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My son plays mostly with a pick and some classical. He has some pain and has been diagnosed with mild carpal tunnel syndrome. Are there any recommendations for subtle changes in right hand position that minimize the effects of carpal tunnel?

I've suffered but mostly left hand. I would strongly recommend stopping playing completely for as long as you can bear, you really dont want this recurring, I first had it at eighteen and still get it on and off and am now thirty four. It's really got me down at times. look at other activities that might be excacerbating it, the weight on my wrists cycling really didnt help for me. As far as guitar ergonomics I'm not an expert but i went to see some and they watched me play and made suggestions. It was mostly to do with the wrist being straight so the tendons have an easier time of it but I would advise seeing someone good. Doesn't have to be music related, I saw a sports injury guy at one point who was very helpful.

years ago when i was gigging 3-4 nights a weeks i ended up with pretty severe carpal tunnel. so bad i couldn't even start my car with my right hand. i started getting acupuncture, that and rethinking how i held the guitar and learning to relax my arm while playing saved me. it would be hard to suggest how your son ought to change his posture without seeing him and i'm certainly not qualified to give any real advice but from my experience posture and tension are the things to think about. good luck!

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Yes, rest and recovery. That's the very first course of action. Continuing to play on an injury is likely to make things MUCH worse. If you tore a muscle in a leg you wouldn't be advised to carry on trying to do the 100 metres in 10 seconds! You wouldn't be advised trying to do it in 100 seconds either.

The theory states that the hand should maintain a straight line with the forearm, the hand neither canted to the left nor canted to the right.
Over arching of the wrist (both arms) should also be avoided.
Playing or practice time (after he's cured) should be done in relatively short bursts, say 15 minute sessions and then rest for 5 minutes. Perhaps he should also go through some basic warm up sessions even before picking up the Guitar. It requires discipline but don't take this stuff lightly. It can get very serious, severe injuries can lead to never playing the instrument ever again.

https://www.youtube.com/watch?v=5KydzlD2rng

Although he is referring to the left hand and Classical Guitar the basic ergonomics stay the same, irrespective of the style of playing.
Another very common problem seen amongst Guitarists is the shoulder being pushed forward, one or both. Any deviation from a 'neutral' position can lead to severe problems. It's quite possible that the underlying cause of the carpal tunnel lies not in his hands or arms but much further away in the upper back. Once you are 'out of shape' it can have consequences that are seemingly unconnected. Having said that there are a great many musicians who maintain awful posture but somehow go through life without the usual injuries. I guess they are the lucky ones.
Send him for a lesson with someone who is very familiar with posture problems. It may only take one single lesson. Playing plectrum and some Classical may make things a touch more complicated but there's no reason why it can't be diagnosed.

Please take up this issue with your son's medical care givers -- no matter how eloquent, Internet health commentary or anecdotes cannot replace expert personalized professional advice and direction.

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Ken Cierp

http://www.kennethmichaelguitars.com/

What Ken said, he needs to understand his condition and what he can do to live with it. I've been living with carpal tunnel for 40 years. It started when I was working as a carpenter. Many of the older musicians I play with also have it to some degree. Not unusual to see us older guitar players shaking our hands between songs to try and work out the numbness. Mine is aggravated if I do manual labor such as carpentry, cutting firewood, etc. When it gets bad I wear a brace on the affected hand while I sleep which helps a lot. Don't ignore it, carpal tunnel can become very debilitating if not managed properly. Find a doctor who has a background in carpal tunnel treatment, figure out the options and go from there.

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Steve Smith
"Music is what feelings sound like"

Yes, he is seeing a doctor. By the way, he is 45. He had and EMG Tuesday that showed slight nerve damage, presumed to be from carpal tunnel. His hand specialist is out of the office for a while. My experience with MD's is that none of them knows everything, which is the same for any profession or craft. People who have experienced similar things often have good advice. I think the advice is good that the medical professionals might actually watch him play and be able to see positions that he should avoid. He has recently increased his classical training, so that might be it. I sent him a video of a classical guitarist who holds her wrist straight, as some do, unlike the right-bent wrist that most of us do.

FWIW a friend of mine had it bad. She dealt with it for years. She would wake up every night with intense pain. It's amazing what people can put up with over time. She went and got surgery and it's completely gone now.

I think the right bent wrist came from the Tarrega/Segovia school of thinking. That's how I used to hold my wrist. Why wouldn't I? It was the late '70's and Segovia was God.
It took me years (more like decades) before I started playing with a straight wrist. Some of these habits are very difficult to shake off. Unfortunately there were many years when I just didn't play because of pain. The modern school is much more tuned into this kind of thing although I'm pretty sure that Sor had it worked out back in 1800! Most of the modern classical players are playing with a straight wrist. It isn't often you see players with that exaggerated deviant wrist anymore.

In my orthopaedic career it seemed like carpal tunnel syndrome was an epidemic in west central MN. We saw and treated a ton of it. What it is is a compression of the median nerve at the wrist causing positional numbness commonly at night. If there is a positive EMG and classic symptoms and conservative treatment fails surgery works great for the numbness. It is quick and safe in the right hands.

Commonly the nerve compression is caused by inflammation of the surrounding tendons from whatever cause. Occupational, overuse, inflammatory arthritis, etc. Surgery will NOT help the tendinitis pain only the numbness.

The flexed wrist position typically aggravates the nerve compression that's why night splints help.

With only a mildly positive EMG and a probable cause for the inflammation, a combination of a straighter wrist and the usual non-operative stuff like night splints, anti inflammatory meds, and maybe a cortisone shot in the carpal canal may have a high likelihood of success.

This is a situation where an experienced classical guitar teacher may be as important as the doctor.

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It's not what you don't know that hurts you, it's what you do know that's wrong.

Ever seen Stanley Jordan play ? Notice how his wrists are bent in these strange positions ? He now says this is a bad idea. For a while I was into the tapping guitar / Stick scene and they like to advertise that holding a guitar vertically in front of you is much better for your wrists.

As far as building, on the days after I do a lot of planing (almost everything I do now is manual), I am really hurting, more in my hands than wrists.

http://www.paul-galbraith.com/engl/bio.htm

Paul Galbraith holds his classical like a cello.

I suffered from carpal tunnel from many years. Relief only came to me when I didn't do the things that irritated it. Even then they were marginal improvements. I finally had the surgery, first on one hand and then the other a few years latter. That was 35 years ago and still no return of symptoms.

I would say try physical modifications and treatments and see where that takes him. But when it is all said and done, most likely he will need surgery if he wants to be able to do what he needs to with his hands.

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Joe Beaver
Maker of Sawdust

My life partner Mollie suffered with severe carpal tunnel symptoms for many years and resisted the surgery. In April she had the procedure done with a specialist who had done over 3,000 using an endoscopic technique requiring only small punctures. Both hands at once, good hand function almost immediately, could wipe her butt that night totally amazing results all pain gone. The old technique requiring a long cut is still done, another ortho guy tried to tell her the results were better, after research we found some studies that kinda proved that but not really, if you need the surgery get it, if we knew how easy it can be would not have waited.

Guitar Foundation of America has an issue of Soundboard magazine dedicated to healthy hands. It's Vol. 40 No. 2, It might be worth getting. There's 5 articles with at least one being written by a MD/guitarist.

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Jim Watts
http://jameswattsguitars.com