Playing the clarinet effectively, as any other instrument, requires a heightened use of specific physical attributes not normally used in daily activities. Unfortunately, because we are usually so focused on listening to our sound and playing our best, we often neglect the maintenance and proper care of those same physical attributes we require to perform. As a result, potential damage may be caused over time which can conclude in career de-habilitating injuries. Two of the most common maladies affecting professional clarinetists are tendonitis and carpal tunnel syndrome.
Both tendonitis and carpal tunnel are injuries of the hand and wrist, in severe cases causing playing to be extremely painful or impossible. These disorders are known as Musculoskeletal injuries, or MSI. MSI is primarily caused by continued aggravated practices, rehearsals, or performances where constant pressure and strain are put on the affected muscles, in this case, the wrists and fingers. Musicians are second only to jobs requiring prolonged computer use as the highest risk for MSI. The progression of pain during performance normally begins with irritation after practice, followed by pain during practice, and finally increasing until all aspects of daily life are affected. In severe cases, surgery may be the only course of action in repairing serious damage. Even so, scar tissue may form after surgery, severely limiting performing ability. Fortunately, steps may be taken to reduce the risk of MSI or repair damage if identified early. However, it is necessary to define these disorders to identify their causes and ultimate remedies.
Tendonitis is defined as a disorder in which the tendons become inflamed and irritated for a variety of reasons. A tendon is a flexible, but tough, band of fibrous tissue which connects the muscles to the bones. When muscles contract in daily life, the tendons absorb the force of the muscle contraction to relieve pressure placed on the bone. In clarinet playing, the small tendons in the wrists and fingers serve to relieve the enormous pressure that each finger movement can create after extended playing. When the tendons become inflamed, finger and wrist movement then becomes painful. Thus, tendonitis literally means inflammation of the tendon.
The most common cause of tendonitis is overuse. As musicians advance, the increased level of difficulty forces them to utilize the wrist and finger tendons at a faster pace. The tendons are unaccustomed to operating at the level of demand, and will eventually become inflamed and painful. Age is also a factor in tendonitis and carpal tunnel syndrome. As we get older, the tendons lose their flexibility and ability to stretch as they used to. Individuals are more prone to experience symptoms of tendonitis and carpal tunnel with increasing age. An additional disorder similar to tendonitis named De Quervain’s Syndrome consists of pain in the tendons at the base of the thumb and on the thumb side of the forearm. This makes it extremely painful to twist the wrist or move the thumb away from the hand.
Wrist tendonitis, also called tenosynovitis, is also a common disorder affecting the tendons, particularly the tendons around the wrist joint. In addition to pain around the affected areas, swelling can also occur over the area of inflammation. Similar to De Quervain’s Syndrome, tenosynovitis can affect the tendon at the base of the thumb, causing pain whenever the thumb is moved away from the wrist. Tenosynovitis and De Quervain’s Syndrome are advanced cases of tendonitis, and require the immediate attention of a doctor or physical therapist. Immediate action can also be taken by icing the area with a cold pack, which stimulates blood flow to the inflamed area. Other treatments for mild or early cases of tendonitis are similar with carpal tunnel syndrome; several of which are listed below.
Carpal Tunnel Syndrome is related to tendonitis because they are caused by aggravated pressure in the hands and wrists, but carpal tunnel syndrome has distinct differences from tendonitis or related disorders. The carpel tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand. This surrounds the median nerve, which runs directly from the forearm into the hand. The median nerve controls the receptors to the palm side of the thumb and fingers, which allow the fingers and thumb to move easily and smoothly. Carpal tunnel syndrome occurs when the median nerve is squeezed or pressed at the wrist. Swelling from irritated tendons can also be a factor in the compression of the nerve, such as in a previous injury or trauma. Carpal tunnel syndrome, however, is not caused by tendonitis or vice-versa. They are completely separate disorders and have individual symptoms; however, proper diagnosis from a licensed professional should be sought immediately after experiencing any reoccurring painful sensations in the wrists and hands.
Carpal tunnel syndrome can be caused by a variety of sources, including genetic disposition. The carpal tunnel may simply be smaller in certain individuals, placing them at higher risk. Carpal tunnel syndrome also usually occurs only in adults. Women are also more likely to experience carpal tunnel syndrome than men because the carpel tunnel itself is in most cases smaller than in men. There is no clinical proof that correlates the heavy use of the hands and wrists in playing to carpal tunnel syndrome. These actions usually result in tendonitis or the similar disorders mentioned earlier. However, other causes of carpal tunnel can include prior strain or trauma to the affected areas, fluid retention, joint or mechanical problems in the wrist, work stress, or the development of a cyst or tumor in the carpal tunnel. In some cases, no cause can be identified.
Symptoms of carpal tunnel syndrome usually start gradually in the hand and fingers, including a burning sensation in addition to tingling or numbness in these areas. These symptoms usually appear in one or both hands at night, but can increase during the day with increased discomfort. Decreased grip strength, such as the inability to hold the clarinet, is also a common symptom. Physicians can detect carpal tunnel syndrome in its initial stages, in which several forms of treatment are available.
Treatment for tendonitis, carpal tunnel syndrome, and related disorders can be treated by the individual if discovered early. Of course, preventative measures can be taken to reduce the risk of injury, or further aggravate an existing injury. However, seeking the direction of a medical professional should be considered before any other options. Illustrated below are several techniques to lessen the risk of tendonitis and carpal tunnel syndrome:
Exercise before and after heavy practice is beneficial to maintaining healthy joints and muscles. Taking frequent rest breaks can also serve to relax the tendons and prevent them from becoming inflamed. Remember to keep a natural posture whether playing standing up or sitting down.
– Heat and Ice
Using ice and heat packs are helpful in relaxing and cooling off muscles. These packs can also stimulate blood flow and decrease swelling. It is important to proceed only with a doctor’s recommendation if pain is already constant
Stretching is the primary deterrent to future injuries in the joints. Stretching exercises that are performed constantly before and after practice can serve to effectively prevent injuries caused by overuse and constant pressure on the tendons.
 Musicians and MSI: Symptoms and types of Injuries. Safety and Health in Arts Production and Entertainment (SHAPE), p. 1.
 Your Guide to Orthopedics. Cluett, Jonathan. p. 1.
 Ibid, p. 2.
5] Ibid, p. 3.
 Carpal Tunnel Syndrome. National Institute of Neurological Disorders. p. 1.
 Ibid, p. 2.
 Ibid, p. 2.