Interview with Thomas Lang - Managing Carpal Tunnel Syndrome
Exclusive Interview with Thomas Lang - Managing Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is something that affects more drummers than would care to admit it. It is caused by swelling of the tendons which go through the boney passage through your wrist, or Carpal Tunnel. This swelling can put pressure on the nerves which also go through your Carpal Tunnel, and cause problems such as numbness and loss of control.
Bob Henrit talked to Thomas Lang about his recent diagnosis and operation.
Thomas and I met up at the London Drum Show and he showed me some pretty gory pictures of his hand after he had had the procedure for Carpal Tunnel Syndrome.
How long ago did you know that you had a problem?
I didnít know it was a carpal tunnel problem until I saw the doctor for the first time and had tests done, which was about two years ago. Maybe seven years ago I started noticing numbness, tingling, all sorts of issues, and only about two years ago I finally went to the doctor and had it properly tested. He told me it was carpal tunnel. I thought it was just numbness caused by knots, muscular issues, bad circulation, muscles pressing on nerves. Iíve had all sorts of physical therapy, massages, acupuncture for many years and everybody kept telling me it was a muscular problem. But it wasnít, it was actual carpal tunnel.
Did you have the numbness at night?
During sleeping no. I sometimes woke up with it, but that only happened in the last maybe year and half to two years.
There is a school of thought that says texting is what gives you carpal tunnel.
I donít text much at all and according to my hand surgeon, who is a specialist obviously, the biggest cause of carpel tunnel is anything that requires gripping and vibration - it''s that combination. A lot of bikers, who ride motorcycles frequently, get carpal tunnel. Professional motocross guys, race car drivers, anybody who drives a lot for example, holding on to a steering wheel - a combination of vibration with gripping tightly. That is one of the major reasons for carpal tunnel.
They also say that obesity has an impact, but that''s definitely not you. They were also saying that carpal tunnelís not preventable - itís going to happen and itís genetic.
Yes, he also mentioned that there was a genetic aspect to this, but, in my case, I have spoken to people in my family and nobody has this problem. So it can also just be brought on by activity.
And speaking of activity, do you think that the activity of playing the drums has exacerbated it?
Yes, I think thatís the only reason.
Thatís the only reason?
The only reason in my case and according to the doctor thatís the only reason, because I donít do anything else that could bring it on. The one thing that I do in an extreme way is play the drums.
So has this changed the way you approach drums? Are you still attacking in the same way as you did?
No, I changed many things, including the most fundamental things, like grip, general approach to playing set up, stick size... everything. Iím currently designing a new stick with Vic Firth. Iíve changed my grip completely, from traditional to match grip. Iíve changed my drumstick completely, Iíve changed the configuration of the kit, the set-up, angles, everything. Itís totally made me reconsider everything.
I didnít realised you had changed your grip, so do you play with both styles these days?
I try to only play match grip now.
And do you find itís better?
I find itís better, itís more balanced. I find I have less back issues, I have less general issues with tingling and stuff. My left hand hasnít been done yet, but itíll get done .
Itís going to get done?
Yes. And so I will notice a definite improvement.
So just to rewind Thomas, if you get it in one hand you can get it in the other?
Absolutely, yes. Most people have it in both hands.
Let me rewind through the whole process. When I first noticed this numbness it was only during and after playing for a while. If I played a two hour show, maybe an hour into the show I would realise, between songs, I had to drop my hands down, take the sticks out of my hands, wiggle my fingers, let blood rush back into my hands and it would go away. I could play another two, three songs.
Then it would reoccur, I''d do the same things, or Iíd play with one hand and relax the other hand during playing, so I realised there were certain things I could do while being on stage and performing to get rid of the issues of the tingling and numbness. After a few years of that, I realised it didn''t work any more and then the numbness also occurred off stage, for example when I was holding a pen and just writing, or watering the yard. Just holding something tightly, not even playing hard and in an aggressive manner, but also doing very gentle things like drawing, painting, writing, very, very soft fluid motions even brought on the numbness.
So I realised there was obviously a problem and then the right hand was always the bigger problem for me. Then, only after the surgery, I realised then that for about five years Iíd had no sensation in my fingertips at all. I was texting my wife from the hospital and for the first time in five years I felt contact - when I was texting on the phone I realised. As soon as I was back home on the computer I realised I could feel the contact with my fingertips on the computer, but when I was playing keyboards in the studio Iíd actually felt nothing for so many years. So, only after the surgery, I realised how bad it was, because it was then back to normal.
My left hand which had been the good hand is now the bad hand and I now realise after this right hand was fixed, how bad the left hand really is. Itís one of those things that gets gradually worse and if you donít do something immediately, it gets much worse very quickly. Itís also, as the doctor my hand surgeon confirmed, the longer you leave it untreated the worse it gets and the harder it is to treat. You can do endoscopic surgeries.
I saw the pictures, so you obviously had it cut right open. Why did they not do endoscopic?
I didnít want that because this Brown procedure as itís called, the endoscopic procedure, is something that is less successful, they only cut open a very small part of your carpal tunnel. With the full operation - open carpal tunnel decompression surgery - they cut a big slice of that tunnel out, so you can never grow back together. Thereís an absolute guarantee that there can never be any compression again. Itís safer, itís a much longer recovery time.
How long did that take?
Well, I had the surgery on the 18th July and on 12th August I was performing again at the drum festival in San Jose, so about three weeks later I was performing again.
And was this mind over matter, you said to yourself ďIím gonna do thisĒ?
What did the doctors say? How long is recovery supposed to take?
Everybodyís different, but he told me he had a guy whoís a cowboy and obviously, in his case, he was holding onto the horse and working with the horses that brought this issue on. He told me that after two weeks this guy was hammering and nailing horseshoes back onto the horse.
But he was a cowboy!
He was a cowboy. I said the same thing, Iím not a cowboy, but the guy said that between three and six weeks, everybodyís different, it depends very much on their attitude and exactly as you mentioned, mind over matter.
In my case I was booked at the San Jose drum festival, and I knew that was on 12th August and just before my surgery I had to play the Mexico drum festival. So I had this month, just over three weeks and I decided that was enough time to get it done. The scar wasnít fully healed by the time I played in San Jose, so it was a little painful, but, mind over matter. It was great, that was the first time I played after the surgery and no problems.
How long before you had drum sticks in your hand after the surgery?
So you never had your drumsticks in your hands before that? You didnít sit at a pad or anything?
No. I wanted to wait as long as possible. The thing is you canít get the scar wet, but it was summertime and I was in LA at the beach, pools and stuff, so it was a bit of a drag to have this big gaping wound and the weird Frankenstein looking hand. I actually had two procedures on the hand because I had carpal tunnel surgery and I had a trigger finger release surgery at the same time. They cut this whole thing open, I can show you pictures.
Trigger finger release, is that Dupytrens contraction?
Itís tenostenosis. Itís quite a nuisance. That was the problem that I had and thatís the reason that I went to the doctor in the first place, it wasnít even the carpal tunnel, it was strictly the trigger finger release.
They cut my wrist open to access the tendon inside that allows me to bend my thumb. This tendon had a chronic inflammation that caused a node, like a knot on the tendon. Every tendon runs in a tunnel, like the carpal tunnel here. A knot grew on the tendon from gripping the stick too hard. The numbness caused me to grip harder on the stick and this caused this tendon to get chronically and permanently inflamed, which caused a knot on the tendon. Then this knot doesnít fit into the tunnel any more. Once itís in there it gets stuck and it canít pull it back out and soÖ
Thatís what I had but it was called Dupytrens contraction. But, as you said it ainít gonna get any better, soÖ
My finger was permanently stuck, so I couldnít text, use a remote control or anything. It was really a nuisance and holding a drumstick was a problem too, because I had to actually use my other hand too unclick my finger and then it became very painful. Every time this knot on the tendon was pulled out of the tunnel it got even more inflamed and painful and it was just a vicious circle at that point.
My surgeon said he would do this trigger finger release if he could do the carpal tunnel, because he could not guarantee that the surgery would be successful unless I could feel the sensation in my thumb, which meant that it had to be done at the same time. He didnít want to risk causing me any damage or me not having any sensation, so we had to do it at the same time.
Were you concerned that it might all go badly wrong?
No. Heís a top doctor. You know I had cortisone and steroid injections just to be able to play, perform and tour and stuff? In 2011 I was on tour for three and a half months in Europe with an artist playing every night and this just got so bad, the injections didnít help any more. So I went to see him in the summer and of course he Googled me and I told him Iím a musician and he knew who I was and he said ''Listen, youíre one of the worldís best drummers, right and he said Iím one of the worldís best hand surgeons, trust me with this'' and he told me he does ten of these procedures every day, heís done many other musicians.
And this was in LA?
Does Blue Cross take care of this?
I have private insurance. They do if itís a real major problem, then youíre covered.
Because itís $30,000 for the procedure I believe.
I know itís not cheap, but I have insurance soÖ
Great. Thatís the reason for having it of course. Interestingly enough Carl Palmer had the surgery and he was the first person I knew who had it. Lots of musicians seem to have had it.
OK, so now it''s done...?
One of the most important things is to have good therapy after the surgery. I had four therapy sessions every week , each about two hours long after the surgery. I think that makes the recovery much, much faster and after about two weeks itís almost back to normal.
Do you have to wear a splint at night?
No, after the surgery for about a day I wore a splint and then it was just a soft bandage and a pad to make the scar lay down flat and put a little compression on it. I had the stitches out a week after the surgery.
Have they given you any prognosis about when you have to have the other one done?
Iíll do it as soon as I have some time. Iíll take a couple of weeks off.
There is a new procedure where they put anti-collagen into it. The anti-collagen gets rid of the collagen and then they get rid of the problem with exercise. I didnít know what the little finger did. I knew I had one but I didnít know how important it was.
It steers the golf club, it steers the tennis racquet, but it bounces a drum stick. Youíd think after all these years I wouldíve known that and I didnít.
Thanks a lot for your time Thomas, please let us all know when the other hand is done.
Interview by Bob Henrit
|The surgeon who performed the operation on Thomas is Dr. Glen Cohen|
Man. This looks nothing like the surgery I had. My incision was a mere inch but everything else was about the same. My surgery was three years ago and it has been WONDERFUL! Unfortunately I haven't been able to get my left hand done. Hopefully soon. Glad your hand is better. Good Luck!
Hugh Grubbs, 15 February 2012
I've had both of my wrists done by the same method used in Thomas' case, one privately and one on the NHS. My private op cost £1500, the NHS was free and there was little difference between the two procedures.
What it did do though was free me from years of discomfort and sleepless nights.
He mentions use of steroid and cortesone injections prior to surgery, but any surgeon worth their salt will advise against this as it makes the surgery much more difficult and less likely to succeed.
Iain R Wilson, 19 February 2012
Just to clarify things a little, Carpal tunnel syndrome, trigger finger and Dupuytren's contracture are three medically distinct conditions which all tend to occur in the same patients - so if you get one of them you are at increased risk of getting the others.
Iain Wilson's comment on steroid injection, curiously, is exactly opposite to the truth. CTS which responds initially to steroid injection actually does better with subsequent surgery, not worse. This has been demonstrated in several scientific studies and any surgeon who claims otherwise is exhibiting a common surgical bias.
Jeremy Bland, 27 June 2012
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