Non-trauma hand injuries in knifemaking...anyone?

bladsmth said:
Just a note, but when the pinky and ring finger gets numb, it is usually due to cubital tunnel syndrome ( ulnar compression).
Click to expand...

Actually it is usually trigger points in the infraspinatus and or subscapularis muscles due to strain and repetitive injury. If not that then look to a history of trauma to the elbow as a possible cause. Ignoring trigger points often lead to incorrect diagnosis and treatment and unresolved symptoms.
 
Since I am an orthopedic surgeon, I figure I can maybe help out a little here...I'ver certainly learned alot about knives and knife-making from you all of you :thumbup:

Avigil - you can certainly get trigger points in the subscap or infraspinatus, and they CAN be from overuse.....but they do NOT cause ring/pinky numbness.

Easiest way to understand upper extremity nerve issues is by an analogy to electrical circuits. The Cervical spine is the "circuit breaker box" for the upper extremities.
For each cervical level ( C1/2, C2/3 etc) you have an exiting nerve (wire) to each side - like a individual breaker circuit

Next the nerves pass down from the neck, combining with each other into different "wires" - first in the brachial plexus (junction box) then in peripheral nerves which are like individual circuits that go to their selected targets - either muscles (motor nerves) or sensation areas (sensory nerves)

The symptoms you have in a particular area - say ring finger - can come from pressure ANYWHERE along the fibers starting in the neck and going all the way thru the arms. The Ulnar nerve IS the terminal nerve to the ring and little finger, and its "original" wires start at C7 and C8...so much of what has already been said is correct - the trick is to find out WHERE the pressure on the fibers occurs...

Trigger fingers can be congenital but are usually due to repetitive use and irritation - vibration is also a contributor. If they are very troublesome, a cortisone injection will usually calm them down, but if one continues to recur, then a very minor surgery to release the triggering pulley can be done

Generally speaking, the reason folks get "hand pains" and spasms is that the intrinsic hand muscles are fairly weak and easy to fatigue. Tight squeezing and holding with fingertips will fatigue the muscles quickly. Anytime you can use larger muscles (ie forearm muscles) - you should. This is why utilizing the largest sanding "blocks" possible is often helpful, and why sword smiths traditionally would use even larger muscles (core muscles) by pulling with long "body" strokes when possible
for heavy shaping

hope this helps - if you have specific ?s feel free to ask them

Bill Flynn
 
Thank you very much Bill, for the clarity. As a massage therapist I see such issues daily, and have to cut through common knowledge fiction daily as I'm sure you do. One thing I would like to add clarity to is the issue concerning the ring finger. The ring finger will be involved in both cubital and carpal issues but only half of the ring finger with any syndrome! Often if both pinky and index are involved I find the issue is in the shoulder (thoracic Outlet Syndrome) A very important thing to note in my practice.

For non trauma, I suggest massage (of course), but everybody involved in physical labour should be very concerned with proper stretching routines- taking your body through full ranges of motion will combat tension and reduce daily stresses. We are meant to move fully, and doing so has great health benefits. Plus most stretch routines can be done by yourself to great effect. Ask your physiotherapist, doctor, personal trainer, yoga teacher, massage therapist for a stretch routine if you are unsure, all should be able to give you safe, effective movements for your particular situation.

But in my opinion the most important thing to do is NOT WAIT!! If you feel something is wrong, don't just wait for it to get better. Something you did aggravated things, and if you don't address the aggravation then it won't get better. I plan on doing massage and knifemaking until I did, so I try to follow my own advice.
 
bladsmth said:
Just a note, but when the pinky and ring finger gets numb, it is usually due to cubital tunnel syndrome ( ulnar compression). Carpal tunnel affects the thumb and index fingers. It
Ulnar compression is a type of tennis elbow condition where the ulnar nerve gets squished against the ulna bone by long sessions of using the arm with the elbow bent at more than 90°. Straightening out the arm and "shaking it out" regularly can help with most hand and finger problems. As we age, these problems get more common. At 47 with a long history of heavy arm and hand use already, I can only say, "Welcome to the Club:) "
Click to expand...


The symptoms I highlighted above are/can be EXACTLY the the early symptoms of what is called "Spondylosis" (http://en.wikipedia.org/wiki/Spondylosis). This is a condition associated with a form of degenerative spinal osteoarthritis.... which I have. In some cases this is managed with medication and other treatments. In other cases, spinal decompression and fusion surgery may be/is required.... as in my case. Two ends of the spectrum. What Stacy describes is also exactly what I felt at the onset of two years of increasingly debilitating pain leading to surgery. I exhibited classic symptoms.

-Peter
 
Again, there are some differences between people as well as known anatomical variations. Pure ulnar nerve syndromes usually involve just half of the ring finger ( the pinky side)....but in some people it can be the whole ring finger

Thoracic outlet is somewhat uncommon (seen more in left side than right side) but is a definite possibility, since it can cause compression as nerves traverse between the clavicle and ribs. You can also (less commonly) get arterial compression, which can lead to "numbness" secondary to impaired circulation.

Actually "spondylosis" MEANS arthritis of the spine...but that can occur at ANY or at MULTIPLE levels. The nerves exit the spinal canal passing by the facet joints, and when these joints are arthritic they can compress the nerves. Ring and pinky numbness is associated with disease in the lower cervical spine, but not at other levels typically...

Again, one has to localize the source of compression to treat it effectively !

symptoms are rarely confined to just one possibility....

Bill
 
billf said:
Again, there are some differences between people as well as known anatomical variations. Pure ulnar nerve syndromes usually involve just half of the ring finger ( the pinky side)....but in some people it can be the whole ring finger

Thoracic outlet is somewhat uncommon (seen more in left side than right side) but is a definite possibility, since it can cause compression as nerves traverse between the clavicle and ribs. You can also (less commonly) get arterial compression, which can lead to "numbness" secondary to impaired circulation.

Actually "spondylosis" MEANS arthritis of the spine...but that can occur at ANY or at MULTIPLE levels. The nerves exit the spinal canal passing by the facet joints, and when these joints are arthritic they can compress the nerves. Ring and pinky numbness is associated with disease in the lower cervical spine, but not at other levels typically...

Again, one has to localize the source of compression to treat it effectively !

symptoms are rarely confined to just one possibility....

Bill
Click to expand...

Thank you Bill for contributing.
 
Dipping your hands in water from wet sanding and cooling blade's for many years. Have caused arthritis in my hands
 
Bill,

I am going to try and stray from going WebMD on bladeforums, but I can't resist posting. My issues do relate directly to my knifemaking though.

Quite a few years ago I was in a car that went off a cliff. The roof was smashed flat on my head and left shoulder, so damage in my upper back and shoulder area.

I was still fairly young, so rebounded quickly. In old pictures though, I can see my left shoulder/upper torso sagging. I suspect I may have had problems on that side before the accident.

At first I would experience soreness. Now, burning in my shoulder joint area, stabbing pain underneath my shoulder blade, popping in the joint and surrounding area. Stabbing/tingling pain along the inside of my left arm to pinky/ring. During flare-up, intense burning in upper back and across traps.

Now I'm getting moderate muscle atrophy (I am left handed) in my left hand. The muscles in my left hand have atrophied to where they are smaller than the ones in my right at this point, while my left arm as a whole remains larger than my right. That is just wrong.

So far, 3 different ortho surgeons, many x-rays, 3 MRI's (one with contrast), 2 EMG's, PT, meds, I feel like I'm still at square one. My sister is a physical therapist and suggested looking at TOS, and I won't lie the symptoms list reads like my life... But it is dangerous to self diagnose.

I'm still hanging in there but the clock is ticking. I won't badger you for a diagnosis, but could you suggest any tactics I might employ to resolve this in any way?
 
Last edited:
billf said:
Again, there are some differences between people as well as known anatomical variations. Pure ulnar nerve syndromes usually involve just half of the ring finger ( the pinky side)....but in some people it can be the whole ring finger

Thoracic outlet is somewhat uncommon (seen more in left side than right side) but is a definite possibility, since it can cause compression as nerves traverse between the clavicle and ribs. You can also (less commonly) get arterial compression, which can lead to "numbness" secondary to impaired circulation.

Actually "spondylosis" MEANS arthritis of the spine...but that can occur at ANY or at MULTIPLE levels. The nerves exit the spinal canal passing by the facet joints, and when these joints are arthritic they can compress the nerves. Ring and pinky numbness is associated with disease in the lower cervical spine, but not at other levels typically...

Again, one has to localize the source of compression to treat it effectively !

symptoms are rarely confined to just one possibility....

Bill
Click to expand...

Bill, I certainly didn't intend to say "ring and pinky finger numbness is Spondylosis". I only tried to respond to Stacy's post and offer an alternative possibility. In my case the ring and pinky numbness was merely the fist of several indicators of my specific problem finally resulting in c4-8 ACDF.

My apologies if I muddied the waters.

-Peter
 
billf said:
Avigil - you can certainly get trigger points in the subscap or infraspinatus, and they CAN be from overuse.....but they do NOT cause ring/pinky numbness.
Click to expand...

Bill,

The good thing is it is easy enough to test. Since the the referral pattern goes down to that region simple pressure on the trigger point if it is the cause will reproduce the symptoms and with continual ischemic compression decrease the symptom.

If it does not then it is something else.

But it is easy enough for people to test themselves before doing more invasive procedures.

infraspinatus.gif
 
Peter

no apologies needed at all !

Actually, I think it all fits well with the larger point I was trying to make - that there are MANY potential causes for a given symptom, and fortunately in your case your doctors correctly identified the underlying problem, and so were able to fix it for you. BTW a 4 level ACDF is quite an extensive surgery, so I suspect you have some hardware in your neck :)

Ian
from the info you've relayed, I suspect you do not have a "simple" problem. certainly, the fact that you have atrophy in your hand and not your arm is suspicious for injury to either the lower cervical nerve roots, or one of the divisions of the brachial plexus. The burning is classic for nerve pain, and the fact that it can be very severe suggests the possibility of reflex sympathetic dystrophy, or what is now called Complex regional Pain Syndrome. TOS could in fact be a cause for your symptoms, particularly given the fact that you had significant trauma involving your shoulder girdle.

My suggestion - find one of the closest large medical schools (you have many good ones in CA) and look for someone with particular interest/expertise in Brachial plexus injuries and thoracic outlet. The big tertiary care places will often see more "weird" cases in a year than the average doc would see in decades, so they may be able to fully check out the possibilities

good luck!!

Bill
 
Thanks a bunch Bill. That reminds me of an ex, her brother had a severe nervous disorder and after going through normal channels they were able to get him involved in a study at ucla.

I felt that the ortho surgeons I saw were competent, but so used to diagnosing and treating acute sports/workplace injuries that anything outside that box was a head scratcher. All of them seemed to feel sincerely that there was something really wrong, but none were able to give me much more than sympathy unfortunately.

I just wanted to add as an incidental, crippling flare-ups can be triggered by something as simple as wearing a long sleeve shirt or sweatshirt, just by the tiny extra weight added to the top of my shoulders. Sometimes I have to work shirtless for pain management.
 
Last edited:
Bill,
Thanks for posting. I didn't explain that any compression on the ulnar nerve will cause similar symptoms. I just referred to one of the more common ones.
Ian, I am sure Bill would love to try and help, but without a real history and exam, any advice would have to be pretty generic.



To keep the post on topic of this thread:
Seemingly non-trauma hand and nerve problems are often caused by a previous trauma.
My ulnar compression is almost surely a product of hitting my elbow hard about 40 years back causing a tiny fracture.
Peters is from osteo-arthritis, which may be from years of stress and trauma (or just bad genes).
Ian had a car fall on him :)


All of these caused hand and finger numbness later on. the common factor as far as this thread goes is that with figuring out the cause, and doing any therapies that will strengthen muscles, stretch tendons and ligaments, and generally increase flexibility of stiff and old joints will help alleviate the symptoms to some degree. In many cases, a physical therapist can help with the problem more than an osteopathic surgeon can.
 
Thanks Stacy, I was hoping not to get too "diagnosey", just seem to be at a bit of a dead end for the last couple years. Not gonna lie, I'm a bit desperate for any scrap I can get. ;)

I completely agree with you on PT, it did some good if anything for my general well being, even if it did irritate my symptoms more often than not. I wish I lived closer to my sister.

This is pretty much the reason I'm doing knifemaking, besides love for all art and craftsmanship.

I would like to say, a lot more on topic, those of us that experience these issues can't pay enough attention to ergonomics in our work. I must have adjusted the height of my 2x72 about ten times now. I've even adjusted the height of my dip bucket stand several times. I actually custom built my workbenches specifically because of these issues.

The main reason I felt I was even remotely on topic (kind of a stretch) was that these issues have been with me through my career in hand craftsmanship, continuing with knifemaking, and I feel that knifemaking and the related skills I've used through the years, have a big effect on my condition, for better or for worse. I have noticed more hand pain now that I've been doing this.
 
I just erased a reply that was very well written and true, but the point was and still is how do you get better. simple answer.
unless your hands are lying to one side upside down. Stay away form anyone who is not a certified therapist or is not a Neuro Dr... That is your only hope. I have lived with constant pain, numbness, burning, etc. since 2003. The point made about trigger points and locating that cause, should be left to those who understand nerves in the body. Every case is not black and white, sorry.
 
Hey guys

I realize that this thread may be wandering a bit and I apologize for my part in that. I am happy to help out when a subject comes up that falls in my area of expertise :D

So...I will try to answer any specific questions that I can, or you can email me off the forum, whichever you'd rather.

Bill
 
When I first started grinding on a 2X72 within the 2nd week , I woke up and my thumb would pop out of its socket ( at least that is what it felt like) I thought that this was very strange because I did not recall injuring my thumb in any way or it even hurting at all before that. I wrapped it with tape to immobilize it for about two weeks while grinding and it seems to have gone away. Besides that weird incident , just the normal tired cramped hands from long periods at the grinder. I was a mechanic for many years before I started making knives. Mechanic work is hard on the hands , it also develops a good amount of hand strength if you do it for awhile.
 
I used to work in machine shops that did big work. The machines were big, the work was big, the tooling was big and heavy. My arms were either numb or I had a burning sensation from the elbow down to my fingers (this went on for 15+ years). The dexterity in my hands was similar to wearing welding gloves. As I've quite doing big work and started spending more time on knives, my arms and hands have recovered, and my dexterity greatly improved. I still work with my hands 50-60 hours a week but I don't pick up anything over 100 pounds and I don't do that very often.
 
HallHandmade said:
Bill,

At first I would experience soreness. Now, burning in my shoulder joint area, stabbing pain underneath my shoulder blade, popping in the joint and surrounding area. Stabbing/tingling pain along the inside of my left arm to pinky/ring. During flare-up, intense burning in upper back and across traps.
Click to expand...

Ian- Sorry, I can't resist. The above quote describes, perfectly, exactly, TO A TEE, the symptoms and progression that I experienced. Your underlying cause may be different, but the similarities to my condition are glaring.

Take care.

-Peter
 
You must log in or register to reply here.
Back
Top