my thumb is hurting and the doc said nothing was wrong. what do I do?
October 20, 2013 10:31 AM   Subscribe

my right thumb has been hurting on and off for years. it's at the basilar joint. I have gotten xrays and I was checked for rheumatism (which has occurred in my family) but was cleared. eventually, the doc gave up, stating some things just couldn't be explained. this is not good enough for me.

it has forced me to stop console gaming years back. it shows up consistently when I forget my mouse and use my trackpad for a day. it sometimes shows up when I lift weights, in which case I have to take a break for a week.

I want this pain to stop and never return so I can use my thumb like a normal person. what do I do?

(checkups occurred in germany. I am now in china and do not have the xrays here. I have health insurance and can get medical care.)
posted by krautland to Health & Fitness (15 answers total)
Request an MRI? I had a bone tumor in a finger that barely showed up on X-ray but was really apparent on the MRI.

Or depending on what it is a cortisone shot could help (and if so it would narrow down what it could be).
posted by vegartanipla at 10:36 AM on October 20, 2013

Response by poster: it's been a while since that doc appointment but I think he gave me a single cortison shot. it helped for a few weeks but I'm back to 'normal.'
posted by krautland at 10:40 AM on October 20, 2013

Research says cortisone shots give short term but not long term relief. Also, there are detrimental effects of cortisone use long-term.

I suspect you will never get an answer to this. There are an unbelievable number of random weird things that can happen with your body that are undiagnosable, and they will only increase with age.

In the interest of "may as well try it", why not do acupuncture and other "alternative" healing modalities. It can't be any less effective than what you're already doing.
posted by latkes at 11:05 AM on October 20, 2013 [2 favorites]

They can be less effective, if say, the acupuncturist doesn't use good sterile technique and you end up with an infection.
posted by wotsac at 11:11 AM on October 20, 2013 [2 favorites]

If you're really serious about having something done, try a hand surgeon. (Look for a plastic surgeon or an orthopedic surgeon with a hand surgery fellowship type training). They tend to care very much about fixing problems that are causing activity restriction.
posted by sanderman at 11:15 AM on October 20, 2013 [2 favorites]

I am going to suggest that you try the topical ointment Penetrex for an extended period. I don't know where you get it in China, however.

Also, is it possible that it is low grade arthritis but not readily apparent to your doctor? Can you do some sort of low-inflammation diet (The Perfect Health Diet, perhaps) and see if that reduces the frequency of the pain?
posted by mecran01 at 11:25 AM on October 20, 2013

They can be less effective, if say, the acupuncturist doesn't use good sterile technique and you end up with an infection.

Sure, but that's actually true for treatments performed by medical doctors as well. I am an RN in a hospital - I see patients with hospital-aquired infections all the time. Acupuncture is very low risk and I challenge you to point to evidence that infection is a significant risk.
posted by latkes at 11:34 AM on October 20, 2013 [3 favorites]

OP, are you right-handed? Could this be some kind of repetitive stress injury, where something about the way you write/game/mouse-click is pinching or irritating a nerve? Maybe a physical therapist or ergonomic expert could observe and figure out the problem & give you a corrective brace.
posted by oh yeah! at 12:00 PM on October 20, 2013 [1 favorite]

I have de Quervain's tenosynovitis, aka "Mommy thumb," as well as more general hand woes. Both conditions come and go (flare up) as you describe, and are aggravated by all kinds of things but especially doing screwy stuff with my hands - me filling in for the payroll clerks and thus having to write a bunch of stuff out with a pencil is more or less a sure bet for weeks of pain.

One test you may not have done that might help rule out stuff, at least, is a nerve conduction test (I wouldn't bother unless you get numbness, too - they did it when the pain and numbness started shooting up my arm, etc. - those tests were what pointed us to the tenosynovitis.) It's also fairly easy to rule out a bunch of things which are almost exactly like de Quervain's by wearing a wrist brace with a thumb spica and seeing if it works (it may make you feel better while you're wearing it, but it takes a fairly narrow set of circumstances such that you'll still feel pretty great three hours into the workday if you wore the brace overnight but haven't worn it since you got out of bed.) I more or less swear by the one I linked to - I've bought most of the ones that Amazon (and my local pharmacy, and a bunch of random OT-oriented websites) sell, and it's actually comfortable while still actually immobilizing the thumb.

Topical (steroid, etc.) solutions don't do a darned thing for me, but steroid shots (even for my asthma, in my buttocks) are amazing while they last. I also respond pretty well to classic arthritis cold/heat treatment, but it has to be actual heat or actual cold - that might just be a me thing, but the Aspercremes are ineffective. They're putting me on an RA drug for a while to see if it helps - I'm serum-negative (which I guess is what you mean when you say it was ruled out,) but I do have consistently moderate-high inflammation "scores" on other relevant blood test line items. Also, my pain gets very slightly better as the day goes on, and is excruciating in the mornings and tends to wake me up in the night - these are other things that point toward RA (osteoarthritis usually feels great in the mornings and crappy in the evenings.)

I also second getting an MRI, as X-rays are a bit like a hammer-in-search-of-a-nail thing when you don't really know what you're looking for (example: soft-tissue damage and bone damage can require slightly different procedures.) Unfortunately, you're probably going to want to learn more than you care to about medical imaging if you really want to get to the root of what's going on. The only reason I haven't bothered is that the wrist brace + thumb spica is so incredibly helpful, and the steroids helped for weeks rather than a much shorter period of time.
posted by SMPA at 12:01 PM on October 20, 2013

Oh, and here's information on nerve conduction studies, etc. I hated mine - it was all Frankenstein's monster-ish, because they seriously made my hand jump by jolting my arm. Involuntary movement is not fun for me, it seems.
posted by SMPA at 12:14 PM on October 20, 2013

Have you tried to get a second opinion? You might just need a new doctor. Maybe they don't know exactly what's wrong and won't know, but there must be something (whether it's a pill, a cream, or something) that will give you some relief. I wonder how often you are gaming with a console though. I was never a big gamer, but even just one day of GTA Vice City left my thumbs feeling achy.
posted by AppleTurnover at 2:14 PM on October 20, 2013

Definitely see a hand surgeon. If you're in SoCal I can refer you to a few.
posted by These Birds of a Feather at 2:38 PM on October 20, 2013

I had a situation where my knuckles on one hand suddenly got stiff and painful. I couldn't make a fist, and it hurt to do things like use a screwdriver or sometimes even pick up a glass. I worked my way up to the "best hand orthopedist" in this smaller city, who told me he could not see anything on the x-rays and offered to give me steriod injections "because it will probably help for a while."
I went to my accupuncturist instead - it was gone after about 3-4 visits. Maybe it would have gone away anyway, but it had been sore for a long time, and got better quickly.

The same lady also fixed my carpal tunnel with accupuncture and some Chinese herbs.

It's non-invasive, relatively painless, not too expensive and sure won't cause lasting harm like surgery or long term steriod use - might be worth a try.
posted by rudd135 at 4:54 PM on October 20, 2013

Response by poster: is it possible that it is low grade arthritis but not readily apparent to your doctor?
it could be but I asked specifically to be checked and he seemed sure it wasn't the case. I have to look into the diet.

are you right-handed? Could this be some kind of repetitive stress injury, where something about the way you write/game/mouse-click is pinching or irritating a nerve?
I am and it could be. but it makes me wonder because I don't particularly overuse the thumb. I go out of my way to use a mouse instead of my trackpad, etc. — sometimes this happens merely because I did pushups.

I have de Quervain's tenosynovitis,
this sounds like something I should ask a doc specifically about. thank you.

If you're in SoCal I can refer you to a few.
thank you. shanghai, unfortunately.
posted by krautland at 6:56 PM on October 20, 2013

You might find it informative to read chapter 7 of the book "How Doctors Think". That chapter is about the M.D. author's experience visiting several different doctors for his own hand problems, and discusses how he evaluated the different treatment suggestions he received from the doctors.
posted by yohko at 12:38 PM on October 21, 2013 [2 favorites]

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