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View Full Version : my hand- please speculate


stregapez
23-05-2006, 05:15 AM
My right hand, mostly my fifth finger, is messed up. At least 4 months ago now I slipped on the bathroom floor in my new house while getting out of the shower stall. My fall was broken, in part, by the ulnar side of my right hand. I am pretty sure I did not tear any ligaments. Pain was not terrible even at first. I rested my hand and it got better, but has never recovered completely.

For some time, post initial healing, my pinky did not hurt unless I bumped into something by mistake, the dog yanked my hand with the leash while walking him, etc, though the pad of my finger just below pinky has remained sore upon rubbing it this whole time.

When movement does hurt it, it hurts during both flexion and extension of all 5th finger joints, aduction & abduction. ROM seems normal except that pinky does not abduct as far as left pinky (for all i know its always been that way though; no idea) The last couple weeks it has hurt more often with simple movements, even slight ones sometimes (as opposed to only when its bonked) It does not usually hurt unbearably or anything, and sometimes stops hurting entirely upen completely resting it (like watching tv for an hour or two with fingers slightly flexed) but it is not right.

Thumb in same hand is messed up from doing deep massage a year and a half ago now and , I believe, tearing a ligament. ( i DO NOT do agressive work with my hands anymore, that , in fact was an isolated case of me experimenting on some deep thumb compression on my son). Though the thumb has steadily improved, even up to a few months ago, it still feels odd (usually stiffish, not usually painful anymore)

About 2 years ago now, post specific injuries, I began, out of the blue it seemed, to have stiff hands and pain. Got Xrayed for arthritis (negative) and had sed rate, Rh factor, ANA test done , all negative. Decided it was from lifting weights, too much too often, including on days I am too tired/sleep-deprived etc. Slacked off on that and in time (a long time) my hands have gotten mostly over the original symptoms. Left is relatively back to normal. Right hand is mostly abnormal only in thumb and pinky. I dont use my pinky that much. Honestly, I do only a few massages a week (and have gone weeks at a time lately doing none, partly as i had no office for awhile, and was moving houses, plus many of my clients (aka my impoverished friends) ran out of money) I use my pinkies very little when I do them and it does not appear to agravate especially , though i cannot say for certain. Still use exercise machines, but only about twice a week at most, and not excessively when i do. I have the feeling my pinky would still be abnormal if i was doing neither of those things (niether of which seems to cause more than very mild discomfort in pinky if at all) Using computer hurts more than anything, other than bonking it.

Why dont my hands heal and, or, why does it take so long for my hands to heal ? Is it "old age"? (40) I feel sure thats partly it, maybe partly from the intitial overuse sensitizing them, but it still seems freaky. The thumb i can more see since it was a major tear, but not the pinky.

Oh yeah, my right had is usually colder than my left. Does that mean ischemia from interference with a nerve, or a tight muscle, or damaged tissue, or something to do with parasympathetics, or what? (I used to tend to have cold hands and feet generally , by the way, but that has changed quite a bit for the relatively warmer in the last couple years. But the the right hand is till cold, lately anyway)

And what should I do? I am trying heat intermitently, as of two days ago, thanks largely to this article http://www.ampainsoc.org/pub/bulletin/nov04/inno1.htm
and was thinking of trying constant heat (a mit, etc) I am going to see an orthopedic surgeon i know, mostly so he can send me to a decent PT, since I saw him once before for something else and he did so, plus he seems to know his stuff (and both my osteopath and rheumatologist seem utterly, in fact frighteningly dumfounded by such problems) Appointment is not for a month though .

I am really curious about why my right hand is cold, and not my left?

I will be a while before i am up to speed with most of you folks (give me a couple more incarnations) but i suppose it can't hurt to inquire here anyway

Dana

EricM
23-05-2006, 06:04 AM
Hi Dana, I'll see if I can help you get started.

Why dont my hands heal and, or, why does it take so long for my hands to heal ?

Why do you think your hands have not healed? By what measure are you defining healing?

Thumb in same hand is messed up from doing deep massage a year and a half ago now and , I believe, tearing a ligament

Ouch! How is your son? :eek:

eric

stregapez
23-05-2006, 06:44 AM
Hi Dana, I'll see if I can help you get started.



Why do you think your hands have not healed? By what measure are you defining healing?

eric

This is one of those trick questions , isn't it ? ~

Something is amiss as indicated by the pain in the finger(s) thing, and the fact everytime i injure a hand (as opposed to a sprained ankle, which heals quickly) makes me think it has something to do possibly with not only generalized things (age etc), but more with a specific area of my body. I get pain in my back if I spend lots of time on computer (even if i'm reading love letters or comics), but all I have to do is stay off for a couple days and it goes away etc.



Ouch! How is your son? :eek:

eric

Broke his back, but it healed quickly, and he's very forgiving (Just kdding. He's fine :))

It is easy to tear a ligament pressing down with thumbs, as i was told in my massage texbook, though not by the thumb-obsessed massage teacher I was emulating

nari
23-05-2006, 09:02 AM
Dana

Sympathetic system overactive; sensitive CNS comes to mind.
Sometimes the brain gets into a loop and continues to deliver pain if it feels threatened. Remember, though, you would not necessarily be aware of this perceived threat.

How long does it take for tissues to heal?

Nari

emad
23-05-2006, 02:55 PM
Dana:

I agree with Nari,s comments ,seems you do not give your injuries sufficient time , i mean here not to complete rest ,at least in case of injury you return to over-moving which could lead to Nervous System Sensitivity that appears speedly in your complaint as pain with any activity.

I feel very well your complaint of NOT feeling complete recovery and i believe you,seems injuries do not return back to normal this is very clear in my work with orthopedic patients ,the free/smooth motion is lost .

Your post here raise an important inquiry ;

Do injuries return to normal ?Or in another meaning can the CNS sensitivity disappear??

Regards
Emad

Diane
23-05-2006, 03:26 PM
Sounds like overuse type pain.. the vascular tree around hand joints are configured on the same plan as the knee.. lots of branching, anastomosing, horizontal encirclement.. the nerve net supplying it has a lot of navigating to do. Something that worked for me with a similar sort of "sore paw" brought on by overuse (sculpting with plastic putty) was Mulligan mobilization.. I was at the workshop at the time and got the finger mopped up volunteering for a demo. Mulligan mobe on fingers involves a complex pressure combined with slight twist combined with active movement. It's pretty much a monkey trick, indescribable in words.. you'd have to go see someone trained in it. But I think it would help.

stregapez
23-05-2006, 07:24 PM
Thanks all.

Maybe I can advertize for someone who does Mulligan mobe ? :)

By the way, I think the people who do the hend-work in the hospital where i'm seeing the doctor are occupational therapists. I saw a physical therapist previously for the thumb and he was no help, and i think this hospital is one of the few other "reputable" places they have folks who work with hands

I have no idea how long it takes for tissue to heal Nari. Do you? I would guess it varies from person to person, tissue to tissue, situation to situation. The PT I saw for my thumb told me a ligament should heal in a month, but I've read things saying it tends to take three months. I'm assuming a tendon *typically* heals sooner, and a muscle much quicker, even, and i figure it's one/some of those, as opposed to a ligament i hurt in my pinky area, and it's been four and a half months

Whether it's tissue or CNS independent of injury or combination, I don't want to immobilize it, both because that's not exactly good for blood flow, and because I don't want to put my activities on hold forever. I should probably start holding the dog leash with the left hand though (cats in the street equal uncontrolable dog and thus hand pain)

Dana

nari
24-05-2006, 12:11 AM
Dana

It can be reasonably assumed that after 5-6 weeks, all injury has healed. Pain and dysfunction which persists after that is likely due to sensitisation - the brain has kept a 'tag' on the initial flood of information.

Sometimes, just sometimes, it is useful to rest/immobilise an area of series of joints. Anything can be used, but Coban (available from pharmacies) is self adhesive and appears to be modulatory; remember kids and bandaids - the pain relief with a bandaid is almost instant. Placebo, as well...
I would try in the interim, wrapping Coban around the 5th digit for about 24 hours. Wrap is the operative word - don't pull it tight, just wrap it around the full length. Check the tip of the finger for colour change after 20 mins or so. If it is darkish, unwrap and repeat, more loosely.

If you can read up about sensitisation, it will help. Finding a PT who does Mulligan work could be useful too. But most of all a PT who knows about pain physiology and not just muscle/joint....or an OT.

Nari

stregapez
24-05-2006, 02:56 AM
Nari, I will try that in the next few days (on a day i have no massages) Can't hurt to try. But shouldn't i wrap or somehow imobilize it so that the carpometacarpal joint doesn't move either? I could wrap fourth finger and then put it in a wrist brace thingy, that might inhibit more.

Some more questions/thoughts on healing time. If I already (still ) had a repetitive strain situation when this ocurred, like "tendonosis, " for example http://www.tendinosis.org/ and if i still haven't rested it enough, couldn't i still have microtrauma? And could that not be at least part of it?

(Yes, I know i am disagreeing with myself; truth is i don't know.)

Is that what you are suggesting, Diane re overuse?

I have an ongoing deficit of sleep. Have had my whole adult life. I basically sleep ok every other night, and every other day i am basically exhausted. That can't be ideal for healing normally either, though i somehow don't appear to be deteriorating rapidly at all on the outside (i still get carded) so hopefuly it's not so bad.

Dana

bernard
24-05-2006, 08:18 AM
Dana,

I moved the thread to the Virtual Clinic. It is the place where we are taliking about patient cases and our own health problems.

emad
25-05-2006, 06:58 PM
Hi Dana :
You wrote ,

I have an ongoing deficit of sleep. Have had my whole adult life. I basically sleep ok every other night, and every other day i am basically exhausted. That can't be ideal for healing normally either, though i somehow don't appear to be deteriorating rapidly at all on the outside (i still get carded) so hopefuly it's not so bad

I like very much to clarify for me this Quote please?! Does the disturbed sleep other day is related to pain ?

As well the thread has gonna long ,you received much replies , when you appply the suggested techniques tell me the outcome ,please !

Best Wishes
Emad

stregapez
25-05-2006, 07:31 PM
Emad, yes, on days I haven't slept well I am more likely to have hand pain, and hand stiffness, especially as the day progresses (actually i do have relative stiffness sometimes in that whole hand) I have knee pain too sometimes and it's the same as far as poor sleep aggravating it.. PMS (pre-menstrual syndrome) also makes knee pain more likely, by the way, not sure about hands. Things like back muscle pain (which i get sitting at computer) don't seem to be affected by sleep too much though.

I never have pain that keeps me awake, and I almost always get to sleep easily, but every other night I wake up prematurely or somehow just don't sleep right.

(I really need to go to sleep earlier and drink less caffeine, which i've known for years. It doesn't seem to cure the problem , but it helps somewhat. Unfortunately my best friends are night owls, who i mostly get to see on weekends, LATE, and that throws the whole thing off.)

Yesterday i had slept very well night before and mostly stayed off computer and my finger felt much better. Today isn't bad yet either, in spite of less sleep last night. Doing computer stuff does aggravate it significantly, which is a bummer, as i like being able to use computer. Too bad i'm not left-handed.

I'm lukwarm on the wrapping the pinky, after thinking about it more, because flexion does a lot more for comfort than extension, and static extension seems to aggravate it (thoughts?)

It will be a month or so before I can see the PT, uness I find an independently employed one i trust.

Dana

emad
27-05-2006, 06:13 PM
Dana:

In your own view what is the appropriate environment/circumstances/surroundings for relieving pain ??

I think you are right in most of your descripations regarding flexion fingers and computer-related pain activities , so let you relax it !

Best Wishes
Emad

stregapez
27-05-2006, 07:17 PM
Thank you for you concern, my dear. Better sleep might help (working on it)
Also i have a habbit at the computer of sitting with my right hand on the mouse; eliminating that seems to help.

I really need to learn nerve anatomy sometime, in addition to muscle anatomy

Still don't know what book to buy for nerve anatomy..

Dana