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924193 tn?1243876373

Daily hand pain!

Hi Everyone.  I tried posting this question in another forum, but didn't get a response, so I'll try here.

I have chronic pain at the base of my thumbs in both hands that I don't seem to be able to get rid of.  I've had it for about 10 years, and it is worst when I am playing my cello or rock climbing, but flares up for even simple tasks--opening valves, writing, washing dishes, scrubbing surfaces, etc.  I tried going to a sports/musician's specialist about nine years ago, and had months of physical therapy to teach me to stretch the area well, hold my pen differently to write, but it hasn't helped!  The pain gets so intense that my hands will lock up almost completely for minutes at a time, almost like a cramp, which is annoying when I'm trying to get something accomplished, and dangerous when I'm trying to climb outside.  

I'm hoping someone has experienced this and can give some advice, or that a doctor has heard of these symptoms.  I wonder if it might have to do with electrolyte imbalances in my muscles, due to hyperhidrosis, and if it might be related to the intense "pump" I feel in my forearms when I'm playing sports that seems to effect me a LOT more than others (but drinking a lot of gatorade hasn't helped).  From a look at some pictures, I think the pain is located in my abductor pollicis, abductor pollicis brevis and flexor pollicis brevis muscles.  I don't think it's carpal tunnel, because I don't get whiteness, coldness or tingling.  Any thoughts on what I can do to address this??  Thank you in advance!
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924193 tn?1243876373
**I had another user contact me to see whether this was ever resolved, and thought I should post an update here in case any others could use the information. Please feel free to weigh in at any point.**

Question:
I wanted to know if you have found relief. I suffer the same problems and hoped you could provide some insight.

Answer:
I'm sorry to hear you suffer the same pain, though I'm mildly relieved to hear there are others out there thinking and asking about it. I have not found a solution yet. Unfortunately, the practical solution was for me to stop rock climbing, something I really miss now. I've taken up other hobbies, but I recently had my cello into the shop for repairs, and would like to start trying to play again. Each time I've tried, the pain comes back very quickly.

The only other bit of news I've had on the matter recently was a casual conversation I had with a physical therapist who said my problem sounded a bit like thoracic outlet syndrome (TOS). This is a diagnosis my doctor mentioned briefly years ago, but that he and my physical therapist at the time suspected wasn't the problem. I'm thinking it is a distinct possibility because 1) my symptoms show up very quickly if I hold my arms over my head and alternate clenching/spreading my hands (thought of as a casual, but useful test by some docs) 2) the pain and swelling is often in my forearms, also, and was especially so when I climbed, and 3) I do sometimes feel like my armpits are slightly swollen, something exacerbated when I'm sick and have swollen lymph nodes.

I've looked into TOS briefly, but haven't followed up with the PTs at Group Health here in Seattle where I live now. Your post reminds me that I should give it a try. As I hear it, the first interventions are to lose weight and start with a set of stretching exercises that need to be done with the PT. (Weight wasn't an issue in the past, but I've put on a decent amount of it since I first posted now that I'm not climbing.) If these are unsuccessful, a surgical option exists, and this usually involves removing tissue from the armpit/pectoral area, or even removing the first rib. This sounds miserable to me, but I may just be willing to try it eventually...

What have you tried? I did have one course of acupuncture from a former girlfriend/acupuncture student in 2009/10 that did nothing, but I'd be willing to try that again if I could find an acupuncturist I respected, who had a good medical background--the absurd tests she was taking at school belied a really muddled interpretation of physiology and neurology. I do remember that one of the needles she inserted into the muscle at the base of my thumb caused immediate and excruciating pain, just like the ultrasound did back in high school (from my original message). There could be something to this.

So, long story short, the next step for me may be PT or acupuncture, but I realize now that what I should really do is try to find a doctor who is interested in following this through and thinking about it seriously at a physiological and neurological level, perhaps even someone who would be willing to consider a study of the condition. I'll also look into MRIs now that I have a different health plan--MRIs of my hands may now be covered...
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Avatar universal
Hello,

Beings you are chronic, try doing ice for 2-3 minutes followed by heat for 2-3 minutes, 3 times each, 2-3 times a day.  This brings blood to that area to promote healing.
Also, massaging that area with a super ball.  Put the ball on a hard surface and place your hand (on the muscle that hurts) over the ball and roll your hand around on the ball.  Be sure not to do it too hard and dont leave the ball in an area for too long, as you could do more damage than good.  But the massage will also promote blood flow to that area for healing.
Adding exercise and stretching will also help.  For exercise, squeeze a tennis or raquet ball, dont over due it.  And stretching, I like to do it in the shower by putting my hands on the wall straight out in front with my finers pointed down to stretch your forearm muscles letting the warm water run over my muscles.  And also by placing the hand flat on a table palm down and lift my thumb up with the other hand pulling it back and toward the hand.
And wear your brace at night.  When you start to feel relief from the pain, dont stop doing any of the above, keep on it until you are completely healed.  May take a few months to a year sometimes more.  But keep up on it, when you stop doing the above you are taking steps backward.
I hope this works for you, it has for me.
Helpful - 0
924193 tn?1243876373
Latest update:  NOT Carpal Tunnel Syndrome.  My EMG came back completely normal.  The neurologist who oversaw the EMG said he thought the problem sounded more like a muscle control disorder along the lines of a mild dystonia, but agreed that it is nebulous.  Whereas there are muscle relaxants intended to address such issues (e.g. clonazepam), he thinks these are probably too severe for my condition, as they're really meant for more severe conditions such as epilepsy, and relax the brain as well as the general musculature.  Interestingly, though they're also indicated for Restless Leg Syndrome, which is a BIG problem for me, and has been for years, so there may be an underlying, more widespread muscle condition.  

I have another appointment with the original neurologist next Friday to discuss possible referrals, further diagnoses, and medications... Looks like my hope of a definite diagnosis is once again squashed!
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924193 tn?1243876373
I've got an update on my progress that I thought I'd post.  

6/11: Saw my GP to get a checkup on the hand pain and hyperhidrosis.  She gave me Drysol for the hyperhidrosis, which I started on that day, and which seems to be helping.  She was incredibly helpful, and wanted to get to the bottom of the problem, even though it's nebulous.  She scheduled me for blood tests that day for creatine phosphokinase, general blood chemistry, and thyroid function, and referred me to a neurologist for nerve conduction testing.  

6/12: Saw neurologist the next day, and he took me through a series of basic tests.  He had me touch each finger with my thumb, respond to a hammer on vital nerve points, register vibrations and cold on fingertips, push the backs of my hands together.  I think I responded well to all of the tests.  The only pressure that caused discomfort was direct pressure on the offending area.  The neurologist scheduled me an EMG (Electromyogram) for next Friday, 6/19, and prescribed me 800 mg Ibuprofin to curb inflammation, and wrist splints for sleeping.  His best shot at a diagnosis: Carpal Tunnel Syndrome.  I don't quite fit the profile (no numbness, tingling), but we'll see...

6/13: Climbed outside, and made sure to take Ibuprofin and Drysol beforehand.    Also wore splint on right hand (don't have both yet).  Drysol worked like a charm--no sweat on hands--but ibuprofin did nothing, and the pain in my hands came on quickly, and was agonizing.  Now, two days later, the area is still sore, slightly swollen, and throbbing a bit.  

6/15: Got lab results back, and all blood tests were normal.  

Oh well... nothing yet but possibility elimination, but I'm hoping the EMG will turn something up.  If not, my GP said she'd refer me to an orthopedic surgeon.  Normal blood tests suggest there's no need to refer me to a rheumatologist.
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924193 tn?1243876373
Oh, and of course, I'm still eager to hear any other thoughts... Thanks!
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924193 tn?1243876373
Molly and Tuck, thank you so much for your replies!!  It's a relief to have any feedback at all, since I've had such trouble explaining this pain in the past.  

I'm a graduate student, and covered under the student health plan at my university, so I'll head in and see if they can refer me to a rheumatologist, perhaps to other specialists, and for an MRI/XRay.  

If I do manage to find help, or I suppose even if I don't, is this the best place to post updates on the condition and treatment, or is there another forum within MedHelp that allows members/patients to describe their experience with a condition, and post helpful links/recommendations? I suppose for now, I'll just keep throwing updates on here, but if it'd be helpful to sort of assemble the pieces and write one larger summary somewhere else, I'll happily do that.  I greatly appreciate any help and advice, and I'm always happy to give back.
Helpful - 0
547368 tn?1440541785
Hello and welcome to the Pain Management Forum. I'm sorry you are having so much pain in your thumbs.

I am not a physician but I am wondering if you have a tendonitis, basal joint arthritis or carpometacarpal arthritis or a similar condition. The primary symptom an arthritis is a deep, aching pain at the base of the thumb that is made worse with activities that involve pinching and gripping such as you describe. There are additional symptoms.

An MRI along with a good clinical exam can provide you with a correct diagnosis. You may have a vitamin or mineral deficiency. Again your PCP can best diagnosis your condition. I have a Vit D and B12 deficiency that caused severe muscle cramping but the cramping was not just in one area.

Best of luck. Please let us know how you are doing. We all learn from one another.
Peace, Tuck
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535089 tn?1400673519
Hi offrouter:

I don't know what to tell you other than to keep at the Medical Community until they give you a diagnosis. Sometimes it takes a while to get there.

Have you seen a Rheumatologist (sp)? Possibly for Arthritis? In my opinion, I would start with them and go from there.

Please take care,
Molly
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