I feel a bit like Dr. Strangelove

June 1, 2011 3:27 PM

YANMD, YANAD. But, do you have any idea what might be going on with my hand/arm/fingers? General description: sharp, acute pain and lack of mobility, followed by growing tingling, burning, itching sensation. WAY more details inside.

So, a month and a week ago, I was smack in the middle of finals. My hands hurt like normal, from over using them and typing too much. (I have Rheumatoid Arthritis, well controlled, but over use tends to make them ache badly.) This was perhaps worse than normal, I thought, but nothing particularly bad. Except on the Tuesday of the first day of real finals, the ring and pinkie fingers on my right hand start to HURT.

So I take a hydrocodone 10/500, and go about my day. And then they hurt more. And then they can't flex open all the way without excruciating horrible pain, and even then, will not go past a particular point on their own. I call my RA doctor, go in and get the nurse on call to look at it, she thinks I need to be seen, but I can't be seen till Thursday. Cue three days of pain that I would describe as "Having the side of my hand slammed in a door over and over" or "Half way between kidney stone and the worst tooth ache you can imagine" - not good.

Well by Thursday, the fingers are a bit more flexible, with a bit more motion in them. But not much. And not much less pain. Doctor says... ew, puts me on oxycodone and a prednisone dose pack. I take an incomplete in a class, hoping I'll be able to get back to the paper ASAP, but well... no dice so far. Anyway. A week pases. The hand is no longer excruciating, but now, my ring and pinkie fingers are tingly. And burning. And worst of all, ITCHY AS HELL. And this feeling goes past my hand, past my wrist, and almost all the way up to my elbow, on the outer side of my arm (ulnar side). And my elbow is starting to ache. Worse, I'm not regaining much more dexterity in my fingers, and typing for ANY length of time hurts like hell (20 min + constant).

Doctor sees me three weeks after first appointment, to check on progress. She's alarmed that the tingling is replacing the pain, and says its likely an entrapped ulnar nerve, but that she is out of her specialty with this one. She sends me to a neurologist, telling me that the neurologist will order MRIs and do an eval.

Well. I just had said neurologist's appointment. I didn't have any MRI's ordered, but instead was subjected to about 30 minutes of nerve conductivity testing. Which confirmed there isn't any obvious nerve damage, at least, but that they don't know what it is other than that. No mention of MRI's, or anything like that. Just told to go see my other doc again, and go from there.

Anyway, here is the current situation:
1) Right hand pinky and ring fingers, and associated side of hand, wrist, and ulnar side of arm go from burning/tingling/itching, to painful burning/shooting pain.
2) Pain is not responding to lyrica (already on it) or gabapenten (already on it). It does respond to 5/325mg percocet tablets, but NOT to 10/500 hydrocodone tabs.
3) I keep dropping things. I also have very poor fine motor control in my ring and pinkie fingers. I swap keys while typing (and am now typing 3 fingered on the right hand just to avoid that).
4) Any sustained or focused physical activity with the hand will make the pain spike. Driving for more than 30 min makes it hurt. Tying my SHOES in the morning hurts.

Also: No neck pain. Was asked this twice by the neurologist today. Nor any pain anywhere other than my arm that I can feel. But again, you could likely drive a nail through my foot and I wouldn't feel it till you were done right now, given how many pain blockers/painkillers I'm on in a given day now. And the nerve tests they did today at the neurologist made my hand hurt nearly as bad as an hour of forced typing does. No idea why, but my whole arm aches, right up to my shoulder, but the tingling and burning stops at the elbow. They tested the other hand as well, and that arm doesn't hurt at all.


So, here are my two questions. One, what do you, hivemind, think might be wrong with me. Entrapped ulnar nerve? Something else? Two, what can I do to at least ease these symptoms? The itching, burning, and pain when typing is NOT something I can live with right now. And this is from someone who has Trigeminal Neuralgia. I can deal with pain, but these sensations are just... unworkable. Particularly the itching and burning.

Thanks in advance.

posted by strixus to health & fitness (8 answers total)

Your symptoms and their sequence reminds me when I had a nerve pinched in my leg due to improper snowboard shoes. The trauma was limited to a short time period (a couple of days) but sufficient to bruise a major nerve conduit to the top surface of my left foot. After the major pain I got the warmth and tingly sensation for weeks. It was bearable after one month, and healed over the course of a full year.

Nerve doctor explained the external nerve conduit was not severed but the internal structure of the nerve was damaged. Because the external conduit was preserved the nerve was able to heal, but it is a slow process.

I wish you a speedy recovery.
posted by knz at 3:36 PM on June 1, 2011

Sounds similar to the pain my daughter had when she had carpal tunnel syndrome.
posted by tamitang at 3:46 PM on June 1, 2011

Sounds similar to my experience with carpal tunnel syndrome too.
posted by MT at 4:02 PM on June 1, 2011

I would get another neurologist's opinion. Perhaps the person you see for trigeminal neuralgia. I hope you feel better.
posted by brevator at 4:06 PM on June 1, 2011

Re: Carpal Tunnel - I've considered it, but its been my general impression that carpal tunnel affects the index and middle fingers, not the pinkie and ring fingers, because the carpal tunnel encircles the median nerve not the ulnar nerve.

And brevator, I would, but I haven't seen anyone for it since my diagnosis over 10 years ago other than my rheumatologist. She pretty much manages all of my meds and health issues.
posted by strixus at 4:11 PM on June 1, 2011

I am not a doctor.

Ulnar neuropathy would explain the palm and fingers, but not sensations up to the elbows, which I believe would involve the median cutaneous nerves.

Nerves can take weeks or months to heal once injured, and that's assuming there's no ongoing source of damage/inflammation.

Taking both pregabalin (lyrica) and gabapentin simultaneously seems redundant, given that the former is essentially a more potent version of the latter. I'd dump the gabapentin, upping the dosage on the pregabalin if necessary. If that doesn't cut it, consider branching out; amitriptyline or duloxetine. It'd be a lot safer than the opiates long-term.

You also might want to consider something topical like capsaicin.
posted by dephlogisticated at 4:45 PM on June 1, 2011 [1 favorite]

This does sound a lot like cubital tunnel syndrome, which is the ulnar nerve equivalent of carpal tunnel. The nerve gets pinched or entrapped around the back outer edge of the elbow, and you feel it in the elbow, pinkie, and outside half of the ring finger. I've had issues with this on and off for a long time and your symptoms sound pretty much the same, except far more severe than I've ever had to deal with. It's not an uncommon form of RSI, so maybe when you're looking for another medical opinion, it might be worth trying to find a RSI/occupational health specialist? If the nerve is entrapped, there are surgical solutions.

In the meantime, about the only thing I can suggest that might help is keep your elbow braced so that your arm is straight as much as possible, especially while you sleep, to keep it from getting pinched and twisted any more than it already is. (Wrap a bath towel around your arm if you don't have a proper elbow brace.) Also, I find that a support/compression glove helps my fingers feel stronger and more useful, if I can't just avoid using that hand altogether.

Good luck, and I hope you can get this taken care of...
posted by robt at 4:45 PM on June 1, 2011

IANAD etc. It does sounds like the ulnar nerve, which does run through the cubital tunnel and can be having issues there or at various other points in your body. When I had hand&arm issues I found that doctors were really not that helpful at diagnosing it, but stretching, relaxation, and massage really helped. (Try massaging gently between the triceps and elbow and see if that does anything.) My symptoms were different, though. Intermittent non-severe pain in my forearms, tingling in the fingers, and it was obviously brought on by typing.

I recommend this book, which was great when I had pain and tingling in my hands. Pay close attention to her explanation of the "stretch point" and how to stretch in a very specific way.
posted by callmejay at 6:20 PM on June 1, 2011