Ulnar Tunnel Syndrome In Guitarists: Causes, Treatments And Prevention

A common problem among both acoustic and electric guitarists, as well as other stringed instruments, is the development of forearm pain, tingling, and numbness, commonly on the same side that the instrument is played on. This article will explain a specific type of repetitive injury called cubital tunnel syndrome , which affects the inner side of the forearm and the palm of the hand. Most musicians are probably unfamiliar with this syndrome even though many experience the symptoms.

We will discuss the typical presentation of the syndrome, the anatomical structures involved, along with prevention and treatment options.

Anatomy and Symptoms in Cubital Tunnel Syndrome

Cubital tunnel syndrome typically involves pain and / or abnormal sensations in the elbow area, along the inner side of the forearm . The pain may descend into the little finger and may be accompanied by tingling or numbness in the palm of the hand. The muscles of the forearm can be sore and tendonitis may be misdiagnosed by an inexperienced physician.

This syndrome generally only affects the ring and little fingers , as these fingers receive the nerve supply from the ulnar nerve. Some variations in the nerve supply to the fingers can allow the middle finger to be affected as well.

The ulnar nerve begins from the nerve fibers that come out of the spinal column in the neck, called the cervical spine. The nerve runs through the arm, passing through the “funny bone” area of ​​the elbow, then travels down the outer side of the forearm to the hand muscles along with the fourth and fifth fingers. The purpose of the nerve is to allow communication between the brain and the hand, allowing both motor control of the hand and the sending of sensation from the hand to the brain.

If the syndrome progresses, it can lead to decreased function of the hand, especially grip strength . It is also common to experience tingling and numbness in the fourth and fifth toes. Additionally, there may be wasting or atrophy of the muscle pad on the palm side of the hand below the little finger. Typically, the person notices that flexing the forearm tends to increase symptoms.

Another symptom is that the musician begins to notice that he cannot control the fourth and fifth fingers very well. It is as if they are trying to control the movement of the fingers, but the hand is not receiving the signals and has a “mind of its own”, the loss of dexterity, speed and control of the ring and little fingers is a distinctive sign of this syndrome. .

The culprit for this syndrome is compression of the ulnar nerve. Just below the elbow, the nerve passes through the flexor carpi ulnaris muscle (flexor carpi ulnaris) to descend into the hand. A small tunnel forms in this place, and the nerve ends up surrounded on all sides.

In this tunnel, the ulnar nerve is located at the top of the flexor digitorum profundus muscle and a ligament forms the top layer of the tunnel (it is important to understand the function of the muscles in this tunnel, as they play an important role in the development of the syndrome). The flexor carpi ulnaris muscle attaches to the inside of the elbow, and its function is to flex the wrist and move the wrist to the inner side (the little finger). The flexor digitorum profundus is attached to the medial elbow and inserted at the fingertips. The function of this muscle is to flex the fingers (especially the tips).

Causes of Cubital Tunnel Syndrome in Guitarists

Now that you have survived the anatomy lesson, let’s see how in real life these anatomical structures are affected by playing the guitar. As I have said before, this syndrome typically affects guitarists in the hand that it is played with, so in a right-handed guitarist, the left hand is typically involved. If we dissect the way to play a simple barre chord, we will notice:

1. Thumb contraction against the bottom of the guitar neck,
2. Contraction of the opposing fingers at the top of the neck,
3. Flexion of the fingertips when pushing against the strings,
4. Flattening of a finger against the neck to form the chord (usually the first finger).

Because the ulnar nerve passes between the muscles that flex the wrist, bending the tips of the fingers and stretching the little finger to reach the highest frets can irritate the muscles that surround this nerve. With constant overuse of these muscles, they can become inflamed or even form “micro tears” in the elbow area.

This is especially evident in guitarists who have not developed strength in the forearm muscles that must be prepared for all the hours of practice that will be done. The inflammation involved can begin to compress the ulnar nerve, causing the symptoms mentioned above. Therefore, bending the forearm will worsen the discomfort, the ulnar nerve is stretched when flexing the elbow and if the nerve is already pinched, the stretching will amplify the symptoms.

Cubital tunnel syndrome can also occur from other conditions, such as traumatic elbow injuries from car accidents, falls, fractures, and elbow dislocations. Many musicians also have jobs in front of a computer, repeatedly typing with poor posture and little rest time, and constantly leaning on their elbows, this posture in front of the computer can predispose the musician to basic ulnar nerve problems.

The general poor health of the musician is also a factor that complicates the situation. Not exercising, poor diet, alcohol and drug use, and pre-existing health conditions can weaken the body so that it is more susceptible to neurological problems.

A very important cause of the syndrome that should not be overlooked is neck problems. Since the nerve fibers traveling to the hand must exit the spine first, any problems with the cervical spine in that section will irritate the nerves. For example, if you have suffered a whiplash injury from a car accident – even many years ago – it can predispose you to cubital tunnel syndrome.

Chronic poor posture and forward head tilt can also lead to compression of the nerves. Consider your posture while playing your musical instrument . How many guitarists do you see with their heads down and leaning over the neck, playing difficult chords? Chronic poor posture places tremendous stress not only on the neck, but on the entire spine and nervous system. Unfortunately, in most cases, you will never experience real neck discomfort with cubital tunnel syndrome. It is important to note that only a chiropractic physician can determine if the neck is the source of your problem.. Physical therapists and physicians are not trained to locate and correct spinal subluxations, that is, misalignments that irritate and distort nerve function.

How to prevent Cubital Tunnel Syndrome

For those of you who don’t have the above symptoms and would like to prevent them, there are some simple steps to follow:

1. Take more breaks during rehearsal or practice times (about 10 minutes after every 45 minutes of playing). Playing constantly for hours on end without resting can lead to micro-tears and repetitive stress.
2. Before playing and during pauses, increase blood flow to the forearm and hands by stretching and self-massaging the area.
3. Start getting regular massages by a professional massage therapist to keep your muscles flexible and relaxed.
4. Get an evaluation by a chiropractic doctor to make sure the alignment of your neck, shoulders, and elbows is correct, allowing the nerve to flow properly to the muscles in your hands.
5. Improve your nutrition and use nutritional supplements so that your body has all the necessary components for cell repair and nerve transmission. In this article you can check  the top 10 vitamin and mineral supplements .
6. Initiate and / or maintain a weight training regimen that targets not only the major muscle groups, but the forearm and hand muscles as well. The stronger those muscles, the less likely you are to be fatigued and injured.

Treatments for Cubital Tunnel Syndrome

If you have the symptoms mentioned in this article, you can apply these treatments:

1. If you simply have muscle pain in your forearm, use heat on your forearm before practicing and ice your elbow and forearm area after playing. The heat will stimulate the irrigation with more blood to the tissues while you play, and the ice will deflate afterwards. Stretch up to the forearm three to four times a day.
2. If you are experiencing nerve-related symptoms such as tingling and numbness, burning sensations, muscle fatigue, and lack of finger coordination, immediately consult a chiropractic physician who is experienced in treating musician injuries.
   Many musicians make the mistake of seeing their GP who is unprepared in the care of repetitive stress injuries. Most musicians who follow medical advice are given dangerous drugs that can actually make their condition worse. Even something as simple as ibuprofen can damage the kidneys and liver. With this in mind, don’t become an anti-inflammatory junkie. Repeated use of anti-inflammatories will simply mask a more serious underlying problem, and can lead to organ problems.
3. Always try conservative measures first, such as chiropractic, massage therapy, or acupuncture. Rest at least six to eight weeks to heal.
4. If you notice worsening symptoms or weakness in your hands, even with conservative care treatments provided by chiropractic and massage, your GP should refer you to a neurologist for a neurological consultation and examination. In my experience working with musicians through chiropractic care, this rarely happens.
5. We can use a support splint that will prevent us from bending the elbow and at night it is very useful.
6. Surgical treatment should always be the last resort. The surgery consists of releasing the ulnar tunnel ligament by cutting and dividing it, allowing the tunnel to increase and healing over time.

If you are a guitarist or musician of any instrument, and you begin to notice changes in the functionality of your hands, do not wait for the most serious symptoms. The faster you get medical attention, the faster they will heal. Musicians who postpone treatment for cubital tunnel syndrome risk the most serious consequences of muscle wasting in the hand, numbness, loss of ability to play their instrument, and chronic disability. Treat your body like a temple, and take care of it daily.