Hand operation shows how the body will heal itself

Hand operation shows how the body will heal itself
An unusual procedure called a 'healing cascade' saved a pianist's career.

By Frances Glover
Published: 7:00AM BST 14 Jun 2010


Alicja Fiderkiewicz Photo: CHRIS WATT When pianist Alicja Fiderkiewicz played the haunting opening notes of Franz Schubert's Sonata in B flat major at a small Cumbrian music festival last July, it was with more emotion than usual. The internationally renowned musician had tackled the challenging work many times before, but on this occasion, it was with the knowledge that it could be her last performance – of any work, in public or in private.

But passion and determination were not enough for Warsaw-born Alicja, who studied piano at the Moscow Conservatoire as a child before attending the Royal Northern College of Music in Manchester. The award-winning pianist, 58, who lives in Carlisle with her husband David, also had to rely on strong painkillers to see her through the piece. In agony from a tendon injury in her left wrist, she was about to undergo a make-or-break operation.


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Less than a week later, Alicja was operated on by consultant hand surgeon Mike Hayton at Wrightington Hospital, Lancashire, in an unusual procedure where he made a surgical incision in order to cause the body to react, triggering a "healing cascade" whereby the body starts to heal itself.

Alicja had first experienced pain in November 2008, following a performance of the same Schubert sonata. She had suffered soreness in her hands in the past – "I have small hands for a pianist which makes the big works very demanding and tiring," she says – but she had never had trouble with her joints before. But, two days after the concert in London, she felt an ache in her left wrist. Over the next few weeks she continued to practise, ignoring the twinges that were becoming more frequent and uncomfortable. Eventually, she was left with a permanent, dull ache.

"I took Christmas and New Year off on holiday in Cyprus, hoping it would do the trick, but when I came back to playing, the problem was worse. I often couldn't play at all for the pain."

She was initially referred to a local orthopaedic consultant, but unsure what was causing the problem, he was reluctant to operate on an exploratory basis because failure could have ended Alicja's career. Instead, he referred her to Mr Hayton, who is known for his work with sportsmen who often need procedures with the same type of career implications.

After an MRI scan and examination, Mr Hayton concluded that the tendon that passes around a tiny bone called the psiform – a small knobbly, pea-shaped bone located where the ulna (inner bone of the forearm) joins the wrist – was inflamed. The cause was unclear, but no doubt related to Alicja's dedicated hours of practice.

Initially, Mr Hayton tried steroid injections into the site. "They were not very nice," says Alicja. "The needles looked large enough to use on horses, and I suffered a reaction to the medicine that made me feel sick and kept me in bed for a day or so each time."

It was just after playing at the annual Melmerby Music Festival in July last year, which she helps to organise, that she went into hospital.

Mr Hayton explains the procedure. "After consulting with orthopaedic surgeon, Ian Winspur, who specialises in musicians, and a colleague at the Mayo Clinic in the US, I decided to open up the wrist, and make an incision through the tendon exposing the psiform," says Mr Hayton. "Then I drilled four tiny (0.1 mm) holes into the bone itself, which had the effect of inducing a 'healing cascade'.

"What we did was to stimulate the bone, stirring up the body to react urgently to a now acute situation. Opening the bone meant chemicals released by cells in the body to promote healing, could pass from the bone marrow out to the area of tendon that was inflamed.

This was also assisted by more blood flowing into the area, bringing healing white blood cells." In effect, Mr Hayton made the situation more acute so the body would react to the emergency and make it better by itself. The surgeon carefully closed the incision with two dissolvable sutures and the 30-minute operation was over.

Alicja's wrist was in plaster for four weeks – a tense time, when no one knew whether the operation had worked. When it was finally removed in September, she waited three days before approaching her piano with trepidation. "It was terrible – I put my hand on the keyboard and nothing happened – my fingers wouldn't move. I thought: 'Oh my goodness, it hasn't worked. I will never be able to play again.' "

But, Alicja worked on her recovery, bathing her wrist three times a day in sea-salted water, which she found helped suppleness, and following prescribed exercises. Within two weeks, she started to notice a difference. The pace of recovery increased and by November she began to practise again fully, always careful not to overdo her sessions. The pain had gone, but the memory of it was strong.

"I held a masterclass in February this year and then on April 23, I played my first full concert – a performance of works by Chopin and Schumann – with no problems at all. It was wonderful and perhaps even more emotional than ever."