19 04:32 PM
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If possible, I'd think it be interesting to see a video of you playing a scale or anything you've described. That's usually more telling than verbal descriptions.

Just based on the entire discussion so far, you've pursued most options short of surgery, localized cortisone, and (retraining using alternate strategies), and you haven't seen any noticeable results. Did any of the clinicians you've seen actually give a diagnosis or why they ruled things out? I'm just a bit surprised that you've run that gamut and none of them pursued dorsal interosseus nerve entrapment more.

But at the end of the day, what outcomes are you exactly hoping for? What do you consider to be your last shot? Would opening up the arm really be worth it just for a diagnosis if there were alternatives that solved or at least worked around the problem by minimizing the need for the extensors, even if you never got a clear answer about what was going on?

I'm actually now more curious about your training history, which you haven't really discussed. Were you trained/taught to use the extensors to lift the fingers like what's described in Hanon or even tabletop independence exercises?

Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912515 11/15/19 05:24 PM
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Originally Posted by johnishere
Originally Posted by Jethro

My only question would be did they address the supinator muscle which is at the proximal aspect of the forearm. Soft tissue mobilization there, neural glides, cortisone injections or even surgery at times is tried to either bring down inflammation and/or release the entrapment.

Yep, did quite a bit or work on both ends of the arm: fingers to elbow. This was for the obvious reasons, but also because in 2015, about a year after the finger issue began, I was starting to feel a very minor amount of lateral epicondylitis (tennis elbow). This is believed to be from working out, and it later became bilateral (in the left arm also) [those symptoms are gone now], along also with some tendonitis/tendonosis at the quadriceps (patella) a few months after that [I was 49 years old at that point, so those minor ailments alone aren't highly suspicious. But of course I made note of them for possible correlation.]

Since it was at least possible that there may have been some correlation between those two issues, I spent a good amount of focus on trying to :

a) 'Dig in' to get some manipulation/separation between all of the extensors, the supinator, pronator. Get those things moved around to make sure there were no trapped nerves in between the many muscles of the forearm, or irritated nerve pathways.

b) Some focus on active release to try to manipulate the tendon sheaths in case there were any adhesions there.

c) Work done (exercises, ice/heat) to ensure there was no impingement/compromise at the carpal tunnel.

d) Work/massage to the hand to make sure the interossei (both palmar and dorsal) and everything else wasn't getting 'stuck' together in some way, or being compromised there. [The interossei do act on the finger flexion/extension in a complex kinda way, so anything's possible as a cause.]
Also hand stretching and massage to make sure that the palmar fascia is loose and pliable - and not pulling against finger extension efforts.

You've done pretty much all the conservative treatments available. There are more invasive approaches but they are not 100% sure this is due to nerve entrapment. A cortisone injection may help but that's a typical fall back when we don't know exactly what's going on, but the treatments tell me they are on the same page. I'm still leaning heavily towards PIN entrapment though and all those techniques may not fully address the situation. Have you tried rest or have you been practicing all throughout this ordeal?


Working on:

Bach/Busoni Chaconne in D minor BWV 1004
Chopin: G Minor Ballade
Schumann/Liszt Widmung

Shigeru Kawai SK2
Kawai VPC-1
Re: NEED HELP. My finger's fallen, and it can't get up [Re: anamnesis] #2912540 11/15/19 06:19 PM
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Originally Posted by anamnesis
Just based on the entire discussion so far, you've pursued most options short of surgery, localized cortisone, and (retraining using alternate strategies), and you haven't seen any noticeable results.

Correct, no noticeable results.

Originally Posted by anamnesis

But at the end of the day, what outcomes are you exactly hoping for?

Just a normal (or close to normal) working finger. When a normal person puts his hand on the piano, presses finger 1 while simultaneously raising finger 3 to play a note with that finger, the finger normally does exactly that: it simply raises up to press the key. Mine doesn't, or does so only with strained effort, which distorts the other fingers away from a usable technique. Raising your finger is nothing complicated; no special technique require nor modification required, since this is a 'built-in app' for humans. You're born, and your fingers are able to raise in coordination with the other fingers. It's so easy even a caveman could do it.... And did, as of a few million years ago.

Originally Posted by anamnesis

What do you consider to be your last shot?

Without at least some indication pointing in a specific direction (like if there were tingling, numbness - that would 'at least' give a "some idea" specifically - a better than "experimental" chance at identifying a specific condition). Once I narrow it down, or it gets worse which 'might' make it easier to know what's happening - of what's 'not' happening. As of this day, there's not enough info to reasonably consider opening up the arm.

Originally Posted by anamnesis
Would opening up the arm really be worth it just for a diagnosis if there were alternatives that solved or at least worked around the problem by minimizing the need for the extensors, even if you never got a clear answer about what was going on?

I'm actually now more curious about your training history, which you haven't really discussed. Were you trained/taught to use the extensors to lift the fingers like what's described in Hanon or even tabletop independence exercises?

Same answer as above: This is not a "technique modification" issue; can't get the finger above the keys (or into position) without straining. Maybe 'after' if the finger starts working again,I'd look at if there has been something deleterious in my technique to prevent this from happening again. But, as I said in an earlier post: I've played for 37 years with no issues to speak of before this started 4 years ago.

FUNNY BUT TRUE (and a perfect example of what I'm talking about):

With all of my explaining about "wide arpeggios", I was inspired to revisit what I've been describing here - so I sat down at the piano (I do so only occasionally nowadays). Guess how much playing it took before my problem to become apparent: Zero seconds. Here's how:

The only composition with any wide hand positions that I had been playing around the time that this all started is Jeux d'eau (Ravel). There's a specific passage (the cascade somewhere around measure 12 or 14 I believe) with some wide-arpeggios wherein the very first 3 notes encompass one full octave: D(6) - A - D(7) (then A(7) Fingering is 1-2-3-5). In order to play that passage relatively quickly, as soon as you place your hand on the keyboard, fingers just brushing against the top of the keys.... before you even play the first note your 3rd finger needs to be floating just above the keys and slightly moved off axis and ready to point toward D(7). Otherwise, there's no way you can move your entire arm sideways to cover the distance. (It'd be nice if composers wrote everything as c-d-e-f-g-f-e-d-c, but we know that is not the case.)

AS SOON AS I put my hands on the keyboard, with my 1st finger and 2nd finger in place, I had to strain to raise the 3rd finger up and slightly off axis to get it in position 'before' I even played a note. This something that normally happens automatically; your brain just does it.

It's one of those things that is so automatic, that you can't imagine how much you 'can't' do without it. Your flexor and extensor muscles are in such a normal balance, that it generally should not require any effort to simply hold out your fingers as they brush against the top of the keys. My 3rd finger just kind of lays on the key since it is not supporting on its own.

Talk about a pain in the

Yes, I "can" hold out my fingers and get them all level. But, for normal hands, you should not be using much muscle at all to do so. In my case, all my other fingers are in balance and are straight outward without effort just fine. But with the middle finger, it feels like picking up a dumbbell with that finger just to get it up there and keep it there. There's no way you can just 'work around' that.
It just ain't working right.

Lastly: Yes, if I just lay my hand on the table, don't engage any of the other fingers, and not spread the other fingers, then 'yes' I can raise the finger with pretty much full strength like that.
That is why I have been leaning toward a neuropathological root cause (but still keeping an open mind for other possibilities).


Last edited by johnishere; 11/15/19 06:27 PM.
Re: NEED HELP. My finger's fallen, and it can't get up [Re: anamnesis] #2912552 11/15/19 06:59 PM
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Originally Posted by anamnesis
Did any of the clinicians you've seen actually give a diagnosis or why they ruled things out? I'm just a bit surprised that you've run that gamut and none of them pursued dorsal interosseus nerve entrapment more.

I didn't want to bias any thought earlier, but I'll mention now. The first hand surgeon consult, with a surgeon who I have no problem with is experience, seemed intelligent, old as dirt and appeared to know his stuff.

HIS GENERAL ASSESSMENT: (Again, to be fair to him: He wasn't attempting to give a guaranteed certain diagnosis just by looking at the outside of the arm and performing a few palpations.)

After a good 30 or 40 minutes of history, and some exercises, etc. it was his belief that the cause might be a . . . stretched tendon (the extensor tendon).

?

He has a lot of years experience, so I can't 100% discount his assessment. But, I'm hard pressed to consummate that conclusion. Especially, considering that I've had no trauma to the fingers, hand wrist or arm to cause such a injury.

I mean, is it possible that over time that the tendon could have elongated itself - maybe possibly due to some sort of biophysiologic changes in the body (that's my theoretical explanation, that's not what he said)?? Well, theoretically I suppose anything is possible.

Now, in fairness me: I don't feel that he was truly too interested in my case. My primary physician sent me to him for the consult, and I get the sense that he kinda felt like "why are you coming to me for this?".
Now, in fairness to him: I do feel he took it seriously and gave his true professional opinion, and "he" was the one who did order the ultrasound for me (a few of months later).
Although, in fairness to me: "I" was the one who asked him for the ultrasound. hahahaha
I had sent him a letter, a laid out the medical justification for ordering an ultrasound. He agreed.


The other docs didn't bail on me, but for the most part all of the other possible diagnoses are still not definitively confirmable, and are all at the mercy of physical therapy - which is what we did (well, more so what "I" did).
If it's nerve entrapment, all can you do is PT... and see if it gets better. You still won't know for sure if that's what is was. (Unless you 'only' did exercises geared toward 'that' issue.)
If it's adhesions, all can you do is PT... and see if it gets better. You still won't know for sure if that's what is was. (Unless you 'only' did exercises geared toward 'that' issue.)
If it's carpal tunnel, all can you do is PT... and see if it gets better. You still won't know for sure if that's what is was. (Unless you 'only' did exercises geared toward 'that' issue.)
You get the idea.

If we had the ultrasound and saw lesions or carpal tunnel thickening (retinaculum), that would be different. But, nothing on the ultrsound or the EMG.

So, the likely outcome is that I'll do a complete PT and rehab program, I should be able to get it at least a little better, and will possibly never know exactly which of the things I did contributed most to fixing it.

Last edited by johnishere; 11/15/19 06:59 PM.
Re: NEED HELP. My finger's fallen, and it can't get up [Re: Jethro] #2912555 11/15/19 07:05 PM
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Originally Posted by Jethro
Have you tried rest or have you been practicing all throughout this ordeal?

It was difficult to do so at first, but eventually I gave up on it altogether; so I've gone as long as 9 or 10 months without sitting down at the piano (and even then not for very long).

(Well, good news is that at least I can say that it hasn't really gotten any worse since the initial onset.)

Last edited by johnishere; 11/15/19 07:13 PM.
Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912697 11/16/19 08:13 AM
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Time to take up the violin.

Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2912742 11/16/19 10:48 AM
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Originally Posted by johnishere
Originally Posted by Jethro
Have you tried rest or have you been practicing all throughout this ordeal?

It was difficult to do so at first, but eventually I gave up on it altogether; so I've gone as long as 9 or 10 months without sitting down at the piano (and even then not for very long).

(Well, good news is that at least I can say that it hasn't really gotten any worse since the initial onset.)

Ok your issue is now officially driving me crazy. There IS answer to this but I don't think I have a clear picture of what you are experiencing though in my mind- though I thought I did.

I understand you are having a hard time lifting your right middle finger when all your fingers are extended (in a relaxed position) and laying on the keyboard. The R middle finger droops about 1/2 inch below the other fingers in this position such that you cannot raise the middle finger to hit the black keys and even when you are just playing the white keys the motion is twitchy moving from 4-3-2 or 2-3-4. (Now of course, if your middle finger is already drooping 1/2 inch below the other fingers even off the keyboard this motion is not to be smooth).

So- there are very few reasons this could be happening. The main ones to start with is this a musculoskeletal issue (muscle, tendon, joint capsule) or a nerve issue (signal not being sent to that middle finger) or there can be a physiological issue (such as OA, RA, history of stroke).
So I'm going to ask you several questions to try to clarify things for me- cause I really want to help you out and it pains me that a pianist who has played the piano for 37 years hasn't played for months due to this.

So first any background medical history would help (if you are comfortable to share) that may explain this such as: any history of osteoarthritis in the hand/fingers? any history of rheumatoid arthritis in the fingers? any history of stroke or ANY other neurological condition that you are aware of? Any circulation issues. Have you ever had a history of neck problems? Do you have neck pain now?


Are you on any medications?

Do you have any pain in that right hand?

Tell me how and when this deficit started. Was it suddenly? Did it happen over time? Did you experience pain when you first noticed it? Did have any numbness or tingling when it first appeared? Did you have accident involving that middle finger any time in the past when you were playing sports ie. was it ever badly sprained- even in your youth?

What bothers me the most is that I'm having a hard time understanding what you mean by having bulk strength but not fine motor control. By this do you mean you have strength in your wrist and fingers into extension but there is a lack of strength only in the middle finger?

To help me with this last question I'd like for you to do some manual muscle test on your wrist and each joint of your middle finger. I'm assuming you have full grip strength and that you are right handed? So, when you compare your left grip to your right grip they are about equal or maybe even the right hand being a little stronger? If this all yes then do this:

There are 3 joints in your middle finger, the MCP joint (metacarpophalangeal joint), the PIP (proximal interphalangeal joint), and DIP ( distal interphalangeal joint). All these words do is just tells me which is the knuckle, which is the next closest joint to the knuckle and which is the farthest from the knuckle (ie. distal). I need for you to isolate each one of these joints. But start with the wrist.

With your wrist in neutral (aligned with your forearm) Take your good hand and resist extension of the wrist of the right hand and then compare that test with the left hand. Do they feel about the same?

Now with your wrist in neutral take your good hand and resist motion at the MCP (knuckle) by resisting motion at segment of your finger just distal (towards the finger tip) of the knuckle joint and compare it to your L hand. Do they feel the same?

Finally test the farthest joint (DIP) in extension by resisting extension of the most distal joint in your right middle finger by resisting motion at the fingertip. Compare to the left does it feel the same?

Now check range of motion (AROM) Active range of motion. Can you make a full fist with the hand? When you open the hand with your wrist in neutral are all the fingers in alignment and all fingers fully extended?

Now check range of motion (PROM) passively. And check each finger (2-5) and compare to the left. So what I want to do is check each joint for flexion and extension (MCP, PIP, and DIP- the 3 joints in each finger starting with the knuckle (MCP)). So relax the right hand and with your good hand check the range of motion in each joint with the right hand and fingers always relaxed and take each joint through its range of motion all the way to the end and in each direction. At the end of each range do you feel any pain, any resistance, anything tight or not wanting to go all the way? Do you feel any restrictions in the joint itself- does it feel stiff?

Finally palpate that right middle finger starting from knuckle all the way to finger tip. Press hard everywhere is there any pain where you press?

If you can provide a video of how the right hand moves when its on the keyboard and off the keyboard that would be very helpful. Just open and close each finger independently and together as if you were mimicking a duck bill.

This would give me a clearer indication of what's going on and maybe (not promising) can give you a better advice. I am still leaning towards PIN as it seems to make the most sense, but some of the things you are describing don't make sense to me especially in regards to your individual finger muscle strength when its in certain positions.

But what I also want you to do is to seek out the best "CERTIFIED" hand therapist in your region and get their advice.




Last edited by Jethro; 11/16/19 10:55 AM.

Working on:

Bach/Busoni Chaconne in D minor BWV 1004
Chopin: G Minor Ballade
Schumann/Liszt Widmung

Shigeru Kawai SK2
Kawai VPC-1
Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2913020 11/17/19 02:45 AM
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Iaroslav Vasiliev Offline
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Originally Posted by johnishere
Originally Posted by anamnesis
Did any of the clinicians you've seen actually give a diagnosis or why they ruled things out? I'm just a bit surprised that you've run that gamut and none of them pursued dorsal interosseus nerve entrapment more.

I didn't want to bias any thought earlier, but I'll mention now. The first hand surgeon consult, with a surgeon who I have no problem with is experience, seemed intelligent, old as dirt and appeared to know his stuff.

HIS GENERAL ASSESSMENT: (Again, to be fair to him: He wasn't attempting to give a guaranteed certain diagnosis just by looking at the outside of the arm and performing a few palpations.)

After a good 30 or 40 minutes of history, and some exercises, etc. it was his belief that the cause might be a . . . stretched tendon (the extensor tendon).

It seems a good guess, and what is more important, it may be that the shortening of the tendon can fix your problem whatever the cause is. But certainly you need to consult with other specialists before making decision.

Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2913029 11/17/19 05:05 AM
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johnstaf Offline
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Would a compression sleeve help a stretched tendon if it wasn't too badly damaged?

Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2913087 11/17/19 10:09 AM
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Jethro Offline
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A stretched tendon would make sense if it happened over time or if there was a previous history on injury but it seems a logical scenario but not necessarily in this case. That why it would be nice to know his strength in each joint.


Working on:

Bach/Busoni Chaconne in D minor BWV 1004
Chopin: G Minor Ballade
Schumann/Liszt Widmung

Shigeru Kawai SK2
Kawai VPC-1
Re: NEED HELP. My finger's fallen, and it can't get up [Re: johnishere] #2928127 12/30/19 02:51 AM
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Iaroslav Vasiliev Offline
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Take a look at this:
https://en.wikipedia.org/wiki/Focal_dystonia

It seems to match your condition.

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