Jill Dew is one of my favorite people. You can't help but love her charisma and her enthusiasm. She is a superb singer and vocal coach who loves her students. She also loves playing the piano, sometimes in tearful wonder of the instrument and her accomplishments. Then she was robbed. Robbed by the effects of arthritis.
Jill is not naive—arthritis is an inherited gene in her family. Her hips and her hands seem to be the most affected. Jill is a positive person who believes in shaping her own destiny. I wasn't surprised when Jill decided to have a trapeziectomy in order to reclaim her piano playing.
The trapezium is one of the carpal bones in the hand, located at the base of the thumb. A trapeziectomy is the complete removal of the trapezium bone. The space where the bone was removed is filled with scar tissue that performs as the trapezium. A trapeziectomy is recommended if the joint above or below the trapezium is affected by arthritis.
Jill had trapeziectomies in both hands. We chronicled the operations through pictures and through Jill's diary.
Arthritis does not need to result in the end of piano playing. In fact, Jill's new flexibility has resulted in a vastly improved pianist. There are "tricks" that speed recovery. Certain finger exercises are extremely helpful in regaining flexibility, others send up red flags.
The following article is the first of a two-part series on Jill's trapeziectomy. This article focuses on her operation and recovery. The next article will offer advice to teachers and students going through this process.
My trapeziectomy by Jill Dew
Three years ago, I noticed my hands hurt when I played for any length of time. Big knots had begun to appear at the base of each thumb. These knots were sensitive; whenever I accidentally hit them, they would almost take my breath away, they hurt so badly. At first, I had to touch them for pain to occur; eventually they hurt all the time.
The next thing I noticed was my reach was shortening; originally, I could reach a tenth with one hand. My teacher said I have small hands, so I was always proud I could cover so many keys. But now, playing an octave was hard to do.
The evil villain arthritis had places a huge roadblock in the path to my ultimate goal—to become an accomplished accompanist for my voice students. I knew something had to be done. I went to the internet, spending hours learning about arthritis in the hands. This is when I learned about the "trapezium."
Would I need a trapeziectomy? I went to my family doctor, who recommended an orthopedic surgeon specializing in hands— Dr. Due. I took this as a positive sign because my last name is "Dew."
When I met with Dr. Due, I was relieved to find out he was a pianist as well. He understood where I was coming from, what I needed my hands to do, and what my fears were. He explained to me that if I wanted to continue playing the piano, the operation was the only way to go. He explained that arthritis on the trapezium would continue to deform the other bones in my hand to the point where my thumb would be pushed under the palm. It would become like a flipper, as I would only be able to move the first joint.
No power octaves with that kind of hand! I said, "Let's go. What do I have to do?"
Since my right hand was worse than my left, he decided to operate on that one first. Because I teach, I chose to have the operation in early June. This gave me three months to recover before I had to teach again. I was cutting it close—Dr. Due told me not to expect my hand to be back to normal for six months. Always the optimist, I decided to go by the web's estimate of three months. I figured I would be good (enough) to go back to work in September. The plan was to do the other hand the following year.
It took months of preparation to master the art of living with only one usable hand. Being right-handed, I knew I would be at a great disadvantage. In January, I started writing with my left hand. It was a humbling experience, being unable to write better than a second-grader. Things I had always taken for granted became real challenges. Imagine having to relearn how to brush your teeth, button clothes, work zippers, open jars, or just get the toothpaste on the toothbrush. I gave up trying to straighten my hair—I couldn't use the curling iron with one hand.
I developed a Zen approach to it all. I learned to do what I could and accept those I could not. It was a hard way for me to deal with my control issues, but I took it for the lesson it was. And I found out it's amazing what I could do when I put my mind to it.
At my teacher's suggestion, I kept a diary of both trapeziectomies. Below are excerpts concerning my second operation.
Jill's arthritis diaries
Because I'm sixty, I was required to take a physical to see if I can withstand the doctors going in and carving on me. It's annoying, but nothing painful. The guy that draws the blood is done before I even have time to flinch. Nice. Plus, he's easy on the eyes.
Ten days before surgery I quit my daily doses of N-SAIDs (I take prescription Etodolac)—something about effects on the blood. Wow! All the little arthritis spots that run throughout my body jump out. Those little pills were wonderful for controlling pain! I miss them! Still, I suck it up and do what the doctors tell me to do. I keep thinking, "Power octaves, power octaves."
When I come out of surgery, my hand is all bound up in nice clean gauze with only my fingertips showing. They look like little Vienna sausages. The nerve block I was given during surgery killed the pain for twenty-four hours. I highly recommend this. That nerve block is a wonderful thing.
After the surgery
Week One: Wednesday, 6/15
High on pain meds, slept, watched television. A good friend comes over to stay with me. This is important, as I am totally wiped out from the meds.
I'm pretty useless—I can't do much of anything. Thank heavens I thought ahead and cooked and froze meals in preparation for this endeavor. I also lined someone up to clean the house for the week. My poor husband Jim is bringing me food and carryout when he gets home from work, not that I am very hungry. Wish I had lined up someone to stay with me the whole week. We will survive.
The nerve block wears off about noon. I'm one of the lucky people. I was told a block usually lasts eight-twelve hours. The lucky few will feel the effects for twenty- four hours. Woo-hoo.
Pain sets in, but so do the meds. Thank goodness for modern pharmacology.
Going to physical therapy. I am already moving my fingers! If there is one thing I learned from the first surgery, move your fingers as soon as possible! Those tendons tighten up quickly. Having said that, don't over-do. Tendonitis is a painful thing in itself.
I now have a new BFF (Best Friend Forever)—Meg, the Physical Therapist. I will see her twice a week until it is deemed I can come once a week.
Meg takes off the wrapping and shows me the head of the temporary pin (looks like the head of a hatpin) that's holding my bones in place while the scar tissue fills in the hole left by the bone removal. She shows me how to clean the area by pouring a little hydrogen peroxide on it, and then wiping it with a Q-tip. I feel nothing except a little coolness.
She also shows me how to rub the scar with Neosporin to desensitize the area. It's pretty tender at first (really tender, actually), but, after about a minute of her rubbing it, I am able to tolerate the pain. She tells me to do this for five minutes, four times a day and that I won't hurt anything by doing this. The purpose is to desensitize the area and make the skin flexible. I say, "Yes, Ma'am." As I said, Meg is my new best friend.
Meg makes me a removable splint. It begins about two inches from my elbow and goes to the base of my fingers. My thumb is covered up to the base of the tip.
And, yes, still high on pain medications. So what do I do? I take my son Brian out to lunch. He laughs at me because I'm so goofy, but I don't mind—how could I? I'm on those meds.
The pain is subsiding, so I don't need the medications so much today. Still sleep and watch television. Thank goodness we've got a big flat-screen - my second new BFF.
It's back to the therapist. I see Lauren, my third new BFF. She says the rubbing is working and to keep it up. Yay for small victories!
Week Two: Thursday, 6/23
Back to see Meg. Everything's fine with my hand. She makes me an exercise splint and shows me how to work my thumb—top two joints only. I also work my fingers—make a fist, straighten one finger at a time—up and down, up and down. Those tendons get tight fast.
Starting to get tired of television. Reading is a little tough, though, because I can't hold a book and turn pages. Heavy sigh.
A little diversion today. It's the annual picnic for my science club, a lovely collection of mathematicians, chemists, engineers, etc. I make green bean casserole. It was pretty easy for me to do. Jim just has to open all the cans for me.
This is a tiring, but fun day. It is my first time driving, no problems; the car handles well. It's good to get home, though, and get back on the couch.
Week Three: Tuesday, 6/28
Grocery day! Going to the grocery store has become a highlight of the week. It's just long enough to spend out of the house without becoming too tiring.
I still can't do much with the hand because the scar tissue is still filling in and firming up. It doesn't hurt, and that's good.
This is the last week before the pin comes out. The weeks have become routine: groceries on Tuesday, physical therapy on Thursday, lunch with friends scattered throughout.
The big difference this week is (wait for it)—I start my piano lessons back up. Granted the left hand might as well be dead to me, but I figure I can use this time wisely. All this is very exciting, and I'm glad to get back into action—anything to get me up off that couch.
Week Five: Wednesday, 7/13Big doings today:
- Off to the doctor's to get the pin out.
- To physical therapy for my first real exercises. These have to do with mobility; no strengthening ones yet.
- Piano Lesson
The physical therapist is starting to get me to move the thumb more. She gave me an exercise splint so that I could move the tip of the thumb without moving where the scar tissue is attached. She gave me some "putty"—stuff that reminds me of Silly Putty. I wrap it around my fingers and try to spread the fingers out. Then, I try to collapse the putty with the fingers. I'm not engaging the thumb yet. I also flatten it on the table and push, and then pull it with each finger. This is tedious, but I know it is strengthening my fingers.
Throughout the past week, it has been difficult to practice as much as I wanted. My right hand isn't as strong as I would hope, and I was only able to work about twenty minutes a day. I suspect sitting around being medicated is making it difficult to practice. It's amazing how having an operation on one hand affects the whole body. But that's all right. Baby steps, baby steps.
I ask Meg some questions when I go to see her for physical therapy.
Jill: What do you find that surprises people about this operation?
Meg: Two things really. First, that is takes quite a while to recover- twelve weeks MINIMUM. And second, that this is a "salvage" operation. Things will not go back to normal. You have to take care of yourself forever after this surgery; this is not "100% cure." Stay smart. you do not have a "bionic thumb" now.
Jill: Are there options in case I mess up anyway?
Meg: Yes. There's something called "Ligament Reconstruction and Tendon Interposition" or LRTI, for short. This is an operation where the doctor removes a tendon from the forearm and uses it to rebuild ligament support for the thumb. This does not affect any movement in the arm or wrist. If this operation doesn't work, then there's bone fusion.
Jill: Have you ever had patients that "blew" out their scar tissue from the trapeziectomy?
Meg: Yes, there was one woman who tried to do too much way too soon. She thought everything was "back to normal" and she could get on with her life without any changes.
Jill: Then what advice would you give to prevent the same happening in someone who's had this surgery?
Meg: I'd tell you the following:
(1) Break up your work sessions.
(2) Don't over-do it.
(3) This is a very common procedure that has very good results- if you're sensible.
(4) The therapy is not difficult - you just have to be consistent.
(5) NO piano playing till eight weeks MINIMUM.
(6) You can begin your full practice schedule after six months.
(7) For the rest of your life: be SMART about practicing. Take those breaks.
(8) If it hurts the next day, you practiced too much. Slow down.
(9) And for you, your biggest problem will be you'll want to do more than you can, and you can end up having another surgery because you messed yourself up.
Michelle and I start working my fingers this week. We begin by playing on the outside of the hand, engaging the fifth finger. I roll the hand as I hold down the key. The wrist is stiff and the tendons don't want to stretch. This exercise allows the finger to work without requiring much movement on its part.
I see Doctor Due this week to get his inout.
He thinks everything is going quite well. He says I can start practicing piano with the left thumb, paying attention to the pain level. "Your thumb will let you know immediately when you've done enough," he says with a small chuckle. Nice. It's good to have a doctor with a sense of humor.
Seriously, though, I ask him about the operation and its success rate. He says, "If a patient doesn't wait too late, the success rate is very high. This operation has been around for a long time, and there was a time in the past when doctors would replace the bone with spacers, but eventually these would fail. Why not go to the final solution first, and let the scar tissue fill in and support the thumb? With care, this will fix the problem permanently. You have to remember we're replacing bone with scar tissue, which, while very strong, is not bone. You can tear it if you abuse it, so you have to be moderately aware of what you're doing. Having said that, it takes a lot of abuse to tear it out."
So it's back to more strengthening exercises for the fingers with the Physical Therapist. I'm continuing on "range of motion" exercises for the thumb. I've also started a fun exercise in physical therapy. Remember "LiteBrites" from when you were a kid? Well, I get to play with one—it takes about twenty minutes start to finish. First I take a peg out with one finger and the thumb, roll the hand out to make sure I have it; then I put it into the pegboard. Then I take another peg, out, using a different finger. I do this over and over, using all the fingers. When I finish, I get to reverse the process and take the pegs out one by one, making sure to roll the wrist each time. It's amazing how truly difficult this can be. I have to laugh at myself. It's a humbling experience.
The physical therapist has given me a new toy to work with: the Jux-a-cisor. The purpose of the tool is to get the washer from one end to the other, holding the elbow at the side and maintaining a firm grip on the handle, so that only the wrist moves. I liked it so much, I went on the Internet and bought one. I'll probably use this every day until I quit playing the piano or die—whichever comes first.
Then it's practice, practice, practice. My left hand is getting stronger and stronger. It's hard to remember the physical therapist's advice and not over-do.
This week, Michelle comes up with some exercises involving gentle use of the fingers. Oddly enough, when I spread my hand, my thumb felt great—just a little stiff but no pain—but the left side of my hand hurts when I stretch out my fifth finger. A puzzlement, indeed.
This is about enough for me. I can't really play repetitive notes yet, but just holding down a note is all the work I can do for now. Baby steps, baby steps.
I'm starting to see students again. I can't really play a lot, but I can play some. It's good to hear my students a cappella, which turns my liability into an asset.
Week ElevenMy fingers are becoming more flexible. My hand doesn't hurt as much as before, but there is still residual pain under my fifth fingers. I'm beginning to suspect working on the computer may be part of the problem. Michelle says as much at my lesson.
Okay! This is the week I can begin to pinch (gently) with my thumb. It's been a tough past three months, not being able to close a Zip-lock bag, work a button or zipper, open a jar, or hook ladies' underwear— anything involving grasping and holding. Try functioning without using your thumbs. You will quickly understand why humans rule the world instead of dogs!
I have been given the go ahead to play the piano with my left hand. We begin!
I pulled out "Helft mir, ihr Schwestern" from Schumann's Frauenlieben und Leben. Since my goal is to accompany my students, I wanted to see how things stood. This can be a daunting piece to play, so I am using it as a measure of my progress. Interestingly, and very pleasantly surprising, I played it better than I've ever played before! I lay this to the work I've been doing with some finger exercises, including "The Little Pischna." I can't really play much with the left hand yet, but the right hand is much smoother and freer than I've ever played before. I look forward to further progress.
Remember the warning about not overdoing? Guess what—I didn't heed it and now my fifth finger is suffering. I have to watch out and not really exercise it this week. I tried to give my hands some time off and not practice as much, but now that school is in session, I've been playing for my students. Slow. Slow.
It's been four and one-half months since the surgery. I ended the physical therapy at week fifteen, and was sent on my way like a fledgling being pushed out of the nest.
I also had my last visit with Dr. Due. He said I was fine, and to keep doing my exercises. The thumb is still tight; when I spread my hand I feel tightness at the base of the thumb. He said this was fine; it was the scar tissue and tendons doing their job. If it were loose, that would mean the operation was a failure and it would have to be repeated.
As if my body wants to remind me not all is perfect, I found out that arthritis (again!) is the cause of the pain at the base of my fifth finger. There's a little bone called the pisiform that floats above the wrist. Of course, mine doesn't float anymore—arthritis has fused it with the bone next to it. The doctor says he can cut it out if I want. After going through all this, I'm in no mood to be carved on any time soon. He says he could give me a shot of cortisone and see if that helps. I'll go that path.
I know that my thumb will get stronger and more flexible with each day. It will take a full six months for the scar tissue to set in the space left by the missing bone. But what a wonderful Christmas present I've given myself—Power Octaves!
My Definition of Trapezium: a little bone that causes big problems for piano players when it is attacked by arthritis.
My Definition of the result of a Trapeziectomy: A life-saving operation that gives back the ability to play scales, arpeggios, power octaves- and dreams.