How doctors lanced a lump in my wrist… and saved my music career: Anna Karenina violinist reveals how procedure saved his livelihood



21:01 GMT, 13 October 2012

Fit as a fiddle: Jack Liebeck suffered a sharp pain in his hand when he bent his fingers, but treatment solved the problem

Fit as a fiddle: Jack Liebeck suffered a sharp pain in his hand when he bent his fingers, but treatment solved the problem

When Jack Liebeck developed a dull ache in his right wrist, it wasn’t just the nagging pain that troubled him. As a virtuoso concert violinist playing with some of the world’s leading orchestras, his bowing arm was his livelihood.

Jack is also a recording artist – he recently worked on the film score for Anna Karenina, starring Jude Law and Keira Knightley.

‘At first I thought I might have sprained my wrist lugging my suitcase – I tour a lot,’ says Jack, 31, who is also Professor of Violin at the Royal Academy of Music in London.

‘But weeks went by and the pain just continued to throb. And though I could manage to play, whenever I bent the fingers of my right hand forward towards my elbow, I’d get a jabbing pain. It also really hurt if I applied any weight to the hand.

‘As time passed, it started to get more and more uncomfortable. As a professional musician, you can be playing up to eight hours a day. That started to make me a bit scared – I’d think twice about practising when I wasn’t performing as I was frightened of doing any damage.’

Having dabbled with home treatments such as applying ice, Jack consulted a physiotherapist, who carried out an ultrasound scan to try to identify the source of the problem. The test revealed a lump, about 2mm wide, in his right wrist.

‘Just looking at my wrist, it wasn’t visible, and you couldn’t feel the lump even if you pressed. But the physiotherapist suggested I should be referred by my GP to an orthopaedic surgeon to find out what this could be,’ says Jack, who lives in North London with his wife Victoria, 27, a violinist with the Liverpool Philharmonic Orchestra.

Jack was diagnosed with a ganglion. These are fluid-filled sacs that form when synovial fluid, the natural lubricating grease found in joints and tendons, leaks into the synovial space to create a small cyst. Not all are painful, but Jack’s was, because it was putting pressure on a nerve.

They can occur in any joint, but are most common in wrists and knees. Often there is no specific cause, but sometimes ganglions form after a joint or tendon is overstressed.

As the fluid builds up, pressure intensifies and the cyst grows.



They are also known as ‘Bible bumps’ because the traditional treatment (although not recommended today) was to hit the usually visible lump with the Bible or any heavy book, which would hopefully rupture the sac and disperse the liquid.

Though some can clear up by themselves, the fact that Jack had already had his for a year meant that was unlikely. ‘Any kind of procedure which made a fraction of a difference to the way I moved my arm, wrist and fingers could have a massive impact on my playing,’ he says.

Fortunately, the doctor who treated Jack was John White, a consultant hand and upper-limb surgeon who has a particular interest in musicians. He has established a Musicians’ Hand and Upper-limb Clinic specialising in musicians’ orthopaedic problems. He works privately in Harley Street but his treatment is available on the NHS at BMI’s The Garden Hospital in Hendon, North London, if musicians are referred by their GPs.

‘As a musician myself – I started studying the piano when I was six – I understand the psychological and physical challenge of injuries that are triggered by or affect playing,’ says Dr White. ‘Jack had what’s known as an occult ganglion – one that isn’t visible to the naked eye. Surgery for this can be carried out as a keyhole procedure. But any operation that creates scar tissue can make the movement of the wrist stiffer and it may take longer to heal.

‘So there could be the risk of disturbing the subtle balance of the wrist and tendons. In someone with a regular job, this wouldn’t make any difference. For a musician, though, surgery should always be avoided.’

Instead, Dr White chose to treat the condition with an outpatient procedure, carried out under local anaesthetic and known as needle aspiration. Under the guidance of a CT scan, a needle is injected through the wrist and into the ganglion. The fluid that has built up is drawn out to reduce the swelling. The syringe is then changed and filled with a steroid medication. The steroid promotes healing, which then closes the weakness in the joint.

Jack says it was surprisingly painless. ‘It was over in five minutes and I couldn’t feel a thing.

‘Afterwards, my wrist was bandaged and I felt a slight ache for a few hours. But having slept it off, I felt fine the next day.’

There is a 50 per cent recurrence rate after needle aspiration ganglion treatment. With surgery, this drops to ten per cent. However, the procedure is easy to repeat.

Jack adds: ‘I was lucky to find someone who really understood musicians and who was sympathetic to what I needed.’