A Question for the Steel Guitar Medical Clinic

[Michael Lester]

Cubital tunnel syndrome.

I seem to have picked up a case of Cubital tunnel syndrome in my left arm. (I will be confirming my self-diagnosis with my family Physician next week).

Holding my left arm at a right angle while playing pedal steel generates numbness in my hand. I can shake it off in mere moments, but it will come back in a few minutes when I resume playing position. The problem does not affect lap steel or dobro playing - I suspect because the arm angle is less acute. I play a standard height pedal steel with standard height pac-a-seat.

Have any of you experienced this malady and found a physical therapy or some sort of apparatus that helped? Tried wearing a compression sleeve at night, but that did not help.

[Fred Treece]

Cubital syndrome is localized in ring and pinky fingers. I get it mostly in thumb-index-middle, and in both hands, so mine is more carpal. The cause is most likely the same - muscle tension in the neck and shoulders, limiting blood flow and putting pressure on the nerve routes all the way down to the fingers and then back up the arm. The key for me is to not overwork. Regular massage of scalenes and infraspinatus, keeping shoulders relaxed and using good posture and body mechanics (not just when playing), stretching and keeping a healthy spine, and good diet have also helped me immensely. Some people claim herbal treatment alone can help, but in my experience it is only a supplement to all this other activity-oriented stuff.

The best thing you can do initially is avoid the activity that is causing the problem. Even a few days away from it will help. When you get back into your practice routine, stop at the first sign of the numbness creeping back in and take a 5 minute break. It’s a PITA at first, but you will get results.

Good luck with your doctor.

[Gaylen James]

I played Bass for years and years and cant play anymore due to the same thing.
That pinky finger stretch on the bass is now out of the question. The doctor says it problem is in my left elbow, pinching. Oh well.
On the upside I can still hold my pedal steel bar and so I got that going for me.

[Jeremy Reeves]

got a top loader laundry machine? Fill it with cold water and soak your arm as long as you can stand. bomb yourself with as much tylenol as you can stand also

[Michael Lester]

Thanks for your comments. This is particularly frustrating because it doesn't happen when playing other instruments.

Fiddle doesn't bother it. Guitar doesn't. Even Cajun accordion doesn't set it off.

Just the pedal steel.

I have set an appointment with our Physician.

[Jim Palenscar]

I developed a similar problem but seemingly more carpal and developed shooting pain/tingling on my ring finger and pinky when reaching. I recalled reading about fairly high doses of B6 so got some and true to the claims in about 11 weeks it just went away. I also realized that I was resting the underside of my wrist on the edge of my desk when on the computer and have adjusted that bad habit as much as possible.

[Fred Treece]

Thanks for your comments. This is particularly frustrating because it doesn't happen when playing other instruments.

Fiddle doesn't bother it. Guitar doesn't. Even Cajun accordion doesn't set it off.

Just the pedal steel.

I have set an appointment with our Physician.

I suggest you have someone take a picture of you playing your steel so you can show your doctor what the activity is that is causing the problem, instead of trying to explain verbally. Make sure you get one that you can zoom in on your bar hand/arm with good focus. Maybe even take your bar with you and show the doc how you’re gripping it.

[Dave Mudgett]

When you say your left arm is at a right angle - do you mean that your left elbow makes a right angle, and with respect to what plane in space? If that's not what you mean, what is your left arm making a right angle with?

I had all kinds of problems when I started playing. I'm tall, and I didn't fit with any of the guitars I tried. If you look at my avatar, you'll see a perfect example of how not to hold your right arm. The elbow is sticking out from my body, the elbow is angled far away from the vertical plane, and it was flat out uncomfortable. I also sometimes contorted my left arm, depending on where I was playing on the neck. My defense is that I hadn't been playing long, there was nobody anywhere near me to show me how to do it correctly, and the steel (and every steel I had played up to that point) wasn't set up for me. It was too low, I had to contort myself to get my legs under the guitar, I was addressing the guitar all wrong, and it was very uncomfortable and aggravated my elbows and my lower back.

I ultimately figured out that I had to raise my guitars with a lift kit and learn to address the guitar in a much more relaxed and comfortable way. It is generally considered proper form to tuck in your elbows in and address the steel in a relaxed way, with the elbow making its angle at or close to the vertical plane. When when I started doing that, my problems got a lot better. To get there, I had to work to figure out the proper height for the guitar and the seat, and where to sit relative to the guitar. I look at videos like this (of Buddy Emmons) to get a sense of how I need to address the steel - the way he addresses the guitar looks totally relaxed and natural:

https://www.youtube.com/watch?v=55W8kMDm6_w or

https://www.youtube.com/watch?v=tFuYmuZpFiw

Anyway - that's where I'd start - looking at my form. It does not have to hurt to play pedal steel guitar. Put your steel in front of a mirror and see what's really going on. I also found a week working with Mike Sweeney did wonders. A good teacher can probably diagnose any ergonomic problems pretty quickly.

[Fred Treece]

I agree with you Dave, it’s probably bad technique and/or ergonomics that are at the root of it. But first, get the body back in shape. I have had to step away from my instruments twice in my life, for about 3 months the first time, and a little over one month the second time. Scary and frustrating times, but necessary before getting back to the business of building better technique, which also leads to the playing of much better music.

[Tony Glassman]

Just to clarify re: Cubital Tunnel Syndrome.

I'm a retired MD who has treated many such cases. First off, the problem is caused specifically by interference with the gliding motion of the ulnar nerve as it travels through the cubital notch/tunnel on the back of the elbow (i.e.the "funny bone"). The nerve travels from the neck and upper arm to the ring & pinkie finger of the hand to supply it with sensation and muscle activation. Often a nerve conduction test is recommended to confirm the diagnosis and analyze it's severity.

The treatment by your physician typically includes:

[1] NSAIDs: (anti-inflammatoriy meds such as Motrin, Naproxen). Tylenol will not help in reducing the inflammation and should never be taken in massive quantities. The average pill contains 500 to 650 mg of acetaminophen. Over 4000 mg/day can cause significant liver damage (i.e. > 6-8 tablets).

[2] REST: avoid activities which require elbow flexion (bending), as that position can cause increased pressure and subsequent injury to the nerve as it passes through the cubital notch in the back of the elbow.

[3] BRACE: A brace extending above and below the elbow to ensure non-bending of the joint.

Cubital tunnel Syndrome may resolve with the above measures. Without treatment, it can result in permanent numbness and loss of muscle function to the ring and pinkie fingers. In cases that don't respond to the above treatment, surgery to pad or or relocate the nerve out of the notch may be an option.

[Ken Metcalf]

I had this with pain in my forearm.
Cleared it up by going to Airrosti.
https://www.airrosti.com/

[Dennis Montgomery]

I developed cubital tunnel syndrome in the early 90's

I was working as a Software Engineer, typing all day then playing guitar/bass/drums/keyboards for a few hours most every night. The condition nearly cost me my career and ability to play music.

I had cubital tunnel release surgery and it didn't work for me, in fact the scar tissue from the surgery put even more pressure on the nerve making things worse. Even worse was the other surgical option, nerve transposition surgery where the ulnar nerve is moved from the elbow channel around to the top of your arm. I'll never forget what my surgeon told me about that, he said, "Dennis, I'm not a religious man in the least but I believe God put that ulnar nerve in your elbow for a reason and I'm not going to move it".

What finally worked was I began seeing a DO (Osteopath). He did many physical manipulations from my neck down to my tailbone and everywhere in between. When I asked what he would call them he said, "nerve releases". He also began these all the way from my arm to the vertebrae in my back that was connected to that ulnar nerve. It took a few weeks of this treatment to clear up and never once did I take any meds. Once clear, we worked together to define a simple set of stretches and Tai Chi to keep the ulnar nerve and surrounding tissues where they belong and functioning properly.

I still do these exercises first thing every morning - and never, ever touch an instrument without doing them first - and I've been fine for decades

[Michael Lester]

Thanks again for your comments.

I do have an appointment with a Specialist to look into this problem.

I'll share what I learn in the hope that my result may be helpful to someone else.

Michael

[David Ball]

Just to clarify re: Cubital Tunnel Syndrome.

I'm a retired MD who has treated many such cases. First off, the problem is caused specifically by interference with the gliding motion of the ulnar nerve as it travels through the cubital notch/tunnel on the back of the elbow (i.e.the "funny bone"). The nerve travels from the neck and upper arm to the ring & pinkie finger of the hand to supply it with sensation and muscle activation. Often a nerve conduction test is recommended to confirm the diagnosis and analyze it's severity.

The treatment by your physician typically includes:

[1] NSAIDs: (anti-inflammatoriy meds such as Motrin, Naproxen). Tylenol will not help in reducing the inflammation and should never be taken in massive quantities. The average pill contains 500 to 650 mg of acetaminophen. Over 4000 mg/day can cause significant liver damage (i.e. > 6-8 tablets).

[2] REST: avoid activities which require elbow flexion (bending), as that position can cause increased pressure and subsequent injury to the nerve as it passes through the cubital notch in the back of the elbow.

[3] BRACE: A brace extending above and below the elbow to ensure non-bending of the joint.

Cubital tunnel Syndrome may resolve with the above measures. Without treatment, it can result in permanent numbness and loss of muscle function to the ring and pinkie fingers. In cases that don't respond to the above treatment, surgery to pad or or relocate the nerve out of the notch may be an option.

I've had both cubital tunnel syndrome and carpal tunnel syndrome. The brace helps quite a bit, though it takes a bit of adjustment to sleeping with the brace on.

For me, anti inflammatory drugs (heavy duty immunosuppressants in my case) ended up taking care of the problem, but the brace really helped a lot.

Dave

[Dan Robinson]

Michael, your problem may be something altogether different than my own. But I'll share my experience, for what it's worth.

My bar hand used to get numb after 15 or 20 minutes of playing. It was so bad I couldn't hang on to the bar, cuz I couldn't feel it. It would resolve soon after taking a break. I finally realized how much tension I had in my shoulders and neck.

Making that connection was the first step. I had been applying a lot of downward pressure on my bar. Switched to a much heavier bar, Dunlop 921, 3-3/4" x 1" diameter, 11 ounces. A real beast, but using it helped me unlearn some bad habits. Experiments with with seat height, attention to my posture, and learning to relax led to my "cure."

I'm using a "normal" size bar now, but The Beast has a permanent spot in my pack-seat.