Getting carpal tunnel from guitar playing is extremely common. In fact, a day doesn’t go by when a guitarist doesn’t ask us what to do about their numb or painful fingers and hand. Here's what’s going on.
Playing the guitar requires rapid movement of all fingers for an extended period of time. This produces one of the most common “overuse” musculoskeletal disorders today, called carpal tunnel syndrome.
Anybody who uses their hand for rapid and repetitive activities is at high risk for getting this painful condition. So it's no wonder why getting carpal tunnel from guitar playing is so common.
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And this disorder isn't something exclusive to musicians. Other professionals are also at high risk for getting carpal tunnel syndrome because they perform similar, repetitive hand activities. These professions are as diverse as graphic artists, video gamers, hairdressers, carpenters, transcriptionists, typists, and dental hygienists, just to name a few.
At its core, carpal tunnel syndrome is caused by overworked or stressed flexor tendons. These tendons run from your forearm to your fingertips. They're responsible for curling your fingers (creating a gripping or pinching action).
When tendons are stressed, their coverings (sheaths) inflame and swell with fluid. Normally, that swelling isn’t such a problem anywhere else on the forearm. But if swelling and fluid builds up inside the wrist joint, things gets serious.
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Inside the wrist joint the flexor tendons travel through a passageway called the carpal tunnel(hence the condition’s name). As shown in the picture above, they’re accompanied through the passageway by the median nerve.
The median nerve is responsible for activating finger movements and also carries sensory information from the fingers all the way to the brain. In other words, it’s the main motor and sensory highway for the hand and fingers.
As the inflamed flexor tendons swell and expand with fluid, they push against the median nerve. With no extra room, the median nerve gets squeezed and compressed. This results in a “compression injury” to the nerve, causing neuropathy.
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The reason you feel unpleasant symptoms of carpal tunnel from guitar playing is the result of the median nerve’s compression. The compression produces neuropathy, which is when the nerve’s signals between the fingers and brain are scrambled.
This signal scrambling results in motor problems like weakness or limited hand movement. It also results in a variety of sensory problems. For example a feathery touch might feel like a stab or burn.
Symptoms of carpal tunnel from guitar playing can happen on either hand, and for different reasons. In the fretting hand , holding the guitar neck is particularly stressful to the hand’s anatomy. Curling and holding your thumb and fingers forces joints into awkward, stressed positions.
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The result is that tendons stay twisted and contracted more than normal. This also forces the median nerve backward, pressing it against the wall of the carpal tunnel passageway.
Usually, merely twisting and bending your hand isn’t harmful. But if you twist it in that particular position, hold it, and then produce rapid finger movements, you’ve created the perfect recipe for carpal tunnel syndrome.
In the picking/plucking hand , the fingers are rapidly moving (and sometimes pinching). While the wrist joint may be in a natural position, the fingers are in a constant, contracted or flexed position. Now combine that with rapid wrist and finger motions. Given the extreme picking speeds achieved by some guitarists, all of this creates huge stressful forces on these flexor tendons.
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Therefore, there's no mystery about how you acquire carpal tunnel from guitar playing. You can see why I tell my guitarist patients...
The amount of time it takes to go from the mild to severe stage varies from person to person. It especially varies according to how many hours per day you play guitar. Generally speaking, the more hours spent on the guitar, the faster the condition’s progression.
Almost 80% of carpal tunnel sufferers will eventually see symptoms on the opposite hand as well. This is called bilateral carpal tunnel syndrome. Symptoms usually appear on the other hand within 6 months from when they first appeared on the initial hand.
Carpal Tunnel Syndrome
Symptoms of carpal tunnel from guitar playing begin to show up in the mild stage. Unfortunately, this is when patients should do something about it, but they usually don't.
When caught and treated in this stage, mild symptoms will resolve 50% of the time with simple rest and some night bracing. But in cases where mild symptoms are ignored, they will almost certainly worsen.
During the mild stage, pain, numbness, and tingling are only just beginning. They creep up extremely slowly. In fact, many people don’t even notice a problem unless they’re thinking about it.
Before You Play
Also in the beginning, there's usually a stress delay when the symptoms show up. In other words, some people might feel the symptoms immediately after playing. Other times symptoms show up a few hours after playing, perhaps while holding a steering wheel or a phone.
In almost every case, initial symptoms will occur at night while you're trying to sleep. Many say they have to wake up and shake out a numb hand or rub painful fingers.
When symptoms go from mild to moderate, the problems usually escalate fast. It’s also the stage when most people seek professional help. In the moderate stage:
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When these difficulties manifest, everyday life changes for the majority of carpal tunnel sufferers. If left untreated, most guitarists put their instruments down for good during this moderate stage of carpal tunnel syndrome.
In the severe stage numbness or pain is constant, with no respite during the day or night. And it's almost intolerable. It can be so bad that patients often tell me, “I want to cut my hand off.”
Some describe the numbness as “crushing” that’s ever-present and relentless, even at night. If the main symptom is pain, people describe it as cruel or punishing and it's always relentless.
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Eventually patients lose the feelings of hot and cold sensations in their fingers and hand. Also, the muscular bump at the base of the thumb noticeably flattens out, and the skin over the muscle wrinkles. That’s because the thumb muscle has degenerated. This begins the final, irreversible stage of carpal tunnel syndrome.
Guitar players are at very high risk for this condition. In fact, most doctors will tell you that a high proportion of their carpal tunnel patients are guitar players.
Unfortunately, nobody has the exact statistic because good clinical surveys are still lacking. But overall musculoskeletal disorders occur in 26-93%of musicians.(1) That’s very high by any measure.
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In one study of guitar players (2), the average rate of all overuse disorders ( including carpal tunnel syndrome) was 75%. That was further broken down as occurring in:
By any standard, these statistics are astonishing. And since carpal tunnel syndrome is the predominant overuse disorder , we can extrapolate the following from the data: carpal tunnel syndrome from guitar playing is the primary cause of most of these hand problems.
From experience, I'm very familiar with this issue. So when guitar players ask me what to do, I always advise the same thing...
Avoid Guitar Playing Injuries
Getting carpal tunnel from guitar playing is a major problem among musicians. Unfortunately, most guitarists don't take the mile warning signs very seriously, but only take action when the moderate stage hits.
At first, thinking their hands are just overworked, most people try inexpensive, half-hearted measures against the moderate stage. They might soak their hands in ice water. Or they buy a wrist splint from Walgreens or CVS for $16.00.
But it's unfortunate that even with the most sincere intentions, most people don’t realize how serious carpal tunnel syndrome actually is. They don't understand that these insignificant measures are wasting valuable time as the disorder progresses towards the severe stage.
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Simple treatments like rest and night bracing will normally work very well if symptoms are caught in the mild stage. But when I get patients – usually in the moderate or severe stages - simple bracing is too little, too late. The easy remedies are just not enough anymore.
The success of either option is proportional to how long you let symptoms go, and how severe they are. The American Academy of Orthopedic Surgeons (those who regulate hand surgery) and the National Institutes of Health both recommend that surgery should be your last and final option , when all non-surgical attempts failed.
Surgical treatment involves a procedure called carpal tunnel release. After back surgery, it’s the most common surgical procedure performed in the United States today. It can be performed in one of two ways:
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With both ways of doing the surgery, the end result is the same. The carpal ligament is cut, thereby giving more “breathing room” to the median nerve. This also lets excess fluid pressure drain away. The resultant release of pressure on the nerve “decompresses” it, thereby relieving the neuropathy.
After surgery most patients require several months of hand physical therapy and rehabilitation to restore strength and function. Guitar players who had surgery usually must make some type of playing adjustment. About 50% of patients never recover full hand function after surgery.
Most musicians who acquire carpal tunnel from guitar playing seek non-surgical remedies. Understandably, few of them feel comfortable with having their
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