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Double Bass Any suggestions for my student

I have a student in his early sixties. He has arthritis in his left hand, fourth finger. The fourth finger is also shorter than average. He is functioning fine on the D and G strings with the typical Simandl fingerings. He also seems to be able to use the fourth finger on the E and A in lower positions.

The problem comes around IV position. I noticed he was having problems with his hand shape when playing the F# on the A in IV. I tried to alter his instrument angle, his elbow elevation and his wrist angle. Nothing seemed to help.

His hands are, however, large enough to use the third finger for the F# in IV. As some methods employ 1,2,3 and 4 in the middle positions I suggested using the third finger until we can further diagnose the problem.

Has anyone encountered problems with the fourth finger in middle positions that aren't also present in the lower positions?
If so, what solutions did you find effective?

Extra note: He is a standing player. I am considering having him sit to achieve a more cello-like angle, reducing the distance he needs to reach to access the lower strings.
 
Using 3rd finger instead of 4 in 4th position is actually not uncommon. For one, I know from a lesson with him that Owen Lee (Principal bass at Cincinnati) uses 3rd finger and he keeps it pretty consistent through all of the orchestral passages and solos. I would just maintain consistency with all 4 strings, and i just mean that if he is going to use 3 instead of 4 on the lower 2 strings, to do the same with G and D. I am guessing that sitting will also help the problem. I am not aware of any 4th finger problems specific to middle positions except that it may be a bit more difficult to get a good vibrato there for beginners.
 
3rd is fine in those positions, really. I use it sometimes when sight reading (although, if I know the piece, I won't normally).

If you want him to get a more cello-like position, but remain standing, consider the Laborie endpin? It might be controversial, but if it makes you more comfortable, then go for it. Also, make sure his fingers are always pointed down (towards the bridge) instead of up! ;-)
 
The 3 1/2, 4 and 5 positions are where the short little finger really starts to impact. I have a student whose first three fingers are the same length and the pinkie is short yet he can handle the Koussevitsky and Ditttersdorf concertos fairly well. It is not pretty to watch but he buffaloes his way through from 3rd Position up using 1 2 3 in moving passages.

If the fingers turn a little towards the bridge this might make the stretch to F sharp a little more comfortable. To lose G and D with the pinkie in 5th position is hardly a big deal. There are four other better-sounding fingering possibilities that are generally more practical. Choose 4th position to drop the pinkie and use 3rd finger on all strings as a regular changeover point from 1 2 4.

Dp