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Quick Symptom Checklist for Hand/Wrist ProblemsJun 06 '04 Write an essay on this topic.
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The Bottom Line Quick and dirty symptoms guide for your hand/wrist.
I am often faced with a lot of questions from family and friends that want to know if the pain they have in their hands and wrists are the cause of Carpal Tunnel Syndrome. I have doctors that put 'CTS' on the medical prescription for therapy treatments when it is clearly not CTS by the type of symptoms the patient is having. How can you tell what it is? Is it a nerve? Is it a tendon? How do you treat it? Here's a real quick and dirty check list of what the pains in your hands and wrists could be...but I urge you to check with your doctor regarding your symptoms. Here's my big DISCLAIMER: read this at your own risk. I take no responsibility for anything I write here. You have to check with your doctor if you have any questions. Although I have 13 years of experience with out and inpatient hand therapy I do not claim to know everything and not everything may be correct. Please see a doctor. Phew. OK now that is out of the way, here are some really short basics on some COMMON and most often seen symptoms of diagnoses: Carpal Tunnel Syndrome: Please check out my other article on CTS. The most common complaint is numbness and tingling on the thumb, index, middle finger and sometimes the ring finger. It may be painful in these affected fingers or on the thumb muscle (that thick pad of muscles at the base of the thumb). You may or may not drop items due to the numbness. Night time waking is common, most alleviated by shaking out the hand, which only temporarily relieves the symptoms but not always. Nerve responsible: Median nerve. Things that are hard to do: if you have moderate to severe symptoms, it may be difficult to do simple things like grip a pen, turn a key in the ignition, pinch fine items like needles for sewing, pull files, tear open a package or make a perfect "O" with your thumb and index finger, tip to tip. Treatment: splints to prevent wrist bending at night or all the time, anti-inflammatories, in some cases cortisone shots (has not proved to be very effective), stopping the offending motions or job, ergonomic checks to the work station and fixing it up, surgery. Of course, CTS is much more complex than just one cause. If you have diabetes, getting the diabetes under control could help. If you are pregnant, delivering the baby could help too. Swelling is largely the culprit in the wrist/hand...even if you can't see it. Other diagnosis can mimic CTS including Thoracic Outlet Syndrome and Pronator Syndrome. DeQuervain's Tenosynovitis: Pain on the thumb side of the wrist? Does it hurt to lift items, especially when you tilt your wrist towards the thumb or the pinkie? If you are a new mom, did you recently have a baby? If you answered yes to any of the above, you may have something called DeQuervain's Tenosynovitis. Fancy name for thumb tendon inflamation. The thumb tendons cross the wrist joint and its really easy for the tendons to get inflamed at this juncture. New moms frequently get this problem from lifting babies under the arms repeatedly. We had a hand therapist get this after the birth of her first daughter, and she was doing research on new mom's with DeQuervain's before she got pregnant! Tendon responsible: the tendons of the thumb - they are inflamed. Things that are hard to do: tilting the wrist toward the thumb or pinkie, lifting a frying pan, turning a key in the ingition, twisting open jars or door knobs, lifting up your child, pouring liquids from a pitcher or coffee pot, tossing a ball, etc. Treatment: rest the hand. A thumb spica splint may help. Anti-inflammatories. Corisone shot. Last ditch - surgery. Trigger Finger: Does your finger get "locked down"? Does it snap when you try to make it straight? Does it hurt a lot when your finger locks up? Do you sometimes have to use your other hand to loosen the finger from its stuck position? If you said yes to any of these, you may have what is called trigger finger. What is responsible: the tendon in your finger may be inflamed or it could be the tendon sheath or a nodule on the tendon, preventing smooth gliding of the tendon. What is hard to do: almost anything that requires you to use the hand. Most patients are hesitant to bend the finger because of the snapping and the joint "catching". Most often this snapping is accompanied by pain or swelling and/or puffiness at the base of the finger in the palm. Treatment: cortisone shot, splinting, night time "sleeping bag" splint to prevent the finger from getting stuck down when you wake up in the morning, rest the affected finger, therapy. Last ditch - surgery. Ulnar Nerve Impingement: Do you have numbness or tingling in your pinkie and ring fingers? Do you find yourself shaking out your hand? Waking up at night? Losing grip strength? Pains in the palm or elbow with the numbness or tingling? Burning sensations in pinkie/ring? If so, you may have something called ulnar nerve impingement. Impingement means to smash something. Your nerve is smashed somewhere. It could be smashed in your spinal cord, under your arm, in your elbow or in your hand. Nerve responsible: Ulnar nerve. Things that are hard to do: anything the requires you to grip something hard. Most notable weakness is at the ring and pinkie fingers. These fingers are responsible for your power grip. Treatment: find out where the nerve is getting smashed via EMG or MRI. If it is smashed up in your neck, cervical traction from a PT may help; if smashed up in elbow, surgery or rest may help (watch to make sure you don't rest your elbow on hard surfaces or keep elbow bent too long on cellphone or phone); if smashed up in hand, avoid the activities that cause compression of the nerve in the hand (most common culprit is cycling and gymnastics). Osteoarthritis: The most common complaint with Osteoarthritis is stiffness and sometimes pain in the finger joints. Mind you, this is different from Rheumatoid Arthritis. OA is a 'wear-and-tear' arthritis. Stiffness usually found after waking up in A.M. with fingers progressively loosening up with use. Some people get "Heberden's Nodes" on the tips of their fingers on back side of their hands. These are thickening of the joints at the tips of the fingers. Causes: too many to list here. Most likely "old age" and "wear and tear". How hard you worked your hands in your youth. Old injuries. Things that are hard to do: some people do very well with OA and some people have difficulty even with the simplest task like buttoning a shirt, holding a pen, opening a milk carton, writing, chopping vegetables, etc. Treatment: anti-inflammatory, heat in the AM, exercise and mobility of joints, rest when inflamed. Rheumatoid Arthritis: Rheumatoid Arthritis can sometimes be a crippling disease which affects all joints in the body, not only the hand. My guess is that if you have RA, you know it. Most RA patients are female and a lot of them get diagnosed from 20 - 40 years of age. Severe pain, disfigurement, joint changes, fever, etc. Causes: RA is very complex and there can be a lot of causes, but for the sake of simplicity RA may be traced back to auto-immune diseases such as Lupus. Treatment: splinting, joint and energy conservation techniques, joint replacement, medication, gold therapy, etc. the treatments are numerous with RA. CLINICAL NOTES: These are the most common causes of diagnoses that I see in my clinic, listed in the order of popularity. There are tons more diagnoses but these are the most common. Prescription: Mis-Diagnosis: I had one 67 year old woman who was diagnosed with CTS, had the surgery and was sent to me in therapy. She didn't get better and her symptoms were a lot worse. Not only did she suffer from the surgery to her hand for Carpal Tunnel, but she had weakness in her pinkie and ring, which made me suspect something else. Back to the doctor she went. Came back with elbow surgery - this time for ulnar nerve impingement. Got worse. Went downhill. I sent her to an outside doctor because she was getting from bad to worse. Diagnosis: Lou Gherig's Disease. Only had one year to live from the time of dx. She was very upset at me for sending her to this doctor who told her she was going to die. I felt very bad but at least the cutting and surgeries stopped. Her family got to prepare for her death. She died within a few months. Pretty gloomy, eh? This is one rare case, but it does happen. The surgeon that did all the cutting was a very well known and respected neurosurgeon. But it goes to show you that no matter how skilled the neurosurgeon or any other surgeon, if no one pays any mind to the SYMPTOMS and what kind of functional deficits you are having, no amount of cutting will help. Make sure you find a doctor that LISTENS. I will be writing another article in the near future on how to find a good doctor. Thanks for reading...live long and prosper :-)  |
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