Two thumbs down
November 14, 2019 8:21 AM   Subscribe

My thumbs have not been functional since last January, and doctors can’t find an explanation or effective treatment. What should I do next?

Starting ten months ago, I’ve had pain and weakness at the base of both of my thumbs; worse in my dominant hand. There was no clear reason for its onset. I can’t pick up mugs or books with one hand, turn doorknobs, pull on socks, etc. Pain stops if I don’t use them, but begins again as soon as I start. I went one solid month only using one hand, in case it was an “it’ll get better if it can fully heal” thing, but it was back to painful immediately after I started using it again.

Since August, I’ve been working with an orthopedist, who immediately diagnosed it as carpal tunnel syndrome; my symptoms didn’t really fit it, but in his experience that’s the cause of 99% of hand problems. So he recommended the following treatments:

• Wrist braces at night. These led to new symptoms (tingling, numbness) regardless of how they were tightened, and he recommended discontinuing them.
• Tendon glide exercises. No improvement after eight weeks, and some additional symptoms (tingling in wrists).
• Cortisone shot in the wrist. No effect.

I just got MRIs of both hands which were normal. The orthopedist has no additional suggestions for me. Typical bloodwork is normal, including Lyme and B and D vitamins.

What should my next step be? I’m 44 and going without opposable thumbs for the rest of my life is kind of a big deal! If your suggestion is “find another orthopedist,” that’s cool, but based on my past experiences asking for second opinions, it’s only helpful if you can tell me something specific to ask them for.
posted by metasarah to Health & Fitness (15 answers total) 5 users marked this as a favorite
Have you had nerve conduction tests? If it's CTS or something else, that'll be a helpful diagnostic point--sometimes standard treatments don't always work, you know? That's not always the best path toward deciding against a specific diagnosis.
posted by late afternoon dreaming hotel at 8:26 AM on November 14, 2019 [1 favorite]

I would suggest visiting an experienced Certified Hand Therapist. They have a lot more expertise in disorders of the upper extremeties than general orthopedists.
posted by Triumphant Muzak at 8:28 AM on November 14, 2019

Do you have shoulder or upper neck/back issues as well? The muscles are connected.
posted by london explorer girl at 8:33 AM on November 14, 2019 [2 favorites]

This is, perhaps, a silly thought. But I would imagine the occupation that was fictionalized as the character of Gregory House actually exists – someone who solves medical mysteries that doctors are having difficulty with. Perhaps someone who performs that purpose in the real world could be found?
posted by WCityMike at 8:42 AM on November 14, 2019

Response by poster: Nerve conduction test showed very mild CTS; the guy doing the test didn't think it would lead to my current symptoms. The orthopedist said that even if it is CTS, if the stuff I've tried hasn't helped then he doesn't know what would. Apparently response to cortisone shots is highly predictive of results of surgery.
posted by metasarah at 8:53 AM on November 14, 2019

Do you have problems in any other fingers? Both thumbs at once with no clear injury and no pain in other parts of the hand makes me think about looking at dermatome maps and wonder if that might provide some clue. A dermatome is an area of the skin/body supplied by nerves from a single spinal root, and some maps suggest that the thumbs don't share a dermatome with other fingers. The map I linked shows that thumbs are ennervated by the C6 vertabra, maybe there's something going on in that spinal nerve?
posted by needs more cowbell at 9:04 AM on November 14, 2019 [4 favorites]

That sounds unpleasant and frustrating, I'm sorry! Did you start with a GP? If not, I'd go back and start there. They may be able to suggest other specialists or potential causes that an orthopedist wouldn't think of.
posted by wintersweet at 9:17 AM on November 14, 2019

Response by poster: Other fingers are fine. I did begin with my PCP, and his lack of helpfulness is why it took me until August to get anywhere at all...
posted by metasarah at 9:31 AM on November 14, 2019

I have similar symptoms in both my thumbs and am just starting down the path of getting help with my PCP first. Here's what Ive tried, though sounds like you've done these as well:

- Phone case that puts less pressure on my thumb - the kind with a finger loop in the back.
- Instead of wrist braces, I sleep with thumb braces. I have a stiffer one (sorry no link) and a slightly softer one that's much easier to remove and sleep in.
- Thumb compression brace during the day. Sadly I can't escape sitting in front of a computer all day.
posted by homesickness at 11:06 AM on November 14, 2019

You had MRIs of your hands/wrists but did they also look at your neck?
posted by poffin boffin at 11:33 AM on November 14, 2019 [2 favorites]

Mentioning in case helpful: when this happened to me it was mummy thumb (common in pregnant people or new mothers), ie a combination of hormonal fluctuations and repetitive lifting/phone scrolling. Is it possible hormones could be aggravating the joints?
posted by Concordia at 2:10 PM on November 14, 2019

Having a good friend with MS, your symptoms sound like they could be neurological. Maybe get a referral to a neurologist? Not having good thumbs for the rest of your life shouldn't have to be an option! Good luck.
posted by summerstorm at 7:16 PM on November 14, 2019 [1 favorite]

Definitely see a neurologist; the fact that it's in both hands is alarming.

Definitely see a specialized hand therapist. There's a lot that doctors don't know and there is a lot that they aren't trained in. A hand therapist will have knowledge and training that far outweighs your doctor or even orthopedist. It would be ideal if your hand therapist were also an occupational therapist. 80% are, so this shouldn't be hard to find.

With that said, where exactly is the pain and how does it feel? What makes it better? Do you have any changes in sensation in your skin? How do your hand muscles look--are they atrophied? Do both hands look about the same? What happens when you take your hand and extend your fingers all the way out--what do your ring and pinky finger do, specifically? What happens if you take a piece of paper and try to hold it between your thumb and index finger, kind of like holding a key, and then someone tries to pull it out? Can you resist them?

I'd wonder if it's actually your ulnar nerve that's affected and it's knocking out your adductor muscles in your thumb, which help you bring your thumb in toward the rest of the hand. It would certainly affect your grip strength. With that said, it's strange that it's on each side. Has anyone checked your neck? Perhaps something is getting pinched in your neck and it's affecting the nerves that travel out and go to your hands. How's your posture?

Very strange. You need to see a neurologist and hand therapist (slash OT) for sure.
posted by Amy93 at 8:04 PM on November 14, 2019 [1 favorite]

Of course, continue working with doctors and specialists!, however the base of the thumbs is a significant point in many traditional healing methods. If you're at all inclined to that sort of thing, I'd start seeking out reputable practitioners of "alternative" methods, who could offer insight and possible therapies.
posted by hannahelastic at 11:51 PM on November 14, 2019

Response by poster: Update: I tracked down the MRI results myself and discovered that when my orthopedist said they were normal, he was ignoring that they showed arthritis in the exact joint where I'm having pain. I'm seeing a hand therapist and trying to work through my fury. It's unclear what next steps will be (beyond finding a new orthopedist) but at least we have something to work with.
posted by metasarah at 9:28 AM on December 20, 2019

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