Serious Wrist Pain

[JoX2]

It's gotten to the point where I can barely tolerate it.  I've had it since AUGUST 2007!  It's where the thumb meets the wrist.I'm not trying to tailor my symptoms toward it specifically, but I read everything I could about sources/causes of this pain.,  It happened shortly after I started raising my newborn nephew. My brother called me after three years of no contact, and told me he had a baby. A week later, I had to take the baby.  I guess the point I'm trying ot get at is that my body had no idea it was about to raise a baby, and all the symptoms point me to this thing called "Baby Wrist". And believe me, as a Sergeant in the Marine Corps, I don't take too kindly to accepting this title (but if the shoe fits...) Anyway, I have been to the VA hospital more than half a dozen times, and they aren't the most ...."helpful".  One of the residents (I think that's what you call student doctors) thought it was tentdonitis and treated as such.  So two months goes by and while I'm sure there may have been a few times when I pushed it a bit, I AM raising a baby and it comes with the territory. But come one, two months and it's still so bad?? So was pretty sure it couldn't be tendonitis. I was in the Marines. I know tendonitis, and this isn't it.  So I went back, and this time he suggested physical therapy.  I met with the Hand therapist, and it took him two or three minutes to decide that this was not tendonitis.  He said I needed an MRI.  He build me a removable cast (sweet) because I'd spent probably a hundred bucks on this brace, that brace, tape, cream, etc. and sent me back upstairs to my doctor.  He said "Get it exrayed", I got it exrayed.  I came back for the results (the Hand even called me to ask if I'd gotten them back yet) and the doc, my doc, said: the exray was fine, therefore your complaint does not warrant an MRI." He didn't actually say that to me directly, he had one of his nurses tell me, and then added that there was nothing more they could do for me.  That was in December.  It is now February, and tonight as I right this to you now it is KILLING me. I don't know what to do.  The doctor is an hour away, each time I get something done, I need a new appointment.  I really don't feel like going back to them for help, and I just want you to tell me what I can do, at home, to make this go away, for good.  

[steveallen]

As a result of a bicycle wreck a year ago, i had surgery on my left hand, a plate with five screws going into my wrist area, last september. Also, had trigger finger surgery on right hand, the middle and ring finger, earlier this month. I also, went to podiatrist, having had feet pain as well. I went for physical therapy on my feet last week. Will find out when they will schedule more physical therapy within two weeks. My question is, I have a lot of pain. I had the hand surgeries at two different hospitals. I am going to a pain clinic in two weeks. I have smoked pot occasionally during this past year. Should i tell the doctor? Will that stop me.

[JainMD]

Hi,
I am not sure but I feel at this moment you should be getting another 1 or 2 opinions from an orthopaedician and also a hematologists.
Once we have those opinions then you can plan your treatment approach.
Once your treatment approach is fixed then treatment could be put under check every week or fortnight with help of investigations.
You need to certain baseline investigations soon.
Have you been evaluated for your wrist pain?
Keep us posted with your answers.
Bye.

[dupontwest]

Dear Dr. Jain,
I've been on dialysis since Feb. 2007 and I have experienced progressively worse wrist pain in both hands. My left side is weaker due to a 2004 stroke and that's where the pain began. The only medication it responds to is Aleeve but I'm on Coumadin and the combination could be lethal as I recently found out, having had to go to an ER when my INR of 6.1 made the blood seep into my right elbow joint causing an unbelievable amount of pain. Given trhe complete unresponsiveness of the dialysis clinic's attending physician, his smug smile and advice to "quit smoking" to all my legitimate medical complaints, I'm ready to beat the hell out of him with my cane, if I only could. I have trouble picking up even a mug of coffee if I have to reach for it at an unusual angle, such as from a side-table next to my couch and lifting a pot of water (approx 2 liters) causes an excruciating pain. This pain doesn't respond to such narcotic pain-killers as percocet or ultram. I'm having great trouble lifting myself out of my wheelchair or off the couch. Is there a pain treatment center in Albuquerque, NM? Please let me know what to do. Taking steps against this physician's negligent attitude would probably put me on the odds with the clinic which I like because it'as close to my house and I like the other staff there. I don't know what to do. My primary care physician has giveb me referrals to other specialists, but he also seems to have ignored the wrist pain. I will bug his office about it but there are days when I don't even want to lift a telephone receiver I'm imn so much pain. What should I do?
Mark

[JainMD]

Hi,
I feel sorry that after such a long treatment you are still experiencing pain.
When any patient complains of wrist or hand pain, initial differential diagnosis includes carpal tunnel syndrome, De Quervain’s tenosynovitis, ulnar collateral ligament injury (also known as “skier’s thumb” or “gamekeeper’s thumb”), “trigger finger,” fractures, and rheumatoid arthritis.
I would like to know about your symptoms in more systematic way.
Your symptom of pain at the place where the thumb and wrist meet suggests that you might have Tenosynovitis. Patients with De Quervain’s tenosynovitis complain of pain over the radial styloid process.
Do you ever have symptoms at night that awaken you from sleep?
Your other symptom where in the pain started when you were trying to lift the baby suggests that it might be due to tenosynovitis.
You should assess the range of motion of your wrist and fingers. A sudden palpable and/or audible snapping that occurs with flexion and/or extension of one of the digits during range of motion testing is indicative of “trigger finger,” which is generally caused by a fibrotic enlargement of the tendon that causes it to fail to glide smoothly through its pulley system and causes it to catch and give way as it moves in and out of the proximal sheath.
Palpate the anatomic snuffbox, which is the small depression immediately distal and slightly dorsal to the radial styloid process. Any tenderness there would indicate that you might have scaphoid fracture.
Palpate the radial styloid process. Tenderness over the radial styloid may signify De Quervain’s tenosynovitis. De Quervain’s tenosynovitis is inflammation of the abductor pollicis longus and extensor pollicis brevis tendons.
I think the treatment at present would be reassurance and avoidance of the offending activity. Splinting may be used. Corticosteroid injections into the sheath are also helpful. Caution must be exercised with corticosteroid injections because subcutaneous injections may result in skin hypo-pigmentation. After one or two corticosteroid and anesthetic injections into the sheath, 90 to 95% of patients report satisfactory results. Surgery is reserved for refractory cases.
Keep me posted.
Bye.