Anyone who’s been reading Keith Richard’s excellent autobiography will be impressed how he has survived many years of rock and roll, drugs, booze and complicated women. Those with more than a passing interest in rheumatology might have noticed that Keith’s fingers may be aging slightly less well than the rest of him.

These pictures, taken by Francesco Carrozini makes it obvious to this rheumatologist, that Keith has well established osteoarthritis (OA) of his fingers.

Most of us who live long enough will get OA in some shape or form and it is by far the commonest form of arthritis.

The particular type of OA that causes the swelling in the distal finger joints is known as ‘nodal OA’ – so called after the hard and bony ‘node’ like swelling it causes in affected joints. Nodal OA can be very painful at the outset (as the bony swellings enlarge) but it is not uncommon for the pain to ease up a bit once the joint stiffens up and no longer moves properly. Its easy though to see how OA of the fingers could cause significant problems for any player.

Anyone who’s even tried to learn a few basic guitar chords will realize how much force and dexterity are required in the fingers of the fret hand to play an F barre chord – simultaneously firmly holding and index finger across all six strings and at the same time getting the middle ring and little fingers to hold three other strings.

All guitarists (soloists in particular) need a high degree of dexterity to allow their fingers to move quickly around the fretboard with precision and considerable strength. And that’s just the left hand! In addition to the difficulties caused by pain and stiffness of the joints, the enlarged bony nodes can get in the way and make unwanted contact with guitar strings.

Although there has been some speculation in the media that his playing may have contributed to the development of his arthritis, there’s no evidence that playing any instrument wears joints out quickly. Musicians get arthritis, just like the rest of us.

Playing related pain is very common in guitarists though and occurs in between 70% and 80% of them. Most problems relate to the fret hand and wrist (i.e. the left for most players), low back and neck. Guitarists also suffer from shoulder impingement, tennis elbow, wrist tendonitis, carpal tunnel syndrome, finger tenosynovitis / trigger finger and non specific forearm pain. The symptoms relate primarily to the postures adopted playing the guitar, supporting a heavy instrument, moving heavy amplifiers and equipment, long hours of practicing without breaks, increasing practice time to quickly after a lay-off and lack of aerobic fitness. Stress, sleep disturbance and depression will also influence how these performers experience pain and how they present.

Over the years Keith Richards has also made changes to his playing technique which might have made it easier for him to perform as he gets older. In the late 60’s he started using a form of guitar tuning called ‘open tuning’ (which allows a more economical use of the fretboard compared to standard tuning) and started using a 5 string guitar (a standard guitar has 6 strings). On describing this adaptation, he says; ‘there’s a million places you don’t have to put your fingers. The notes are there already’. Keith Richards’ continued ability to perform in one the most hardworking bands in the world is likely to relate to far more than changing his guitar tuning or to his legendary physical constitution. For Keith Richards and for most musicians, giving up music is simply not an option. His observations about the addictive qualities of music and performing give us an insight into the addictive qualities of creating and performing music; ‘a far bigger drug than smack. I could kick smack. I couldn’t kick music. One note leads to another, and then you never know quite what’s going to come next, and you don’t want to. It’s like walking on a beautiful tightrope.’

Health care providers encountering musicians need to be as persistent and as creative as the people we’re caring for in finding solutions to keep them playing. Remember that losing the ability to play music is for many musicians, akin to losing part of themselves.

PS. It has of course occurred to me that by drawing attention to Keith Richards in this way, that I might offend him in some way. Bearing in mind his propensity to throw knives at people who have upset him in the past, I include a link to the Keith Richards Merchandise site to take the edge off his ire. His autobiography, Life, is excellent too.

Dr. Ronan Kavanagh is one organisers of ‘Keeping the Show on the Road’ of Irelands’ first international conference on Musicians’ health which takes place Saturday October 13th 2012 Radisson hotel Galway