Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
Question: Unexplained Hand Pain and more...
|Island_Thinker - Sun Oct 28, 2007 11:38 am||
Hi, I'm a 31 year old male computer progrmmer in reasonably good physical shape. No family history of any illnesses. Not on any long term medications, other than a multi vitamin.
12 years ago, during a period of heavy computer use, I experienced severe pain and loss of function in both hands that come on over a period of 3 days. A general practice Dr. thought it was Carpal Tunnel, and Ortho thought RA was much more likely. At the time I had no health insurance and did not follow up for more diagnosis. Braces on the wrists had no effect, but a 2 week dose of prednisone relieved 90% of the symptoms. I have had manageable hand discomfort ever since, never quite enough to make me seek treatment. Discomfort does occasionaly extends to the pinky area, but never past the wrists. My hand strength is "ok", but not what it should be. It is always best in the morning, and my hands get worse in the evenings. I don't have effects from the carpal tunnel hand position tests. I've never had any hand coordination issues.
3 weeks ago, I noticed wrist sorness and then a lump/cyst/nodule coming out of my right wrist between the thumb and the pulse location. It is bone hard, immobile, and does not hurt when it is pushed.
At the same time I started experiencing bilateral pain in both hands very similar to what happened 12 years ago. In addition, for the past month I have had several periods of just not feeling great. Almost like I'm coming down with something, but never get sick. I've never measured a fever.
Went to general practice Dr, who put me on 1 week of prenisone and did general arthritic/lupus/liver tests. Within hours of taking the prenisone I noticed a reduction in hand pain and an increase in hand stength.
After a couple days, however I started to notice spreading of symptoms. Pain spurts I have never had before from my ankles, a couple knuckles, stiffness in my knees, and a shift in pain of my hands to a more wrist centric pain. I don't have morning stiffness, in fact I feel almost normal in the mornings but by lunch it is bothersome, by 5pm I have significant pain. Every day I was feeling worse than the day before. I did take 4 days off the the computer during this period. I don't have any visibly swollen joints or other visible signs other than the cyst/nodule on my wrist.
At end of prednisone dose, went back to the Dr. for the blood test reults. Everything in my blood work perfect! He couldn't find any issues at all! It was very frustrating for me, because the doctor didn't seem to have any idea and even seemed to suggest it might be in my head!!
In the one week since then, I still have most of the symptoms, although they have not worsened further. I'm finding that alcohol has an almost magical effect on my pain/stiffness and have significantly increased my consumption.
I have a followup with an Ortho in 1 month, he wants me to see a Neurologist, but I have to have the ortho refer me for it to be covered.
I am having a very very hard time performing my job right now and just don't know what to do... :(
Thanks for any advice...
|Dr. Chan Lowe - Thu Nov 08, 2007 7:51 pm||
This is a bit puzzling. The diffuse symptoms and response to prednisone do fit a rheumatologic type of an illness; however, these diseases are almost always much worse in the morning-particularly rheumatic arthritis.
You may have some inflammation of the joints that is slowly irritated as the day goes on with continued use of the joints. This could still potentially be a rheumatologic process.
Seeing a neurologist is reasonable. I would also recommend that you see a rheumatologist for further evaluation of this. I cannot explain why alcohol would improve the condition.
I really can't come up with a cause that fits your symptoms well. I wish I could be of more help to you.
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