Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Hand pain anyone?

After hurricane Irene, I finally have power and internet back. I have been waiting to ask all of you a question.
Up till now, my hands have not been affected by anything other than an occasional ache. About a week ago, both my wrists and hands started getting sore and are getting progressive worse. Now, I cannot lift a book with one hand. I cannot open a twist off lid or hold a pen for long. Is the typical? At first I just thought it was just a pinched nerve due to fusion in my lower c-spine and upper t-spine, but now I am wondering if it is not something else. It is beginning to feel like a typically AS flare only in my hands. Is that even possible? Those of you who have pain in your hands, what have your doctors said is the cause of your pain - AS in hands? Pinched nerves? Or some other crazy inflammatory side effect with a horribly difficult to pronounce name?

this all started quite suddenly in 1998. the first thing was a rib thing, but that only lasted a week or so. then a few months later, horrible dq tendonitis started. first in the left hand in july, then the right hand in september. in between, an upper back (rhomboid) thing happened. and for the first few years it was only the dq tendonitis and the upper back / neck. my dq tendonitis got so bad so fast that i was afraid i'd have to go on disability and maybe even lose the new academic position i had worked so hard for.

went to a hand (physical) therapist (they are awesome by the way and i highly recommend that you ask your doctor to see one) unless the doctor thinks its worse and thinks you should go to a hand orthopedist / hand surgeon. but at least go to the PT. a good one will send you to the hand orthopedist / hand surgeon if its bad enough.

first the PT did a lot of ultrasound and contrast baths and exercises with me. got me to a certain point, then sent me to the hand orthopedist who gave me a cortisone shot in the left wrist. we tried it with just the PT first, but it needed the shot. i save those for only when it won't heal with more conservative treatments.

the right hand never got as bad, and so PT and home contrast baths got it over the hump.

it was a real problem for about 4 years or so. then got better. now it flares now and again. but i can go for months to years where its hardly a problem.

a few things that i think have helped it:

the contrast baths (1-2 minutes hot water, 1-2 minutes ice cold water, back and forth for ~15-20 minutes total, repeated several times throughout the day. have found that just ice sets up scar tissue pretty bad. just heat increases the inflammation and makes things worse.)

my muscle relaxant zanaflex which i started ~2001. the physiatrist (dr of physical / rehabilitative medicine) gave it to me more for my back / neck / SI / butt issues, but the nice side effect was with the muscles pulling on the tendons less, helped my tendonitis as well.

LDN (low dose naltrexone) which i started in 2009. my tendon and ligament issues have improved dramatically since i started it. have not had any serious pulls or tears since. and any more minor pulls heal up so much faster. much less tendonitis too. though i still do get it some.

being careful not to overuse tendons that are inflamed. when my hands are flaring, i use a mouse vs a touch pad on the computer, i limit page turning of books and magazines, ask hubby to peel and chop the fruits and veggies when we prepare meals, have hubby open jars (or i'd buy one of those electric jar openers - same with cans). i only use gel ink pens, uniball are the easiest i've found on the hands and with nice smooth ink; they're my favorite. the hand therapist gave me some of these ideas, and over the years i've learned to compensate. like when the left wrist was very flared, had my students staple the right hand corner of their work instead of the left so i could limit page turning with the left. though an odd request, it made a huge difference, just need to be creative sometimes.

in 2006, i tore a ligament in the left ulnar wrist, pouring water into the sink from a pot. it was just too heavy for my flaring tendons and ligaments and i felt it snap (well, partially snap, as it was torn but not ruptured). hand PT (ultrasound, ionophoresis, and cold laser) after a cortisone shot got it over the hump. then another 2-3 years of not using it and now its about 99% (only bothers me if i push it). the next few years, the right ulnar wrist would get a twinge now and then, but never as bad as the left.

and through the years. have gone through periods of time where its the base of one of the thumbs. that comes and goes.

and lately, its like the joints of my fingers are loose. cause when i go to use them with any force, they crack and hurt when doing so. more annoying than anything else. the pain is very temporary and no damage thus far.

so for me, yes, the hands have been an issue. sometimes all by themselves.

but like most spondy enthesitis. moves around. locations come and go. does lift as mysteriously as it starts.


PS: also tore a ligament in my index finger. and couldn't even tell you how i did that. just woke up one morning and couldn't bend my finger well. as the month progressed, it got worse and worse. then it just got better and better. the hand surgeon told me it was a torn ligament when he evaluated it.

<raising hand and waving>

Yes, still at the 'annoying occasional pain' stage. Seems worse again now that I'm in a flare of sorts (off treatment for 3 months and just getting started back). Wrists/thumbs *were* the worst, but now I'm getting finger pain, too....index fingers OR middle fingers OR pinkie fingers....but not all at once. Saw a hand doc a year ago, or so, and he dx 'tenosynovitis' and said to come back if it got worse. Personally, I'm waiting to see if the Enbrel helps before going back.

Hope you find some answers. I'll be watching to see who posts on this....Sue22 has had hand issues.

Hand probs? Yes, from over here. Have OA in both thumb roots - showed up on X-Rays. Have had OA in hands for several years now and carpal tunnel for 6 years. Have dead thumb and first finger tips with slight numbness middle fingers. Had nerve conduction tests for both wrists for carpal tunnel. Affimative for both wrists. Had carpal tunnel op on R. hand/wrist 4 weeks ago, still got the thumb/finger tip numbness. Possibly 'might' have left op too long, dunno. Also have paraesthesia in the operated hand and very tender cicatrice area - can't grab, can't garden, can't even cut bread - and all the rest! At least not dropping things, but, would I have this op again? Resounding NO.

Now. Hand probs can also be caused by cervical probs - and I got cervical probs in spades. Need to have properly checked out but don't think the Fr. know what they are about. So, aint going to bother - they'll only mess around like they usually do and end up making a bish.

Suggest that you get the nerve conduction studies done for carpal tunnel and if come back clear then look to cervicals - in fact, get BOTH checked out.

And no, most unlikely that enbrel or owt else is going to help. A specific C.T. wrist brace worn at night and whilst on the PC might help. I wear one at night, very comfortable, but find a nuisance to wear whilst on the computer. There are execises that you can do to help alleviate C.T. probs - put in a google search for em. I have started for my left hand - do NOT want surgery, thank you. The exercises are also specified for after the op - so am doing the exercises on 'both' hands.

Hope you can sort -

My OA started in my wrists when I was 15yrs old, I'm now 74.

molly mentioning bracing, reminded me of something.

bracing always made my tendon / ligament problems worse.

don't know if its true or not, but my first hand PT told me that if a brace helps, its carpel tunnel and if it makes it worse, its tendonitis. don't know if that's true, but even a little bracing, allowed the inflammation to get worse and worse for me; my understanding is that it didn't allow for proper blood flow to allow the body to try to heal it. so the secret for me was to not use the inflamed or torn tendons or ligaments, but to allow them to move freely. a careful balancing act for me.

trial and error when it comes to bracing. if it helps, do it. if it makes it worse, don't. that's been the advice from my hand PTs, hand orthopedists / surgeons.

Sue - That is why I specfcally mentioned CT when referring to the CT brace: 'A specific C.T. wrist brace' - or, if you like: 'A brace 'specific' to CT' *for CT. Yes, better to be more specific 'smile'.

Mind you, I did not find any impediment to blood flow whilst wearing the brace. The brace keeps the hand in neutral - which is what it is meant to do - thereby 'not' impeding blood flow. Stops one bending the hand, clenching fist, curling fingers etc etc. A 'neutral' hand, blood flow not impeded. Must not pull the fastenings too tight of course...just comfortable just secure. Think people might have a tendency to over-tighten the fastenings!

Hope you can sort the problem Mathie -

Oh yes. Can also be elbows at fault. IF you have a trapped ulnar nerve then can also have hand problems - I also have entrapped ulnar nerves (both elbows) with osteophytes. Great - don't weaken! <LOL>

Sounds like you have had a rough times with your hands.
Early this spring I had numbness in my fingers when I woke up but this was during a flair that was attacking the lower part of my C-spine. So I wrote it off as a side effect. In my original post I wrote “about a week ago” this started – I meant to say ‘a month ago’
The contrast baths actually sound like a welcome relief – I will try that tonight. And I was just trying to cut back on my muscle relaxers, but maybe that was a bad idea.
Your torn ligaments sound a little scary.

Rumble - There it is ‘the crazy inflammatory side effect with a horribly difficult to pronounce name’ Tenosynovitis. I have not heard of that one. Sounds like something my crazy Greek rheumy would spit out in his heavy accent and expect me to remember, research and repeat.
I am on remicade and it does not seem to be helping whatever is up with my hands. Let me know if enbrel helps

Thank you both for the information
I read up a little on CT after reading your post. My thumb, index and middle finger hurt the worse, and one hand (my right) is worse than the left, which is inline with what the description I read. My top knuckles ache, the base knuckles and wrists are down right painful. What I read did not specify whether the pain in the fingers is in the knuckle or if it is more of a muscle pain. Was the pain in your knuckles?
Sounds like a brace might be worth a try. Also sounds like I should fess up to my rheumy. Saw him 3½ weeks ago and did not mention my hands because it was just an annoyance.

Knuckles sound more like to OA, thumb and finger tips sound more like CT and of course with some tingling. (I have both the OA and CT both hands.) You prob wake up in the morning with hands all numb and having to 'shake' em awake? That is usualy a sign of CT. Holding a book for any length of time, fingers go numb or holding the telephone...ooohhhh, very numb!

Tests. One is to bend the wrist towards you, bend it tight, keep bent, if you get the tingling in the palm then the finger tips, then CT. Another one is to strike the inside of the wrist with the edge of your other hand, does it tingle? If so, CT. Another one is to strike the outer edge of the wrist, if it tingles then CT. Another one is to press the thumb down the little finger, starrting from the top, then the middle then the base of the finger, do all four fingers, if they tingle at all then considered a sign of CT. Called the Phalens test and the other the Tinel test.

Pain in finger tips and numbness is CT 'or' can be radiating down from cervicals 'or' can also be caused from ulna nerve (elbow). Yes, the dominant hand will usually be the worst affected.

Fess up to rheumy and no doubt she will send you for nerve conduction tests - no, they don't hurt.

Try a brace - any good pharmacy should sell em. Must get the right size, and if you do get one, ensure that don't overtighten, should be comfortable and supportive. The brace is to keep the hand in a neutral position, so as to stop fingers curling and bunching and fisting. Can also sleep with arm supported by, resting on, a soft pillow.

Might find this website useful:-
http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

As for cortisone injections - injection is painful and does not do much for the wrist and 'can' severely damage the nmedian nerve *unless done by a very skilled operastor and preferably under ultrasound guidance needle.

Surgery. Open mini or arthroacopy. Arthroscopy 'can' be problematic due to the fact that the surgeon cannot 'see' the nerves - which have been known to be damaged during arthroscopy. So, arthroscopy is controversial... They can still damage in an open surgery! IF you ever do go the surgical route ensure that your surgeon had done hundreds of em, so much so that he can do em in his sleep! It is a simple surgery with horrible potential to go very wrong indeed.

Read up everythng you can find. (Follows separate pot with surgical information - that I put together for my s-in-l).