Wind and brass players get hand pain from two things: HOLDING THE INSTRUMENT’S WEIGHT in awkward wrist positions, and squeezing harder than the keys or valves need.
The common results are thumb base overload, De Quervain’s, a sore and sometimes numb spot at the base of the left index finger in flautists, and nerve symptoms from long hours with the elbows bent.
Supports, straps and grip aids fix more of this than stretching does.
What each instrument asks of your hands
- Flute. The flute rests on the base of the left index finger, with the left wrist sharply bent and the right thumb and little finger balancing it. Arms stay raised and turned for the whole session
- Clarinet and oboe. Fingers spread wide over holes and keys with the thumbs supporting from underneath. Players with small hands stretch to reach
- Saxophone. The strap carries most of the weight, but the palm keys and side keys push the wrists into bent positions, and the right thumb braces constantly
- Trumpet and cornet. The left hand carries the weight and pulls the mouthpiece in. Right fingers work the valves with the little finger in the hook
- Trombone. The left hand and wrist hold almost the whole instrument, off to one side, for the length of a rehearsal
- Horn, euphonium and tuba. Weight and reach. The instrument is heavy and the left hand often grips it harder than the valves require
Your hands should play the instrument. A strap, a stand or a rest should hold it.
What turns up
- Aching at the base of the thumb: thumb base overload, common in the supporting hand, and in some players early CMC arthritis
- Thumb-side wrist pain in trombonists and flautists: De Quervain’s
- A tender, sometimes numb spot at the base of the left index finger in flautists: the flute presses on a small digital nerve. See the nerve map
- Tingling in the ring and little fingers after long sessions with the elbows bent: cubital tunnel syndrome
- Night numbness in the thumb, index and middle fingers: carpal tunnel syndrome
- A finger that catches: trigger finger
- A finger that curls or stops obeying on one passage, with no pain at all: focal dystonia. This one needs a specialist, and more practice makes it worse
The changes that make the most difference
- Flute: a thumb or finger rest spreads the load at the left index finger base. Offset G keys and curved headjoints shorten the reach for smaller hands
- Clarinet and bass clarinet: a thumb rest, and a neck strap or floor peg for the bigger instruments
- Saxophone: a harness instead of a neck strap for long gigs, and palm key risers if you stretch to reach
- Trombone: a left-hand grip aid or support, and resting the instrument on a stand between pieces
- Brass generally: put the horn down between passages. Holding it up through 40 bars of rest is static load on your wrist for no musical gain
- Grip test: once a session, play a phrase with deliberately lighter fingers. Most players find the notes still sound with far less pressure
- Build practice time up gradually before exams, auditions and festival seasons, instead of doubling it in the last fortnight
Getting back to full practice
- Weeks 1 to 2: sessions of 15 to 20 minutes, twice a day, with the support changes in place. Pain during and the next morning at 3 out of 10 or less
- Weeks 2 to 4: add 5 to 10 minutes per session. Slow, easy repertoire first
- Weeks 4 to 8: longer sessions and harder passages. Rehearsals last, because you control the breaks in practice and the conductor controls them in rehearsal
Get it assessed if
- Numbness or tingling in any fingers during or after playing
- A finger that curls, sticks or won’t obey on familiar passages
- Pain present before you pick up the instrument
- A thumb or finger that locks
- Six weeks of changes with no improvement
Pianists, string players and guitarists face their own versions of this. See pianists, violin and cello and guitarists.
For the splints involved, see the short thumb CMC splint and figure-of-eight ring splints.
Let the strap, the rest and the stand carry the weight, so your fingers only have to play.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.