adventures in hand splints
Aug. 4th, 2015 04:00 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ysobelAt 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 onchronic pain patients drugs).
(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