Prosthetic digits for a professional musician : the journey from classical Spain to Hawaii

Excerpt

A 56-year-old gentleman sustained traumatic amputation of all four digits of his left hand after a circular saw injury proximal to his interphalangeal joints. Vascular replantation was not attempted due to the extensive crushing injuries to the digits with gross comminution of bone. Reconstructive surgery was limited to the fashioning of four digital stumps each approximately 20 mm in length. Initially, the patient who was a semi-professional musician at the time was severely traumatised from a psychological point of view. He needed follow-up with clinical psychologists for support and therapy to cope with the injury for several months after. At this stage, he gave up playing the guitar and adapted to his disability over the following 18 months, with a gradual diminution of anxiety and other symptoms suggestive of post-traumatic stress, including flashbacks and persistent and intrusive thoughts. Four years later, he approached the Prosthetics Department, dissatisfied with the appearance of his hand. After consultation he elected for silicone prosthetic fingers. These were designed to match in size and colour as closely as possible his own natural skin colour, and he reported great satisfaction with the cosmetic improvement he obtained. On the patient’s own volition and in spite of explanations that prostheses would very likely have no functional benefits, he returned speculatively to playing the classical guitar and jazz piano in the band he had formerly played with. He reported early success in returning to playing the piano. After a period of struggle when using his left hand to execute chords on the classical guitar, he elected to learn to play the Hawaiian steel guitar. This instrument is played from the lap or on a stool in front of the seated player. Contrasting the classical guitar where strings are pressed against a fret and require agile digital co-ordination, when sounding a note, rather, the player holds a metal slide called steel (or tone bar) in the left hand, which is moved along the strings to change the instrument’s pitch while the right hand plucks or picks the strings. The result of playing with this method is the restriction of the number of chords that can be played. Hence, lap steel music’s concentration is on melodies, a restricted set of harmonies such as in blues. He additionally reports a generalized improvement in his hand function with a satisfactory grip for grasping eating utensils and reports a marked improvement in his psychological wellbeing, in no small part aided by his return to music. …