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Vakul Aren
Vakul Aren, Doctor
Category: Health
Satisfied Customers: 3374
Experience:  MBBS,DTM&H( Univ of Liverpool),30yrs experience in practice
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Severe pain where thumb nail enteres skin. Pain begins along

Customer Question

Severe pain where thumb nail enteres skin. Pain begins along the top of the nail into the skin as if cut. Pain always begins at the same place to extent abour the nail as in a circle then down past the first joint into the joint at the base of the thumb and lately miagrating to the first finger of the left hand. (Left thumb) There is arthritus in the joint, but years before xrays revealed the arthritis, the pain started. At times it feels as if the thumb has been struck with a hammer, which is has not. The only way I can stop the pain is to use topical pain killers and ambasol locally. I have had fibromyalgia since 1982 and am taking medications for it. This is NOT Fibromyalgia. I also have diabetes. I am 65 years old. Any thoughts other than 'killing' the nerve. If it works, I will settle for that. Pain keeps me from sleeping, occurres from temperature changes, (at times the thumb during extreme pain is cold at the tip.) Pressure will also case pain. At times I want to slam it against the wall. There is no specific time element when this pain occurrs except during the night during sleep. It does occurr during the day. Any ideas how to stop the pain. I already tramadol, and oxycodone for the Fibromyalgia and am NOT seeking additional pain medication. The topical pain killers, Neosporin + pain relief and Equate Anti-Itch Cream with Diphenhydramine 2%. The Neosporin+pain relief seems to work faster. Some times it as taken 40 minutes to stop the pain pramoxine 10%.
Must get this problem sloved. THE VA has not been able to suggest anything other than OTC arthritis medications. I react and am allegic to so many medications that I carry a list of medical history with me, which saved my life some 18 months ago when seen for a cardiac condition in the ER, or so the doctor said. Any ideas
Submitted: 3 years ago.
Category: Health
Expert:  axedoc2010 replied 3 years ago.
Hi,

Is the nail fold around the affected nail normal or thickened?
Customer: replied 3 years ago.
The nail appears normal, not unusual shape, color, thinkness. It has been looked at my the VA is two different states over the last 5 or six years. They have no idea what causes the pain, except to say it is arthrist according to new xrays. However years ago there were no signs of A in the xrays. The pain is migrating now from the initial site of the on set into the first finger, and second finger. Now it is also spreading during the attacks into the palm of the hand along the bottom joints where the fingers join the palm. Also, the pain proceeds into the top of the hand with such intensity of pain that I cannot flex the fingers because of pain. The pain on occassion has also gone directly up the arm from the left thumb into the deltoid muscle (i think deltoid is correct, but the lage muscle before entring the shoulder. Oh, I fell on that shoulder on Dec. 1, 2009. It was months before i regained us of the arm. BUT during that time there was no pain in the thumb. As the use of the arm returned, so did the thumb pain. Thanks
Expert:  axedoc2010 replied 3 years ago.
Thank you for the information. Your problem is not dermatological. I am opting out and will try and get your question re-listed in the health category where an expert qualified to deal with your problem will respond if available. Regards.
Customer: replied 3 years ago.
Where is the ACCEPT button.
Expert:  axedoc2010 replied 3 years ago.
There is no need to accept as I have not answered your question. When an expert posts a reply that you find useful or informative only then may you choose to accept. All the best!
Customer: replied 3 years ago.
Thank you! Sure hope someone has an idea about this. Thanks, again.
Expert:  Vakul Aren replied 3 years ago.
Since you have diabetes,perhaps we should think in terms of peripheral neuropathy or diabetic neuropathy.A trial of Gabapentin/Pregabalin may be appropriate.This drug will help if the pain is neuropathic in nature.Compressive neuropathy also needs to be ruled out.Opinion by a Neurologist will be of value.
Customer: replied 3 years ago.

The December 1, 2009 fall all on to the shoulder landing perpindicular to the ground resulted in NO pain in the thumb for several months until I managed to regain use of the left arm. Also, inject Novolog insulin on a sliding scale, along with Levemir Insulin. Have been diabetic since since 1997 yet show no signs in the eyes, or feet. Had pain a while ago and it went up the connective tissue to the large muscle joining the shoulder at the arm. I have had severe Fibromyalgia which began in Feb. 1982. I would like to send a ten page printout of my medical history which I made up and carry to all medical events. It shows the many medications I have reacted to, along with the childhood illnesses, and some past family history, and surgeries. Is there an email address or some other address to which I can forward this medical history.

 

I have no faith the Gabapentin will have any effect, having used it prior to the insulin injections. Also have four stints in my heart.

This recent occurence of pain seems to follow the fiberous connective tissue up the arm for the first time I have felt the connective tissue separate from the general pain. The pain is now causing loss of ability to move the left arm and hand during the extreme pain episode (sp) . Also, when the thumb nail is cut, the occurances of pain onset increase until the nail grows outward again. The area around the thumb nail at the base feels as if it is a raw sore, yet there is no visiable damage to the area. I have got to get the pain stopped even if I have to have the nerves in the area killed. I can live with the numbness as I am already doing from dental surgery, and a removed cycist from the ball of the right thumb, which cliped a nerve. Only the ball of the that thumb is numb.

 

I am concerned that it is migrating from the left thumb into the fingers, hand and up to the arm now. I don't know what to do. The VA, (disabled at 60% for Fibromyalgia) just does not have the expertise to work the situation. Someone must know somthing. Surely this has happened to some one else. The only thing I can think of was that while stationed in Taiwan I had manicures while my hair was cut. Could there be some kind of wierd infection. That was years before the thumb problem begain. Okay, I have run off at the keyboard enough. thanks, Don

Expert:  Vakul Aren replied 3 years ago.
You need to rule out nail plate deformity secondary to autoimmune disease,chronic paronychia and nail bed tumours/cysts.Seeing a Dermatologist or a neurologist may help.Pincer nails,lichen planus of the nail bed and other diseases like vasculitis of the nail bed need to be ruled out.Glomus tumours of the subungual area are rare but need to be ruled out.They may cause severe pain at the base of the nail.

Edited by Vakul Aren on 11/2/2010 at 6:56 AM EST
Customer: replied 3 years ago.
the first doc from you guys was a Dermatologist and he said it was out of his area and was referring me to you, I guess. The Veterans Administration major hospital in Salt lake City, Utah could not figure it out 2.5 years ago after examining the nail, etc. xrays, and Dermotologist exam. The nail bed has been examined for turmours/cysts and possible deseases. But they could have missed something. IS THIS A NERVE PROBLEM in conjunction with the Fibromyalgia? I also have daily medical logs on my whole condition which are annotated about the thumb pain. "If it is not written down, it never happended". Yes, I was once married to a nurse. If you have no other ideas, than I will try to get an appointment in the medical community (not VA) for a neurologist. VA keeps sending me to the same PA in the neurological field from Anchorage,Alaska, VA hospital. His idea is to monitor the condition and us over the counter arthritis meds. I already have enough pain control medication to include Oxycodone, and Tramadol (Ultram) for the Fibromyalgia. Since the pain is releaved by Neosproin PLUS (topical pain killer) and another such medication, I don't believe that swallowing pills is the answer. In the earliest complaint to you all, all of this is stated. Either I failed to explain the history correctly or parhaps you might want to re-read my complaints. Thanks for whatever you come up with. Don, Fairbanks, Alaska
Expert:  Vakul Aren replied 3 years ago.
I think that leaves only the neurologist.That is all I can think of.Wish you good health and a fast recovery!

Edited by Vakul Aren on 11/2/2010 at 10:34 AM EST
Customer: replied 3 years ago.
Relist: hoping to get someone with experience that has come across this problem. Open this to anyone who wants a medical challenge. Thanks to all, Don.
hoping to get someone with experience that has come across this problem. Open this to anyone who wants a medical challenge. Thanks to all, Don

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