adventures in hand splints

[ysobel]

At some point...

(One of the most frustrating questions I get from doctors is "when did X start"; with rare exceptions, by the time I notice something, much less see a doctor about it, it's been going on for some indeterminate amount of time. This is especially true for pain issues. I have "white noise" pain that masks other pain; I have transient pain attributable to either FOP or womanly issues, neither of which is worth noting the start of; and many pain issues start off barely noticeable and/or masked by other issues and/or pretending to be transient, such that by the time I tell a doctor about it it's almost always been at least months, but I have no idea how long)

...ahem. At some point, I realized that my hands were hurting. Not in an FOP way, more ... I don't really know. Joint pain. Probable cause as per my uneducated guessing, some sort of arthritis (undiagnosed but with family history of early onset osteoarthritis); less probable but also possible, hypermobility issues (undiagnosed and pretty much undiagnosable given that the general test for hypermobility involves moving joints).

It's worse in the right hand than the left, but present both sides. Using the mouse makes it worse, especially if I clench up (which tends to happen). I can't really mouse right-handed any more, and I have to take frequent pause-relax-stretch breaks if I use my left. (The lack of mousing on right hand was disguised by FOP pain issues farther up the arm, which had meant limited right-handed mousing for probably over a year at this point, whenever I stopped gaming.)

Also noticeable: small nodules on the distal joints of pinky and ring fingers on both hands, and a distinct lack of straightness to the right pinky in particular, as seen here:


(Photo of right hand from above, showing crookedness of pinky finger as well as nodules on joints)


(Photo of same hand from the side; I am holding my fingers as straight as they go, but the pinky is noticeably arched)

I brought this whole mess up when I was seeing my doctor for other reasons. He said that the nodules were mucinous cysts, and the straightness problems had to do with my tendency to hold the pinky up and back, like so:


(Same hand, same side view, but with pinky deliberately pulled up at about a 90° angle, curved into a claw shape; ring finger is about 45° and curved but not clawed; other fingers are flat.)

leading to blah blah extensor muscles overpowering flexor muscles blah blah leading to joint pain blah blah physical therapist for finger splint.

Sure, I said.

The physical therapist, S, identified another possible cause, or at least contributing factor. She asked if there was numbness or tingling; I automatically answered no, but then corrected myself that I hadn't noticed any, but since she asked... Turns out there is decreased sensation along the outside of both the ring and pinky fingers, as compared to the other fingers, which indicates mild ulnar nerve issues, which can cause the fingers to kind of claw up. (And the more weird stuff the fingers did, the more the weird stuff got reinforced.)

So now I officially have two splints to wear, a small one during the daytime to keep the pinky from popping up and back (because it wasn't only doing it when I was trying to) and then a larger one at night that keeps the ring and pinky fingers straight and also keeps the wrist in a neutral position (since I tended to curl it downward, which compresses the ulnar nerve).

I don't have photos of either (yet), but here is the concept:


(iPad-drawn rendition of hand with night splint, view from underneath and from thumb side. Yellow striped area shows where the splint covers; blue arrows/splotches show approximately where the velcroed straps are, two holding the fingers in place against the splint and two holding the splint in place against my forearm.)

I've worn the splint for two weeks (not every night, shhh don't tell S, but most) and it's kind of fascinating: when I wake up, my fingers are actually straight


(Photo of hand from above, showing straighterness of relevant fingers)

but curling hurts, and then by about an hour or so later it's gone crooked again, though less crooked than before.

It hasn't done anything about the pain, but I pretty much don't expect anything to. Probably increasing NSAID dosage again would help (I went way down on advice of the pain clinic, because potential of causing stomach issues, and that was even before the latest FDA thing about NSAIDs increasing risk for stroke) but I'm paranoid to (stomach issues! stroke!). Increasing suboxone dose would help the pain, if not the inflammation, but I'm paranoid about looking like a drug seeker (fucking war on chronic pain patients drugs).

Comments

[blueraccoon]

I don't know what your current dosage is on the Suboxone, but I promise that if your prescribing doctor is any decent they won't give you grief about it. At my highest dose, I was on 8mg 3/day and one extra if I needed it. I...seriously doubt you are anywhere near that.

[ysobel]

yeah, I'm still on fractional dosage.

wanna know the stupid thing? part of why I haven't pushed for higher is I *feel like a fraud*. because my pain is down to "only" 2-4 on the pain scale (even though it's not a competition), because I don't take the max I'm currently prescribed for (2x/day but I only reliably take it evenings because morning is pre-caffeine and I hurt less; I'm not really aware of hurting until mid afternoon) and therefore "obviously" shouldn't need more, etc. so even though current amounts aren't enough, because I'm still hurting, I feel weird asking for more.

brains can be dumb.

[blueraccoon]

this is not a lecture, but: If you make taking the morning suboxone part of your morning routine, you might be hurting less in general by the afternoon. It's a long-acting medication by design; it takes a bit to kick in but it's supposed to last a while.

It took me a while to get over the fear of drug-seeking and ask for enough meds to reliably control my pain levels. They're not constant so some months I have oxycodone left over at the end of the month; some I run out early. I try to balance it, but it's hard. These days I have a reliable scrip from my pain doctor (good pain doctors are worth their weight in gold or oil, whichever's worth more) and it's mostly enough. I still have fears of the ER seeing me as a drug seeker but a) I have a letter from my neuro saying I'm legit and they can treat me and b) they know me by now and they know my routine. Which is depressing but it works when I need it, mostly.

But yes, brains are dumb. I'm fighting with mine over the fact that I tried tapering down on one of my meds. I was at 5mg. I tapered down to 3mg, realized I was getting too anxious, and bumped back up to 4mg. This...feels like a personal failing, even though it's not.

*hugs*

[ysobel]

But suffering is so much more ~fun~!

Wait. Not fun. That other thing. Miserable, thassit.

(Logically I know it's better to stay on top of the pain, rather than trying to chase it down. Illogically I get paranoid about taking drugs I don't need, and even though I have been in pain every day for the last $largenum days, I *might* magically not hurt today!)

Sigh.

(also *hugs*)

[blueraccoon]

There's definitely a different mindset to get in between IR and ER meds. When I was on ER meds it took a bit to sink in that even if I wasn't hurting right then I had to take the meds anyway because I would start hurting soon and I needed to stop it before then. With IR meds it's much easier, just "I hurt--here's my oxycodone". With ER you really have to make the shift mentally that even if you don't hurt that moment you have to take the meds. I ended up thinking of them as maintenance meds, like my psych stuff--I take those every night even though since they're working I don't have panic attacks or bouts of depression. But I know I have to take the risperidone, etc. to prevent that.

Try thinking of the Suboxone not as a pain reliever but as a twice-daily maintenance med and see if it helps at all. My old therapist told me it takes 21 days to establish a habit and make it be part of your routine without having to think about it, if that helps.

[ysobel]

Try thinking of the Suboxone not as a pain reliever but as a twice-daily maintenance med and see if it helps at all.

That might help, yeah. I guess all my pain meds have started out prn and just crept up until prn was max allowed, and I'm not used to ER pain stuff yet.

Also I am kind of amused that it literally wasn't until today that I made the connection between "cutting back on nsaid" and "fingers going super hurty". duh. (have messaged my pcp about getting a referral and also going back to the ibuprofen dose I was on before. in retrospect I'm annoyed I took their advice as a) they were otherwise complete asshats and b) I have no current stomach issues.)

[blueraccoon]

Oh, also re: NSAIDs--they will totally fuck up your stomach lining and can cause all sorts of issues if you take too many. But the research on them raising the risk for heart disease or stroke is reeeeally nebulous at this time. They think it does something, but they don't know exactly what or how much of a something it does. And most importantly, they can't quantify how it affects your overall risk. So if you're low risk for heart attack or stroke normally and take a lot of ibuprofen or whatever, they can't say that it makes you overall a higher risk, or if it doesn't actually do anything.

They also don't know which NSAIDs do anything; whether it's ibuprofen, aspirin, naproxen sodium, whatever. It's possible that one of these has higher risks but they haven't split it down yet to figure that out.

Basically, my takeaway--because I take more ibuprofen than a sane person should--is that it might impact my risk for heart attack but I can either stress over that when there are so many unknowns, OR I can continue to take the ibuprofen which at least helps my headaches and allows me to function. I have had to cut down on the ibuprofen a lot because I have some nasty acid reflux going on, but I still take it and I'm not going to worry about the heart attack or stroke risks until I get a lot better data.

[princessofgeeks]

YIKES.

You are in my thoughts.

[synecdochic]

Fyi if the splints turn out to not help: that looks an awful lot like some of the symptoms of my mom's case of Dupuytren's, which they were really reluctant to diagnose her with at first because it usually doesn't show up until you're in your 50s and she started having symptoms in her early 30s. (They only did because her mom had it too.)

[ysobel]

Huh. Never heard of that! Thanks, will keep in mind.

♥

[synecdochic]

I am not trying to diagnose, especially since the nodes are really obvious and those don't tend to come with Dupuytren's, but if you've got any thickening of the tendon sheath in in the palm, it might be worth keeping an eye on. <3

[cedara]

It almost looks a bit like rheumatic hands, so your idea of arthritis sounds plausible.