Healthy Piano Playing

Thumb Pain and Tenosynovitis


There are various kinds of thumb pain which can affect pianists and other keyboard players. In this article, I focus mainly on Tenosynovitis (also known as De Quervain’s tendinopathy or tendinitis of the thumb). Some of the exercises described below may also be of benefit to pianists with other conditions caused by stresses to the thumb tissue.

Tenosynovitis is a painful condition caused by inflammation of the tendon sheath, which rubs against the tendon as it slides through the sheath. The pain may be localised in the inner side of the wrist at the base of the thumb, or may spread more widely. Pianists may experience a shooting pain down the thumb on impact with the keys, or a more generalised ache.

Finkelstein’s test (video 7) is a simple diagnostic technique that you can do yourself: tuck the thumb under your palm, wrap your fingers around it, then swivel your wrist to pull the hand in the direction of the fifth finger. If you feel pain where the thumb joins the wrist, then you may have De Quervain’s tenosynovitis / tendinopathy.

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Pianists with tenosynovitis are most likely to experience pain when playing at full stretch, especially when playing forte, or when passing the thumb under the hand in scalic passages. Pianists with small to medium sized hands are more likely to experience Dr Quervain’s tenosynovitis / tendinopathy (because the thumb is playing at full stretch more frequently), and may need to modify their technique and repertoire choices. Pianists with chronic tenosynovitis may consider looking into purchasing a smaller-sized keyboard.

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