The trapeziectomy diaries: Part two
The trapeziometacarpal joint, also called the "trapezium," is at the base of the thumb. Osteoarthritis, a well-known condition suffered by many adults, affects the trapezium in some people. Sufferers experience pain, stiffness, and weakness in the thumb joint. This is particularly troublesome when the sufferer is a pianist.
Luckily, there are many operations that can be elected for osteoarthritis in this joint. Our author, Jill Dew, chose a "trapeziectomy." In this operation they remove the trapezium. Scar tissue grows in its place, forming an artificial joint. This is a relatively common operation, and is easy for the doctor to perform. The recovery period is quite long, however.
Jill chronicled her recovery in the previous article called "The Trapeziectomy Diaries." In this second article she offers suggestions for pianists who are recovering from this procedure.
Neither Jill nor I are physicians or physical therapists. Please have the pianist/patient consult his or her physician and physical therapist in order to get permission to resume piano playing and permission to perform these exercises.
I am happy to say Jill is in full recovery at this writing.
How to recover your technique after a trapeziectomy
by Jill Dew
While the operations were a complete success, the real work involved getting my hands (and arms) back into playing shape. This was not an easy task. Physical therapy and creative piano exercises not only helped me recover my technique, but also, in many ways, made me a better pianist than I was before the operations. Here are my suggestions, based on what worked for me.
Please know I am not a physical therapist or doctor. Check with your doctor before doing any of these exercises.
The basic materials—the powerhouse four
Collect these powerhouse technique books, but use them with caution. Do not strain your hand, overwork your thumb, or play anything that tightens the wrist. Since you will not be able to go "full tilt," I suggest reacquainting yourself with harmonization, cadences, and transposition while you are still recovering. The powerhouse four books are Daily Technical Studies for Piano, by Oscar Beringer; The Little Pischna, by Johann Pischna and Bernhard Wolff; The School of Velocity, Opus 299, by Carl Czerny; and Harmonization at the Keyboard, by Arthur Frackenpohl.1
Work with your "good" hand while the other is in the splint
The first two exercises are by Oscar Beringer. Start with these, transposing them to every key (see Excerpt 1).
Increase the difficulty of the exercises. These exercises, also by Beringer, contain held notes (see Excerpt 2). They are a little harder, but worthwhile. Again, transpose them to every key.
The goal is consistency of touch and smoothness of legato. This example is from The Little Pischna book (see Excerpt 3). Be sure to roll your wrist as you play, staying loose.
As you progress, you can alter the direction your wrist moves. The following is also taken from The Little Pischna book (see Excerpt 4).
If you are going to do any accompanying, it helps to review chord progressions and transpositions. You can do this even with limited mobility. Start with simple progressions, then explore more difficult combinations. Modify the chord progression for your good hand and transpose to all keys.
Work for your healing hand
Do not attempt these exercises until given permission by your physician and physical therapist. The following exercises worked for me and may not work for everyone. NEVER continue an exercise if it causes any pain.
You will need a lot of flexibility exercises for the fingers of your hand. This is necessary because your hand has been immobile, causing the tendons to tighten. The hand is a complex system, and what you do to one part affects the whole thing. I found my fingers were numb for quite a while, so be patient!
Finger strengthening and mobility
Your therapist will probably give you a putty-type solution that you wrap around your fingers. Do the following exercises every day—they strengthen your fingers quite well.
Touch the fourth finger and base of the palm and pulse them together. But be careful: four pounds of pressure pinching the thumb equals ninety pounds of pressure on the trapezium. Be aware of this at all times.
On a five-note scale, hold down do with the thumb and play the rest of the scale up and down (2-3-4-5-4-3-2). Then hold down re and play the other notes in the scale (1-3-4-5-4-3-1), and so on. This is good for strengthening and coordination.
The Little Pischna book has an exercise that will be a basis for your healing. Practice it as long as you can do it without pain. If your trapeziectomy was for the right hand, modify it accordingly (see Excerpt 5).
This following exercise is adapted from the Alexander Technique.2
Play on the outside of the hand, engaging the fifth finger. Roll your hand in as you hold down the fifth finger key. Your hand will lie on the outside and make "butterfly wings" by its motion.
After not using your hand for over a month, trying to get the fingers to strengthen and move independently is a challenge. The bridge in your palm will have little strength. We created the following exercises to deal with this problem. They are adapted from exercises found in technique manuals by Cortot and Brahms. The following exercises are for left hand. They can be modified for the right hand if necessary.
Put your fifth finger on Eb , fourth finger on F, and second finger on B. Hold down the B. Play back and forth between the F and Eb . Then move everything down a half step and do it all over again. Do this in all keys for an octave. It is important to keep the fingers into the "wood" while doing this, not on the edge of the keys.
Place your fingers on D, F, G#, B, and D. Hold the thumb on D as you play back and forth among the other notes. If you still can't use the thumb, hold down the B. Place your fingers on G, A, C, D, and G. Go back and forth among the notes while holding your thumb.
Play a G with 3-2-1 over and over, then play the note with 4-3- 2-1, and finally with 5-4-3-2-1. Be sure to play slowly enough so that everything is legato.
Your coordination will be rusty, so the following will help you bring it back to where it was.
Start with something easy in one hand and more difficult in the other, such as the following exercises by Beringer (see Excerpt 6).
Working hands together is important, but so is keeping the wrist free and rotating. Don't go fast on these sorts of exercises—your hand position and wrist position are important. Use Examples 3 and 4 from this article to help develop your hands together technique and your wrist flexibility. Keep it slow and rotate your wrist.
At first your fingers will feel "jerky"—be patient. You may only be able to practice seven minutes at time, but this will improve.
Another exercise for mobility is to hold down the white keys with your fingers. Have your thumb dangle below the keys, and then lift it higher than your fingers. Next slide it under your fingers and then stretch it to the side. Do this several times.
Word of caution
You must be ever vigilant about protecting your thumb. I found this out the hard way when I was walking a very large and strong dog. He was pulling heavily on the leash, which caused soreness in my hand. It was actually bad enough to set back my recovery.
This is a big ordeal—I've had trapeziectomies in both hands, a year apart. The aftermath was hours of physical therapy and hours of piano exercises, but I'd do it all over if I had to. The sacrifice I invested in time, energy, and money were totally worth being able to play the piano pain free. Since I used this time to better my piano technique, I actually came out the other side as an improved accompanist. The greatest proof that I made the right choice to do all this is when my students sing better because of my newfound piano skills. If I'm careful with my hands I should be able to keep playing the piano for the rest of my life.
Jill Dew is a native of Chattanooga, TN, where she received her B.M. and B.A. at the University of Tennessee. She then moved to the Cincinnati area, where she earned an M.M. at the University of Cincinnati College-Conservatory of Music (UC-CCM). She has been to the VoiceCare Network in Minnesota for the past twelve years, studying student-based vocal pedagogy. She apprenticed with the Michigan Opera Theatre in Detroit, and has studied with John Wustman, Martina Arroyo, Italo Tajo, Mignon Dunn, and John Alexander, among others. She has sung in Eastern Europe and across the United States. Locally, she has performed with the Cincinnati Opera, May Festival, Vocal Arts Ensemble, Musica Sacra, and the Cincinnati Camerata. She is a voice teacher, both in her home studio and on faculty at UC-CCM Preparatory Department, where she is the head of the voice division. She teaches privately, one-on-one, as well as adult voice classes at UC-CCM. Currently, she is studying piano with Michelle Conda to help her achieve her lifelong goal of becoming an accomplished accompanist.
1 Frackenpohl, A. (1990). Harmonization at the Piano, 6th edition. Boston: McGraw Hill.
2 Conable, B. (2004). What Every Musician Needs to Know about the Body: The Application of Body Mapping to Music. Chicago: GIA Publicaitions, Inc.