Swelling on back of both hands
Hello,
I have had problems with many joints for over a year now. I suspected CTS in my left hand and this was shown to be true and it is a grade 4. My right hand does not have CTS as I expected.
In addition to the CTS I have some sort of softish swelling on the back of both hands and also on the radius near the right hand. Both wrists are painful and don't move anywhere near as far as they should or used to. The actual wrists are not swollen. My left hand has become very weak. My right hand still has its normal strength but is painful when I use it. Also, on both hands, but much worse on the left, the ring finger and small finger do not feel quite normal, I can't move them as normal, there is also some pain.
My rheumatologist has ruled out any form of inflammatory arthritis and fibromyalgia and has referred me to a hand surgeon but the waiting time is about 13 weeks I have been told. My rheumatologist does not plan to see me again, he has advised my GP to start me on Amitriptyline. I have started the Amitriptyline 2 weeks ago, so far it has not helped.
The other thing I have noticed is that all my life I have been hypermobile but since all these problems started lots of joints seem to be less mobile than normal now and painful.
The rheumatologist was sure that I would need surgery for the CTS. I am a bit concerned about the long wait. Also, what about the other problems with my hands?
I would be very grateful for your thoughts.
Thank you, Meike
Dear Mr Bland,
thank you very much for your reply.
I believe I am going to see Mr James and the appointment is on 11.1.16.
This morning, for the first time ever, I woke up with tingling in the thumb and first two fingers in my right hand too. The pain in the other two fingers is still quite bad and the left hand is deteriorating too. I actually work as a midwife at the WHH, although off sick with Tibialis posterior dysfunction in my right foot at the moment. I am so,so worried as I want to go back to work and be able to do my job. There must something else wrong in addition to the CTS. The Amitriptyline still shows no effect, I do know it might take a while but I have been taking it for over 3 weeks now.
Please help!
Thank you, Meike
Although it is quite often tried in primary care there has never been a trial demonstrating that amitriptiline works for CTS. For grade 4 you may well need surgery, even if the problem is not purely CTS. However, faced with an 8 week wait for surgery I would be very tempted to try a local steroid injection for quick relief. Had you been referred to us for treatment I would have suggested that but you are not my patient which makes life a little complicated. You could ask your GP to refer to us and if we got a quick request this week we could probably inject next week and I would then sort something out with Chris James.JB
Dear Mr Bland,
I am really sorry, I have only just seen your response, I thought I would get a notice through on my e-mail but I don't think I ticked the right box for that - sorry.
Well, the rheumatologist did inject my left hand but it made no difference. My right hand has now also started showing signs of CTS and the swelling is getting worse there too. My GP asked for an US scan on my right hand, that is on 8.1.16, I am seeing the hand surgeon on 11.1.16. But I think whatever is going on is essentially the same thing in both hands (and possibly other joints), it seems frustrating to see the sonographer for the right hand, the surgeon for the left, someone else for my knee and someone else yet again for my shoulder.
Do you think it is still worth asking my GP to refer me to you?
Both hands are very painful and to me it is the kind of sharp pain you get with tendinitis or tenosynovitis.
Again, I am really sorry I didn't see your reply sooner, will keep checking this time!
Thank you, Meike
As the clinical picture is evolving it would be quite interesting from my point of view to see you again and look at the nerve conduction studies and ultrasound imging in both hands to see if anything is changing. However, I am a strong believer in the truth of the old saying about too many cooks and I do not think it would necessarily be a good idea for me to interfere in your treatment when you are seeing both a rheumatologist and a hand surgeon and your GP already. I can find space to have a look at you between Xmas and New Year if you are interested on that basis (re-test out of curiosity - no treatment). JB
Dear Mr Bland,
the rheumatologist has discharged me, the GP doesn't know what is wrong. I saw two orthopaedic consultants today, one for the shoulder, one for the knee, who both believed this was an issue for a rheumatologist and discharged me.
I do have the appointment for the hand US scan and then with the hand surgeon. Unfortunately this is not till the middle of January and I am very worried about going back to work as I obviously need my hands as a midwife.
What if I come and see you and you find something that needs treatment?
Meike
I'm happy to have a look at you and talk it through but my own skills are rather highly specialised - and I certainly know little or nothing about knees and shoulders. One thing we do know you have however is CTS and that is very much my speciality. As you came to the department while I was away perhaps it would be a good idea if we did meet at least so that I can see the problems. JB
No I'll just figure out a time when I can look at you - probably on Tuesday 29th Dec but I'm on a train at present - I'll book something when I get back to the office. JB
It looks as though 12:30 tomorrow (Tuesday) is going to be the best time for this, now that we have dealt with all the Xmas urgent cases and appointment changes - can you make that? JB
Thank you so much. Is there any chance it could be later in the day as I already have two appointments tomorrow morning?
Sorry to be a pain....
Meike
Sorry about the slow reply. I was away when you were tested so I have not had a chance to see your hands which makes it a little difficult and the fact that the rheumatologist has already ruled out inflammatory arthritis and fibromyalgia narrows the field a lot. Which hand surgeon are you queuing for? JB