Case History

Female 61 years old. Piano Teacher.

Slipped on mud and fractured her left wrist. It was put into a cast for 7 weeks.

When the cast was removed, her hand was flexed relative to her wrist. She was only able to play the piano for a very short time. There was a pain going up to her lower left arm to the elbow.

She came to see me because, although she had had physiotherapy, and the muscles were strong, it still affected her work and quality of life.

Examination

She had reduced rotation of the left hand – unable to turn it fully palm up and palm down. Flexion and extension of the wrist was diminished. When she spread her fingers wide there was a reduced distance between thumb and little finger compared to the right hand.

The muscles of the forearm were tight and painful especially up to the outside of the elbow. One of the bones of the forearm had been shunted towards the elbow relative to the other bone of the forearm. This then affected the alignment of the bones of the hand.

Treatment

This was undertaken over 5 treatments.

• Myofascial release of the muscles of the forearm.
• Realign the bones, thus enabling her to fully rotate the palm up and down. Realign the wrist.
• Fascial stretch from the shoulder to the hand.
• Exercises to help stretch the muscles up her arm and across the palm.

Outcome

After treatment, she was able to play complex piano pieces and to demonstrate passages of music to her pupils.