Hands - Heat , Pressure and Touch Sensitive

[deedee4]

About 3 mos ago notice my hands hurt more when carrying briefcase, groceries and chopping food.  Hands would be left with a red line whenever pressure was applied. Skin on hands actually doesn't feel as resilient as it used to be.  Also, the skin is very touch sensitive, it hurts to crumble up a piece of paper and push on the end of a paperclip.  Both leave dents in my skin.  

If my hands are down below my heart they take on a red reticulated look.  If I hold them above my head they go back to the normal white color.  Sometimes my fingers will tingle and throb when I've been using them alot.  Also, sometimes I can feel heat coming off of my hands.  If I'm in a very hot room, above 85, my hands will go red and throb.

I am a 46 white female and work at a desk job.  I haven't used any unusual chemicals, metals or machinery.  For 6-8 mos prior to this problem I had been tired and having night sweats.  I also have a problem that I have dry skin all over by body.  Clothes feel like sandpaper against my body.  Also, have red bumps on tongue and it is sore.

I had blood test for lupus and ms which were normal.  My other blood work is also normal, sed rate, c reactive protein and ANA anti-bodies.  All other blood normal.  MRI of brain also normal.  Will be having MRI of spine tomorrow.

Currently taking 200 mg of Nerontin and .375 mg of Xanax daily.  Also taking 10mg of aciphex.  Don't smoke and don't use recreational drugs.  Had been in habit of having 15-20 drinks per week.  Quit drinking about 2 months ago.  Height 5'3", weight 118 lbs, after having lost 10 lbs due to feeling ill.

Family practice, endocrinologist, infectious disease and dermo drs. have no clue.  Some ideas they are throwing out are scloerdema, raynauds and erythromelagia.

What tests would need to be done to rule out any of these conditions.  What kind of dr. should I see that could do these tests.  Do you have any other ideas of what other kinds diseases or tests should be considered?

[Kevin Pho, MD]

For scleroderma, there are several considerations.  The first would be autoimmune antibodies - including anti-centromere, anti-topoisomerase-I (Scl-70), anti-RNA polymerase, or U3-RNP antibodies.  A rheumatologist can order these tests.

The diagnosis of the Raynauds is based on the history alone since there is no simple office test to confirm the presence of cold or emotion induced vasospasm and provocative testing is not recommended.  This most often affects the hand; attacks also frequently occur in the toes, but patients are less likely to complain of lower extremity symptoms. A typical episode is characterized by the sudden onset of cold fingers (or toes) in association with sharply demarcated color changes of skin pallor (white attack) and/or cyanotic skin (blue attack).

Erythromelagia can be a sign of a disease known as polycythemia vera.  A serum epogen level can be considered.  This disease is normally managed by a hematologist (blood specialist).  

I certainly would consider the tests mentioned above to rule out the disorders.  A rheumatology consult can be considered to evaluate for scleroderma and Raynauds.  A hematology consult can be considered to evaluate for erythromelagia.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Korn.  Overview of the manifestations and diagnosis of scleroderma.  UptoDate, 2004.

[deedee4]

Ultra sound has revealed a swollen kidney and ureter.  Having CT scan on Friday.

[deedee4]

I don't know if this has any bearing on my case, but I've also been having stomach trouble.  Stomach hurts whether I eat or not.  Have yellow colored stools that float.  Dr gave me Levsin and that gave me diarrhea.  Just had ultra sound of abdomen, no findings yet.

[deedee4]

Just got results of MRI back. Found that I have a spinal syrinx. Don't know exact location, but I think it is in the thoracic area.  Does anyone know much about this condition and the treatment?

[deedee4]

In follow up to my initial question, I wanted to let you know that the pain and redness in my hands is mostly on the palm side.  Also, the left hand in general is more red than the right.  Although, I have the same degree of tenderness on both palms.

[taundaleah]

What about just plain old carpel tunnel syndrome.  There are studies that show that a history of regular alchol use can cause carpel tunnel. (I used to be a workers comp claim adjuster)  You would have an EMG to rule this out.  You can try these tests at home to see if it might be CTS. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.

Good Luck!!