Author Topic: Medical advice (for hand & finger) - therapy and/or second opinion?  (Read 836 times)

jeromedawg

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Hey guys,

So since the March/April timeframe, I've been feeling this pain in my left-hand index finger DIP joint (joint furthest out on my finger) - there's constant swelling and it just doesn't feel right. I can't use that finger to do anything in terms of gripping/grasping/pulling/etc. Certain parts around the joint feel sensitive and painful if I slightly twist or bend the finger. My range of motion is somewhat limited in that I can't pull the finger in all the way either. I first asked my PCP about this and he had an XRay done told me it just doesn't seem like anything is wrong with it and it should go away on its own - in the meantime take Advil. If it doesn't go away then it might just be arthritis that you have to live with. I don't have this kind of pain or swelling in any other joint in my entire body. I can't even recall what I might have done to injure the area either... then again, I feel like with fingers I've probably had episodes where I've crushed them lifting something or slammed them against a wall etc and will immediately react with "Ouch!" but then forget that it ever happened.

Anyway, I wanted to get a second opinion so went to another orthopedic hand specialist based on a referral from friends and he had a couple MRIs done (one without contrast and then one with). The one without contrast didn't give enough detail/info so that's why he had me do one with contrast. He mainly wanted to check to make sure it's not some sort of tumor or malignant growth - it checked out negative in that sense but they did see that the area is swollen. They made no determination as to what it is or what's causing it though, other than that it's a "nonspecific soft tissue edema" around the DIP joint. This specialist told me to wait a month or so and if it's still there let him know, so I let him know and he prescribed 18 sessions of therapy to treat it.

I've now scheduled a third appointment with a different hand specialist (also recommended) and am planning to get a 3rd opinion on it. What I'm really wondering though is if I should just proceed with starting therapy or not. I'm not sure if the 3rd doctor is going to tell me something completely different but the appointment isn't for another week and a half but either way it doesn't seem like it's getting any better over time. It definitely impacts my day-to-day as I am limited in what I can do with that hand and finger especially. Typing is fine but many other things (twisting jars open, flossing, pulling things, picking up my kids, etc) it's a hindrance.

Has anyone ever heard/seen/experienced anything like this?
« Last Edit: October 02, 2017, 02:16:02 PM by jeromedawg »

ElleFiji

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #1 on: October 02, 2017, 02:36:38 PM »
Keep going to doctors until you feel comfortable that anything sinister is ruled out.

But also... Check into a vodder trained manual lymphatic drainage massage therapist, nurse, OT, or whoever has the cert in your area. https://vodderschool.com/contacts/therapist

And when you find a therapist who is focused on symptomatic relief, talk to them about your options for hydrotherapy, who would be the reputable people in your jurisdiction to advise you about diet and supplements.

I can't give you any specific advice, but those directions might help.

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #2 on: October 02, 2017, 03:33:25 PM »
Keep going to doctors until you feel comfortable that anything sinister is ruled out.

But also... Check into a vodder trained manual lymphatic drainage massage therapist, nurse, OT, or whoever has the cert in your area. https://vodderschool.com/contacts/therapist

And when you find a therapist who is focused on symptomatic relief, talk to them about your options for hydrotherapy, who would be the reputable people in your jurisdiction to advise you about diet and supplements.

I can't give you any specific advice, but those directions might help.

Thanks... what is it about "Vodder trained" therapists that sets them apart from OTs and PTs btw? The ones I've found local in my area seem to all work as massage therapists at a fancypants resort/spa along the coast. I don't know much about these kinds of spas/resorts but to me that just screams $$$$ (as if I haven't spent enough already on all the medical bills we've racked up this year with all this hand stuff plus birth and other kid stuff... the downside of a high deductible plan for the HSA :T).

Laura33

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #3 on: October 02, 2017, 04:56:58 PM »
Has anyone run any blood tests?  Seems like there are other options than a soft tissue injury -- localized infection, arthritis/rheumatoid arthritis, fungal infection, etc.  I think if you keep going to doctors that specialize in tissue injuries to hands, you'll keep getting the answer that it's a tissue injury to your hand (on the theory that when you have a hammer, everything looks like a nail).  If you've already had x-rays and multiple MRIs, I'm not sure what another hand specialist can test for or tell you.

I would be hesitant to go to PT before I was confident that I was getting therapy for the proper diagnosis and wasn't accidentally doing more damage.
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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #4 on: October 02, 2017, 05:58:28 PM »
gout?
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jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #5 on: October 02, 2017, 06:58:52 PM »
Has anyone run any blood tests?  Seems like there are other options than a soft tissue injury -- localized infection, arthritis/rheumatoid arthritis, fungal infection, etc.  I think if you keep going to doctors that specialize in tissue injuries to hands, you'll keep getting the answer that it's a tissue injury to your hand (on the theory that when you have a hammer, everything looks like a nail).  If you've already had x-rays and multiple MRIs, I'm not sure what another hand specialist can test for or tell you.

I would be hesitant to go to PT before I was confident that I was getting therapy for the proper diagnosis and wasn't accidentally doing more damage.

Good idea - I just requested follow-up bloodwork and an appointment to see my doctor. The last time I had bloodwork it was to check on a high fatty liver count or something along those lines (I had been taking some medications/supplements prior for about half a year which we think might have contributed to that). Since then I've stopped all that junk though. My doctor doesn't think those supplements were related to my finger pain or at least, he didn't seem to indicate anything about it. We'll see what he has to say about it this next visit.

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #6 on: October 02, 2017, 06:59:29 PM »
gout?

I was thinking that as a possibility but doesn't gout usually affect the full extremity? Like the entire hand or foot?

ElleFiji

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #7 on: October 02, 2017, 07:03:32 PM »
You've sought help, and are looking for alternative help. The vodder training is a post graduate training, I know orthopedic surgeons, oncologists, OTs, PTs, RNs, LPNs and yes, massage therapists with the training.

I encourage you to continue to follow up with doctors, but MLD is a specific treatment that can help with chronic pain and inflammation, and I've seen great results in cases that sound similar to mine. In addition, I know that anyone with that training has been taught to NOT treat with MLD if they suspect another cause (i.e. if it looks like your or RA they will treat but refer to your MD, if it looks like cancer or an infection they won't treat and will refer to your MD)

I'd also call a few of the clinics and see if they could do a free 15 min consult, or if they charge for the appointment if they can't treat you. I work in a different country, with different expectations, but it's an international certification

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #8 on: October 02, 2017, 07:35:06 PM »
You've sought help, and are looking for alternative help. The vodder training is a post graduate training, I know orthopedic surgeons, oncologists, OTs, PTs, RNs, LPNs and yes, massage therapists with the training.

I encourage you to continue to follow up with doctors, but MLD is a specific treatment that can help with chronic pain and inflammation, and I've seen great results in cases that sound similar to mine. In addition, I know that anyone with that training has been taught to NOT treat with MLD if they suspect another cause (i.e. if it looks like your or RA they will treat but refer to your MD, if it looks like cancer or an infection they won't treat and will refer to your MD)

I'd also call a few of the clinics and see if they could do a free 15 min consult, or if they charge for the appointment if they can't treat you. I work in a different country, with different expectations, but it's an international certification

Thanks, I tend to be a skeptic by nature so I didn't mean any harm in my initial response. Just curious because I'd never heard of that sort of training/certification before... of course, I don't know much about this stuff to begin with. But alternative medicine is something I've had even less exposure to, except for when my mom and in-laws have gotten herbal Chinese remedies, etc. I'll check around for some references and leads in my area - there are no more than half a dozen from looking on that list from the vodder site which makes it a small pool to select from, which also makes it hard to find any reviews or references from others too.

ElleFiji

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #9 on: October 02, 2017, 08:31:52 PM »
Thanks! I definitely was a little offended, but you apologized and explained beautifully, and I have tea and popcorn so we're good.

Talking about Chinese herbal medicine - I wouldn't rule out accupuncture either (again, for treatment not diagnosis). But it is hard to recommend resources across borders.

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #10 on: October 02, 2017, 08:49:08 PM »
Thanks! I definitely was a little offended, but you apologized and explained beautifully, and I have tea and popcorn so we're good.

Talking about Chinese herbal medicine - I wouldn't rule out accupuncture either (again, for treatment not diagnosis). But it is hard to recommend resources across borders.

Haha, yea definitely didn't mean for it to come off as an attack, etc.

I was actually thinking about seeing a chiropractor in the back of my mind. I don't know all the differences and that there were so many different occupations on the alternative medicine side of things - it's somewhat enlightening. There also seems to be a pretty big stigma towards natural medicine here in the states in general.

CupcakeGuru

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #11 on: October 03, 2017, 02:58:58 AM »
My mother had pain and swelling in her hand for several months. It gradually got worse to the point that she was in constant pain as well as barely able to use her hand due to the swelling and had trouble gripping things. She went to 2 or 3 hand specialists who could not determine what the problem was.

We finally convinced her to go see an orthopedic doctor. It turned out that she had 2 discs in her back that were detoriating. She had the disc replacement surgery which was succesful. No more pain or swelling in the hand.

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #12 on: October 03, 2017, 11:22:56 AM »
My mother had pain and swelling in her hand for several months. It gradually got worse to the point that she was in constant pain as well as barely able to use her hand due to the swelling and had trouble gripping things. She went to 2 or 3 hand specialists who could not determine what the problem was.

We finally convinced her to go see an orthopedic doctor. It turned out that she had 2 discs in her back that were detoriating. She had the disc replacement surgery which was succesful. No more pain or swelling in the hand.

It's weird how the hand specialists would think about referring her to a general orthopedic doctor - aren't they within the same department usually? How did you find this particular orthopedic doctor in this case? And is he a 'generalist' or does he specialize in spine?  What led you that direction?

CupcakeGuru

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #13 on: October 09, 2017, 02:23:55 AM »
My mother had pain and swelling in her hand for several months. It gradually got worse to the point that she was in constant pain as well as barely able to use her hand due to the swelling and had trouble gripping things. She went to 2 or 3 hand specialists who could not determine what the problem was.

We finally convinced her to go see an orthopedic doctor. It turned out that she had 2 discs in her back that were detoriating. She had the disc replacement surgery which was succesful. No more pain or swelling in the hand.

It's weird how the hand specialists would think about referring her to a general orthopedic doctor - aren't they within the same department usually? How did you find this particular orthopedic doctor in this case? And is he a 'generalist' or does he specialize in spine?  What led you that direction?

Jeromedawg
Sorry for the delay in replying. My DH had a degenerative spinal issue years ago. One of the side effects of this was pain/numbness in his hands as well as neck and back pain. His spinal doctor confirmed that this happens to quite a few people with spinal issues. When my mother's hand issues got worse, it was my DH who finally convinced my mother to go see a spine specialist. The hand specialists NEVER suggested it and even tried to convince her to have hand surgery. My DH spoke to his spinal surgeon who refered my mother to a doctor in her area (we live in different states). An MRI confirmed that my mom had disc issues/compression. Here is a link that my DH sent to my mom to convince her to seek a second opinion. I really hope this helps you.

https://www.spine-health.com/conditions/neck-pain/what-causes-hand-pain-and-numbness

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #14 on: October 12, 2017, 06:49:03 PM »
My mother had pain and swelling in her hand for several months. It gradually got worse to the point that she was in constant pain as well as barely able to use her hand due to the swelling and had trouble gripping things. She went to 2 or 3 hand specialists who could not determine what the problem was.

We finally convinced her to go see an orthopedic doctor. It turned out that she had 2 discs in her back that were detoriating. She had the disc replacement surgery which was succesful. No more pain or swelling in the hand.

It's weird how the hand specialists would think about referring her to a general orthopedic doctor - aren't they within the same department usually? How did you find this particular orthopedic doctor in this case? And is he a 'generalist' or does he specialize in spine?  What led you that direction?

Jeromedawg
Sorry for the delay in replying. My DH had a degenerative spinal issue years ago. One of the side effects of this was pain/numbness in his hands as well as neck and back pain. His spinal doctor confirmed that this happens to quite a few people with spinal issues. When my mother's hand issues got worse, it was my DH who finally convinced my mother to go see a spine specialist. The hand specialists NEVER suggested it and even tried to convince her to have hand surgery. My DH spoke to his spinal surgeon who refered my mother to a doctor in her area (we live in different states). An MRI confirmed that my mom had disc issues/compression. Here is a link that my DH sent to my mom to convince her to seek a second opinion. I really hope this helps you.

https://www.spine-health.com/conditions/neck-pain/what-causes-hand-pain-and-numbness

Thanks! I saw the second hand specialist and he was saying no doubt that's inflammatory arthritis. Now what caused it or exactly the intricacies of what kind of arthritis and how to treat it, he suggested I see a rheumatologist to find out. Otherwise, he recommended a cortisone injection to at least bring the swelling down since it's been such a long time. That shot felt weird and hurt as hell btw... not sure how long it'll take to kick in but I'm trying to be gentle with it for now. He referred two rheumatologists one is out of network and the availability of the other (with average to poor reviews on healthgrades) isn't until January!  I found another rheumatologist in the same office who has availability sooner and am looking at yet another one who has great reviews all around in another city. Is it OK to go with a rheumatologist that wasn't by referral btw? I'd assume so but was just wanting to check... I've never had to go through this many layers of doctors for anything before.

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #15 on: October 16, 2017, 02:48:20 PM »
It's fine to see another doctor that wasn't on the referral list. (If the referring doctor has a problem with that, then I'd say you should avoid that doctor.) What's most important is to see a doctor you feel is competent and are comfortable with. And someone that you don't have to wait too long to see, especially since this is a chronic condition that is affecting your quality of life.

Inflammatory arthritis (if that's what you have) commonly starts in the smaller joints, and treatment depends on what type of arthritis it is. I hope the cortisone shot gave you some relief. I had a bad reaction to one cortisone shot in my hand when the doctor hit a major nerve by mistake. The pain worsened throughout the day, then gradually wore off.

If you aren't getting answers that make sense to you, keep pushing. I know it can be exhausting and tedious, but recovery is unlikely unless you figure out what the underlying problem is. I spent 9 months last year solving a painful neck/shoulder with several doctors, PT, MRIs, x-rays, etc. Once I got the right diagnosis (cartilage tear in my shoulder) and good-quality PT (recommended by the sports surgeon), I finally am rid of that pain. Good luck!

jeromedawg

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Re: Medical advice (for hand & finger) - therapy and/or second opinion?
« Reply #16 on: October 16, 2017, 05:11:04 PM »
It's fine to see another doctor that wasn't on the referral list. (If the referring doctor has a problem with that, then I'd say you should avoid that doctor.) What's most important is to see a doctor you feel is competent and are comfortable with. And someone that you don't have to wait too long to see, especially since this is a chronic condition that is affecting your quality of life.

Inflammatory arthritis (if that's what you have) commonly starts in the smaller joints, and treatment depends on what type of arthritis it is. I hope the cortisone shot gave you some relief. I had a bad reaction to one cortisone shot in my hand when the doctor hit a major nerve by mistake. The pain worsened throughout the day, then gradually wore off.

If you aren't getting answers that make sense to you, keep pushing. I know it can be exhausting and tedious, but recovery is unlikely unless you figure out what the underlying problem is. I spent 9 months last year solving a painful neck/shoulder with several doctors, PT, MRIs, x-rays, etc. Once I got the right diagnosis (cartilage tear in my shoulder) and good-quality PT (recommended by the sports surgeon), I finally am rid of that pain. Good luck!

Thanks for offering a story of hope! Yes, these kinds of issues are a huge PITA... the cortisone shot seems to have helped a good amount - I was actually able to rack my pistol (and it's tough to rack too) at the range a couple days ago (even though I was avoiding using my index finger, I slipped up and used it a few times). It still feels slightly uncomfortable but way less than before. I don't know how long this will last but I got an appt with a rheumatologist in a couple weeks - I've heard some things about him that are a bit concerning though in that he may not come to an immediate diagnosis and seems like the kind who straddles on doing so and plays it more conservative. Sounds like the first orthopedist I saw who prescribed therapy without a sure-diagnosis of the issue.

In any case, I have at least one more rheumatologist lined up who I could probably see before next year if I don't get a good answer. Otherwise, I'll just have to wait till next year I guess.