Neck - trapezius tension ... wrist induced?

[Odd Socks]

Hi all,

I'm 48. I get chronic tension on the right side of my neck and right upper trapezius area causing headaches. It occurs almost immediately on performing a radial deviation - type movement (right-to-left) lateral movement of my right wrist with a mouse or, more severely, when playing guitar (during the up-picking action). I don't think it's a guitar technique problem as I've been checked by a guitar teacher, and have tried following 'The Principles of Correct Guitar Practice' book which focuses on posture and relaxation.

Radial deviation with my right wrist (it's fine with left) is extremely stiff unless I effectively push my arm towards the hand as I perform it - the tension induced is then less severe. However, if I hold the elbow position fixed in space when performing it (which is necessary to play the guitar as intended), I feel a pulling sensation on the right side of my palm and right underside of my wrist. This provokes tension very quickly and the right side of my neck will be so tense it feels like tense elastic stretched down to my shoulders and even resists turning my head to some extent. The sudden headache will cause me to feel the need to sleep immediately.

I've seen an osteopath twice, but she only offered hope of remedial treatment for tension, telling me to give up the guitar. But since I can reproduce the tension without a guitar (simply doing a radial deviation and not allowing my arm to move towards the hand) and I noticed the problem the first time I picked up a guitar aged 14, it seems there's another issue to be addressed (+ I want to play the guitar). She thought I might have a shortening of tendons (I did fracture my right thumb at the base, at around age 12, and radial deviation was then tender and I avoided it for some time).

I had managed to play guitar (badly) for years by pressing my forearm on the body of the guitar (unconsciously), which seemed to isolate the right shoulder/neck area to some extent from tension when using the wrist (badly - because of the stiffness when the arm isn't free to assist the radial deviation).

To complicate things, I've recently attempted playing from the elbow without a wrist action - which is actually the first stage of right arm practice from 'The Principles of Correct Guitar Practice'. But even these exercises performed in slow motion with constant monitoring of neck and trapezius tension still leave me with extreme neck tension on the right side for a few days afterwards; although, it'd be much worse and last at least a week if I was using the wrist as well.

Any theories, suggestions e.g. nerve/tendon glide exercises... cut my s*dding arm off etc.? I'm in S.E. UK Btw.

Thanks

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[Odd Socks]

Er...well that's helpful!

Is this a stupid/unanswerable question? Or too much of a conundrum? Anything?

[karen.hankey]

It sounds like a neural problem to me, but is very hard to say without seeing you. I would not suggest any exercises to treat this on here. I would suggest that you go and see a manual physio. You need to work out where the nerve is trapped before you can start to treat it

[Yarok]

hi

is tender the area where 1st and 2nd metacarpal joint togather, if yas do some pressing/massaging it.

thanks

[Odd Socks]

Karen

OK, yes, I think I will see a physio. I have been doing the "Nerve Gliding Exercises" here, a few times:

http://www.dallashandrehabilitation..../exercises.htm

Are these sort of things likely to do damage?

Yarok, no tenderness.

[alophysio]

Hi - a very interesting problem indeed.

As above, the problem seems to be a nerve sliding issue - not very good advice to tell someone to give up guitar now is it?? Kinda like telling Tiger Woods he shouldn't play golf anymore!

Be careful with doing exercises without having someone supervise you. Nerves are delicate things. They don't take much abuse before they get damage then take ages to settle - as you have found out!

I would try to do the radial deviation thing but without going so far as to trigger off the tension and pain. Rather, just start doing gentle movements within a pain and tension free range.

Having the problem start at the age of 14 leads me to think that you have a growth spurt at this age (or developed gangly arms as boys of this age are wont to do!). You then probably set up a recurring irritation of the nerve that simply hasn't settled.

I would also think that your cervical stability needs work.

Find a good physio who won't stick you on machines - you need a manual therapist (manipulative therapist) - check with the Chartered society of Physiotherapists for a post-grad trained manipulative physiotherapist. This way you can be sure they might have a clue - otherwise there are plenty of good physios without this qualification!

Good luck!

[Odd Socks]

... - not very good advice to tell someone to give up guitar now is it?? Kinda like telling Tiger Woods he shouldn't play golf anymore!

Quite right! Glad to see someone's recognised the true significance to the world of my guitar playing.

I will go see a physio.

Thanks for the advice.

[Odd Socks]

I've just noticed something about my wrist.

If I passively extend the wrist (bend back of hand closer to back of forearm using other hand), then pull the wrist into radial deviation (as far as it can at that extension), then reduce the amount of extension while maintaining maximum radial deviation, I'll get to about 30 degrees of extension whereupon there's pain on the radial side of the wrist that's too much to go any further without reducing the amount of radial deviation. It really feels almost like there's a bone in the wrist in the way. However, if I start off with the wrist in full flexion and place it in radial deviation, I can go all the way to full extension, passing through the same 'region', without a problem.

Is there any danger in gently trying to increase this restricted movement - backtracking when I feel the pain? Trouble is, it really doesn't feel like it wants to go past this point in one direction.

[alophysio]

Sounds very interesting odd socks - i wish all my patients had your inquisitive nature!

Maybe it is a ganglion or a growth on the nerve and the nerve conduction has been altered etc etc. Or it is on the dorsal side so when in extension going into flexion, it blocks the movement but when in flexion going into extension, it is out of the way...

Get an ultrasound of the area to make sure...

Good observation though - makes me think it is more local in the wrist...

[Odd Socks]

Hello again....

I've now seen a physio 4 times. Not sure we've found root of problem - things aren't really any better yet. FWIW (if anyone's interested) she concluded:

1. Bad neck posture i.e. head and neck too far forward could be contributing. Told me to tuck chin in and pull neck back. Gave some exercises e.g. sitting back to wall, and moving back of head up wall.

2. Median nerve a bit constricted; gave nerve glide: palm flat on wall to the side at shoulder height and rotate backwards until fingers pointing down. (Can do that now).

3. Pain in wrist probably rough bones rubbing after a fracture at base of thumb. Applied some ultrasound, and recommended rubbing and manipulation to free up.

4. Root of problem likely the shortening of soft tissue on ulna side of hand and wrist; neck tension being caused by controlling this. Recommended stretching wrist in radial deviation.

So...

Q: Based on her hypothesis that basically the soft tissues on the ulna side are behaving like a piece of string going up the outside that's too short and pulling my elbow straight as I do radial deviation, what's the best way of stretching this? Specifically, what's the most intensive stretching I can safely do? E.g. hold it in radial deviation (active or passive?) for how long, how many reps at a time, and per day? But could I strap it up, and leave it in full radial deviation for a whole day at a time/over night? Note: range of movement isn't actually restricted neither is it painful in pure radial deviation, it's just pulls more against this movement.