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A-1150 Hand surgery in musician patients
Philippe Cuenod, Switzerland
Thursday, June 14, 2018 · 2:25 p.m. · 20m 02s
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so i it is very common to say after such a talk
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i don't know if i'm going to tell something interesting
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it's it's a it's a very impressive and uh i didn't know that uh to play
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the piano we need so many things uh it's already difficult to understand option no
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matter now it's even more complicated so uh i'm going to talk about that in
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surgery problems and musicians both the is not the same as the ones in
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normal population what is the normal population and this morning i show these um
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from this uh drawing famous uh omen cruise has been filled baldwin customers and um
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a a big part of the brain is uh for the control of the okay the hand of the four and
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two of uh this perfect ten scale to play the instruments
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we need an intact motor insensitive function in the
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it has also oh it is also the need for a a sensibility for
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interpretation and of course as soon as some a musician as a problem
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at the hand if there is a high emotional impact in it's it's very interesting
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when we go to the internet because we all go to the internet
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and sometimes we try to find something in it they are blogs of musicians and uh
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they say oh my my doctor told me i have a trigger finger and
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oh it says may it just has a small operation i will fix it
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what is your opinion and all the specialist musicians i oh
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i cannot play hackman enough for a pretty number two twelve i don't know
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see the for the since uh i was operated all the single
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but actually i that's what we we really need to have
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not to be technician talking is it trying to find
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a mechanic away to improve the the people but
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we also have to to talk with these people they
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are high demands patience uh for they hands
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probably much more than a other people are not normal
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people that they always hesitated to undergo surgery
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not only for the hands and of course the the fee off
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put into effect on their livelihood and probably i it's more
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this is a bit astonishing is probably more that
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they they are afraid to lose their job
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then not to be able to continue to play piano or
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the the cello so the the seat information everywhere
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and i think that for that internet and the blogs are not that good so store as this man
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and all with remote to clean room no not j. so that this morning i show uh
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not the eight hundred eighty eight instrument that i found on the on the internet
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but the there is a a basic knowledge that we we need for
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for all of the instruments uh techniques we cannot understand
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why the patient as this ten the nineties
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that we don't see any anything that we don't feel anything that knows really needed if we don't know
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how we place the the t. v. we cannot understand
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why i'm a violin is as a uh
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a very thick skin on the tip of the thing is if we don't know how we place it
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and so it's important to know the the basic interface uh an instrument and then of course we
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we should say the same for any patient we have to examine
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incorrectly but we have to examine in some time with
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the instrument of course it's easier if it's a p. c.
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o. that comes with this uh how many can ah
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uh uh then uh a pianist a concert pianist with is a
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a a big stein way and uh but it's possible
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if it's really important it's possible to observe of the the magician during rehearsal
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before any consideration surgery if it's an important surgery
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and we have always to bury my him in mind the the possible uh
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saving sparing function if we operate a patient and there is a
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problem or it could be a problem we have to thing
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yes you need this function if there is a program what should i do now
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either to prevent it ought to be able to make a salvage press you do that it's read it
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easy so that the surgical indication must be absolutely clear
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confirm but appropriate diagnoses that is and here comes a
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little grace though because if you have a uh
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violinist who has a a sided pain
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is fifty five year old and you asked for a
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a and m. or i or a outer email
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right you will certainly find a a hole or a
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problem of a. t. c. c. should we
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we have the proof that he he uh spain here is
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that it's it appropriate diagnostic study but is it really
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a a problem of the c. f. t. c. or is it merely a a chronically jen that could
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uh between should buy a an injection and um of course the known operative
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a treatment is the the the gold standard up to the the
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time it's not possible to do anything else we have always to know that
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or surgery even the best surgery can just change little degrees in little
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um position of of of tendons and think is that
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changes the perception of the musician is been playing during forty
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years the channel in uh in such a in a
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way you operate on his trigger finger is a perfect movement but the fact that the the the if
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and um it won probably as being really if changes all its
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perception and performance then is a less less good and um
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well as a already it say uh it's um
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we have to take into account all the aspect of the musician and this is
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uh uh a bit the the slides if that is the the other part of the
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the the the musician that uh uh to change their habits or the the
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instruments because they had a problem this is the missions yeah was commissioned yeah was go is uh
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uh um decision from uh you need not and uh it was born
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with uh this i can say this uh well formation and when
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it decided suddenly i'm going to show to everybody that i'm able
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to play an instrument and it's it's become one of
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the best in his feel and uh is really good and
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uh it it's the prove that uh it's possible
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so i like very much this kind of yeah because nobody reads it nobody is
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interested in knowing what it is so i'm going to to try to
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to make it short the hyper mobility syndrome in fact
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is it because there isn't hyper mobility that day
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some people are very good musicians or is it because they play all the
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time and they they make a crazy movement that they become i probably
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anyway it uh it it provokes instability of the joint that can sometimes be a problem
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i have a friend who is a used to be a cello player now is
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the conductor because it broke a finger an is
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no more the the the the good
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a position of the finger and it develop an item uh an instability of the d. i. p.
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joint that on the left side that prevents seem to play the cello correctly i i mean
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they still can play rather well and um this um like city
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uh by can be him but um by chronically coming to stress about
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all for the m. c. p. and the c. m. c. joint
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and it is seeing a mostly uh in string would win
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bus cello and keyboard player that is nearly all the
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the categories of instruments of the okay so it increases the
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this uh increase like c. c. can lead to
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not only to to bad performance but you fatty to spasm and pain so
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the treatment must uh the conservative a stab allies the the joint by
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with strengthening uh exercise is to um
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probably assertive uh control and
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sometimes 'cause make 'em customise us plans
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to prevent wasn't ability that the
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the the patient will will wear when we when it doesn't play
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in the refractory cases surgical stabilisation of envious incisions
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when i read this in the literature and i consider the result of the stabilisation of uh
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of what c. n. c. joined by all these uh tended to an oppressed is
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i'm always concerned that the patient will not be able to play the piano correctly afterwards
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so let's be very careful in the law also also i this is very common of course and uh
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is also common musician because they they start early in age and the finnish sometimes
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that uh when they when they die so uh of course it's not
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mm uh uh surely related to do music it's probably related to to life and that
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there is a a a a certain you're a genetic predisposition like everybody and the
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i'm more i'm more and more the patient can uh get problems too
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if to play because of pain and also bowman in c. and c.
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s. e. t. g. i. p. m. b. which are the the
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most commonly have eighty joint that is nearly all and um
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again conservative uh sprinting infiltration surgery only when there is a failure
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conservative treatment that you know there is an inability to play
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john she join fusion in some cases it's not
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it's something that is too bad because for a uh nobody
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player for instance if he has a p. i. p.
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joint fusion on the force think uh it will continue
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to play quite normally but uh in the other
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you know the cases it's not possible i think that the plan is would uh have a uh um
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swanson after press the or the p. i. p. joint will
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be able to continue the is uh is play
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i my opinion is more than a for a reception
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not oppressing case of c. and c. n.
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c. l. site is because i doubt that the process is is could stand for tennis
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the the sum and a movement eighties i eight hours a day
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well here are some uh some possible uh treatment of course
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uh i'm not sure that the the atrocities of uh this lady is a big problem
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to play the piano because she doesn't uh needed but if you want
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to play the guitar it's going to be more a problem and
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it's not sure that the p. i. p. joint will improve a. b.
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a. p. um after per se will be a good thing
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neural pathways are treated like a a a for anybody
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it it obviously if there is a longstanding problem
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with atrophy nerve conduction studies that are positive
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i see no reason why wait still the patient as a a a a
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waste of imbecile cannot ever correct uh uh the movement i think that
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at least for carpal tunnel syndrome uh it's uh
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i it should be done after the usual a conservative treatment when
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uh they are no problem is too big a we
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recently reviewed all co cases of uh uh no
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and your party at the at the elbow and we found that the best weasels and the last page of
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the best patient satisfaction is when we operate them rather
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early so why make an exception for the the
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the the musician i think that it would maybe be prefer
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a a preferable to do it when they realise after
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and there is no change to the difference uh between turns position and uh
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neural a simple your allies is it's a matter of
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surgical preference this is to illustrate the the uh
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uh no no no have available gangly and every day
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we we have two or three persons complaining
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of uh oh this i i don't i want it to be too will be removed but
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i would say that about eight out of ten are non painful
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and they don't interfere with the the movement except the the the extension in um
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with the um with voice and that the the treatment the standard
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treatment with the inject it aspiration coaches on and um
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uh will normally be a be useful and uh
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explain to the patient what it is it's probably the best treatment but if it's frequent painful
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or a regular and functional impairment it can be
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done but i remember having operated on it
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on a on a violin is on the left wrist of a violent
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nice she took us six months to be able to play normally
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and uh we should not maybe favourite also school pictures section
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did we just contraction there is no reason why the the mission would not have uh the peaches
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conviction but we're not going to wait till they are like this to operate on them
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i think we should start with a small operations a
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needle fashion to me as a tummy collision as
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maybe it mean invasive technique may reserve the fate extensive ejected me
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for the eh the recurrence is or after the carrier it is absolutely
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an unusual to have a good day care well like this in a in a musician
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it's uh let's say uh uh before a they most of them have um
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if tonight is that operate oh but the doctor doesn't see anything is
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a bit like a company yuppie emma was for the the the
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the the um the after knowledge is the trigger finger as
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i say it's should be treated conservatively as long
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as possible like the to give 'em but if we have to operate only care of uh huh
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better to make a plus e. of uh the
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the ligament to prevent any possibility of um
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a supposition of the tenant in particular when the the the
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patients uh option it's a the it's again a a
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those were not here uh this morning and they were wrong um there
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when uh uh we have a patient we're we have to
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take time to explain everything and uh uh for the the
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the fracture we we should uh uh uh the
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apply the the principle of faction management that
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ya the the the the normal ones
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uh we have always to take time to explain things end up um
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it's important that the patient and the same feeling of a
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function uh uh to play otherwise i it may
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it may interfere completely with uh is played and
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of course when you operate we have to uh take care of the the location of
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incisions uh uh avoiding is uh the tip
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of the twelve automatic technique and um
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seven i the fracture to have the pitch and uh starting quickly
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to play like the guitar is and uh it is a little
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plan is with the subject you you tell fracture and
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in slavery nonunion a a standard treatment within it yeah chris craft
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uh with stabilisation should normally treat the patient
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tend to nations uh of course they cannot uh that uh it could not to remain like that they should be repaired
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then the uh with the the replay uh uh we all of our technique we
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have or level own protocols but rehabilitation in this case is is of uh
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of the utmost importance and uh one again we should always anticipate
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if there is a problem if this tendon graft we're not a word what could i do should i
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gravity game make it energies is joined fusion and up
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a bit the the wrist injury is uh
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should be address like any other patient that i would be very
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very very reluctant to aggressive surgery a a patient with
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the ascii for an instability to a certain extent will continue
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to play probably as well i used to play
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but if we make any operation on the race to correct this case
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for an eight a disposition i'm not sure it will be
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a good about all if it is a a guitarist or a um
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a a a violinist and the reputation of course is very
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important is the key of success for many patients
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it must be done by experience uh go feed the therapist in order to be successful
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