Finger joint (DIP) fusion surgery - impact on technique?

[johnrussellguitar]

First ever post, so please forgive any protocol breaches or blundering.

I'm wondering if anyone has gone through a surgical procedure I'm about to undertake and come out the other end still able to fully play.

Pinkie/Little finger of left hand - the end bone was broken 30 years ago and was left slightly out of line (something that didn't impede my playing). The last (distal interphalange or "DIP") joint still works but because of the unusual alignment is now arthritic.

Playing for more than 15 minutes now becomes extremely painful, especially when involving flattening across multiple strings - so I'm being offered surgery to fuse that last joint - such that it will never bend again. Cortisone injections provide relief only for a matter of days.

The procedure is not reversible, hence hesitation.


Is there anyone out there that has had similar surgery and "survived" it with technique/ability broadly in tact?

[rpjazzguitar]

You’ve probably already done it but if not I’d suggest consulting a board certified hand surgeon who works with musicians.

If there’s a symphony in your area, the violinists will know who’s good.

[Onlyserious]

I had two recent 'trigger finger" surgeries (different fingers) after trying a shot and therapy first. Turned out to be a complete success. To follow up on rpjazzguitar above, finding the right doctor is important. I started by asking the local music professors, string players, for a name but their go-to guy recently retired. Next stop--my heart doctor. I went to the guy that the heart and neurosurgeons go to for hand issues. Hopefully you'll have access to such a guy.

[Cunamara]

Can they set the DIP joint at an angle to facilitate playing? Sort of like Les Paul had done when his right elbow had to be fused after a car accident.

[johnrussellguitar]

You’ve probably already done it but if not I’d suggest consulting a board certified hand surgeon who works with musicians.

If there’s a symphony in your area, the violinists will know who’s good.

Yes, have sought out a specialist with "musician" background - the trouble is, in the UK it's not so easy to get in front of them without incurring huge costs on top of the taxes already paid for health care. What few there are will be in high demand.

I'll report back to this forum on the outcomes of searches, consultations etc eventually, in case it becomes relevant to others in this area.

But would like also to hear from any guitarists on here that have similar to understand the results and impact.

[johnrussellguitar]

I had two recent 'trigger finger" surgeries (different fingers) after trying a shot and therapy first. Turned out to be a complete success. To follow up on rpjazzguitar above, finding the right doctor is important. I started by asking the local music professors, string players, for a name but their go-to guy recently retired. Next stop--my heart doctor. I went to the guy that the heart and neurosurgeons go to for hand issues. Hopefully you'll have access to such a guy.

Positive outcome then! That's good to read.

My initial hand surgeon that is not confident of achieving the outcome I desire is off searching "from the inside" for similar past procedures for other musicians - hopefully he can come up with something.

[johnrussellguitar]

Can they set the DIP joint at an angle to facilitate playing? Sort of like Les Paul had done when his right elbow had to be fused after a car accident.

That's just what I was hoping for, but the hand surgeon I've seen so far isn't confident that it can be achieved as I want it. I think I'm his first musician that broke a finger in a "plumbing accident"

The previous break of the bone left the finger in an almost ideal position for playing (the end bone sort of points down, then straightens out again) -

but the standard procedure requires a pin screwed through from the end of the finger, through the centre of that terminal bone, and all the way into the middle bone.
He believes that it will straighten the finger position generally, potentially leaving it in a position that's worse that a fixed-straight finger (because my amended finger tip will then point upwards!).

Apparently if the problem had been on the intermediate joint, rather than the DIP joint, a frame could be used to set a position, because there's greater scope for amending the angle of any pins used (those bones being bigger).

I'll still be able to bend the first joint in the finger but I'm unsure how much control I'd then have or how could I play scales/runs using the 1E and 2B strings.
Hence would love to hear from someone who's been through the same procedure (I suspect it's very rare for musicians! )

[rpjazzguitar]

Years ago I had a problem in my right thumb. Apparently bony protrusions due to arthritis punctured the joint capsule (if I'm using the term correctly).The symptom was joint fluid leaking out and eventually needing to come out from under the skin.

I had the surgery, which worked. The joint has been fine. I was under the impression that the surgeon, while he was in there, scraped out (or something) the bony protrusions.

I may have all that wrong. But, I think it might be a very good idea to get more than one opinion about whether there's a way to reduce the pain without fusing the joint.

[pcjazz]

I'll still be able to bend the first joint in the finger but I'm unsure how much control I'd then have or how could I play scales/runs using the 1E and 2B strings.
Hence would love to hear from someone who's been through the same procedure (I suspect it's very rare for musicians! )

If you are most concerned about scales and runs (rather than chords) then you might consider that many jazz guitarists prefer not to use the pinky in line playing. Christian had a video or thread about this recently. Anyway, I wish you the best of luck.

[rpjazzguitar]

If you are most concerned about scales and runs (rather than chords) then you might consider that many jazz guitarists prefer not to use the pinky in line playing. Christian had a video or thread about this recently. Anyway, I wish you the best of luck.

Wes used 3 fingers for single note runs or so I think. Django used 2.

So, a fused joint isn't the end of guitar playing.

That said, I think a second opinion from a Board Certified Hand Surgeon is warranted, even if the first opinion was from a doctor with the same credentials.

[johnrussellguitar]

If you are most concerned about scales and runs (rather than chords) then you might consider that many jazz guitarists prefer not to use the pinky in line playing. Christian had a video or thread about this recently. Anyway, I wish you the best of luck.

Thank you.

Mostly I'm playing solo chord melody so the pinkie is absolutely essential. But apart from the usefulness in "warming up", the ability to throw in runs adds variety and interest and I think what I play would sound a little boring without it.

I've also attempted to rearrange pieces in the short term to reduce the chords dependency on the little finger, but having been playing for decades, much of what I do is hard-wired now. I play those chord progressions accompanied now by the odd squeal of pain - if only I could harmonise that it might be less noticeable!

[johnrussellguitar]

Wes used 3 fingers for single note runs or so I think. Django used 2.

So, a fused joint isn't the end of guitar playing.

That said, I think a second opinion from a Board Certified Hand Surgeon is warranted, even if the first opinion was from a doctor with the same credentials.

You're right - I'll see what happens in the next couple of months with the current surgeon and the potential alternative contact I've found.

As I understand it, from bio and video, Django used 2 for his runs and melodic playing, his 3rd & 4th fingers fused together by the accident in earlier life, were used only occasionally to lay across strings for chords.

As I'm playing chord-melody I really need all 4 fingers - If i have to accept very restricted movement in the pinkie, so be it, but I won't give up looking for the perfect solution.

Thanks for input, much appreciated.

[Cunamara]

I would not give up looking for the perfect solution, either, until it was conclusively proved to me that there isn't one.

[johnrussellguitar]

I would not give up looking for the perfect solution, either, until it was conclusively proved to me that there isn't one.

For those interested - I did find a solution and I'd say it's almost perfect.

I found a specialist hand surgeon who happens to be a Jazz trumpeter that understood the requirement - and most importantly, had developed his own technique that he was confident would provide the solution I needed.


The joint has now been fused - with the requisite angle in the range 36-40 degrees.

Outcome:

Position-wise, I can play my entire repertoire - I don't think there's a position I can't achieve, that I could always play before the problem arose.

Except, bizarrely, the "campfire chord" G major (3rd fret) - is a little difficult to place, though I think this is just temporary as I get better at flexing the middle joint on the little finger more accurately, and I'd never play a G that way, anyway, so I'm not concerned by this.

All those big major 7th stretches across 6 strings/5 frets are actually easier (as the fused joint naturally and effortlessly lends itself to the barre on the E/B strings).

All the tight scales are (or will be) as fluid and playable as they ever were, just a minor adjustment to hand position rather than fingers is required for the E string.

(I'm still "in recovery" I suppose, and the finger tip is still a bit delicate where an incision was made, but playing will harden it up again).


I had to pay directly for this, but given the value of the outcome I'm content that it was well worth it.

So, if anyone ever has a similar problem, there is a potential solution.
(And if anyone in the UK needs similar, I can point you in the right direction).

[Cunamara]

Congratulations! I am happy you had a good outcome.