Strange, bilateral hand pains - Still undiagnosed

[chadicus7]

Pretty troubling situation here that has been progressing over the course of 5 months.  In April I developed a severe burning on the back of my right hand, in the area of the radial nerve so behind the index and middle fingers.  The pain does not extend into the wrist or into the fingers.. just on the back of the hand.  This goes on for two months and suddenly I start having a severe deep stabbing pain located behind the ring and pinky fingers on the same hand.  The weird thing about this stabbing pain is that it becomes more severe when I ulnar-deviate my hand after periods of inactivity (when I wake up, after sitting motionless watching tv, etc).  It seems like a plantar fasciitis of the hand.. in the area of the superficial ulnar nerve.  After that my left thumb starts to intermittently feel numb/full.  Finally the burning of the right hand is now replicated on the left.

I've see a hand surgeon, a rheumatologist, an MS specialist, a peripheral neurologist, and pain management.  MRIs of the hands come back normal.  MRIs of the brain come back with a tiny inactive lesion, MRIs of the spinal cord come back clean.  Spinal fluid comes back with only 1 band found in the fluid not in the blood.  Doctors at the Cleveland Clinic say no MS or Lyme.  Rheumatologist says no inflammatory arthritis.  EMGs come back completely normal.  Skin biopsies were taken from my wrist and shoulder.. comes back with reduced nerve fiber density but on the shoulder, whereas my problems are hand specific and nothing in my fingertips.. so I don’t quite meet the classic criteria for small fiber neuropathy. All $2-3K worth of bloodwork comes back completely normal for any vitamin deficiencies, Lyme, autoimmune factors, elevated antibodies, lupus, etc.

Pain management thought it could potentially be a form of CRPS – performed a stellate ganglion block with no relief.  They suggested ketamine infusions but if the block did nothing I’m unsure ketamine will do much more.  Acupuncture and physical therapy has done nothing.  

I’m worried that this will continue to progress and not really sure where to turn next. Any help is greatly appreciated and sorry for the long post!

Chad