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Vakul Aren
Vakul Aren, Doctor
Category: Medical
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Experience:  MBBS,DTM&H,34 years of experience
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Ive had an issue going for 2 years almost, where most Doctors

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I've had an issue going for 2 years almost, where most Doctors and specialists I've seen thought I had extensor tendonitis or tenosynovitis.(from using mouse click and such) They had MRIs and xrays done and then followed by surgery to "clean up inflammation" however 8 months after surgery I'm still having issue and in fact my issues are also shown a bit in my arms and left hand(probably from trying to compensate for right hand pain by using left hand more) the sites affected in arm are about 2 inches from elbow on the outside and right in front of the wrist. The core point of pain is the middle extensor area about 4/5 of the way from middle knuckle towards wrist.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Natasha replied 1 year ago.

Dr. Cameron :

what symptoms do you have?

Dr. Cameron :

hello?

Dr. Cameron :

Have you seen a rheumatologist?

Customer:

symptoms are pain in right hand, extensor area of middle finger, but only on back of hand, not in fingers. and then as it's progressed I notice some irritation in the arm right beyond the wrist and closer to the elbow, then some minor irritation on the other hand(possibly due to compensation of right hand issues)

Customer:

I have not seen a rheumatolgist. Just a doctor, chiropractor, and hand specialist.

Customer:

I do have MRI scans though

Dr. Cameron :

I am going to have to opt out. I am not going to be online much this weekend and we keep missing each other.

Dr. Cameron :

hang on.

Dr. Cameron :

please don't rate me. someone will be with you soon

Expert:  Vakul Aren replied 1 year ago.
What did the MRI scan show and what surgery was done?What does your surgeon say about the present symptoms?
Customer: replied 1 year ago.

They haven't said much, other than offering to refer me elsewhere. I'm thinking it's tendonosis, I've read gtn patches have had great results assisting recovery.

Expert:  Vakul Aren replied 1 year ago.

The commonest cause of such pains are compression of the spinal nerve roots as they emerge from the cervical spine,this radiculitis apparently has been ruled out by MRI of the cervical spine.The other common cause of such pain would include repititive microtrauma due to typing/computer mouse use for long hours.Tendinosis is caused by degeneration of the collagen in the tendon and should affect the muscle tendons affected by repititive microtrauma,these would include the .Does your work involve long hours at the computer or typewriter?The sites of pain as mentioned by you are usually seen in chronic computer overuse,the extensor carpi radialis brevis muscle is involved and causes problem at the outside of the elbow.Similarly the extensorsand flexors of the wrist and fingers will be involved due to hyperextension of the wrists while using the mouseRepeated trauma to these muscles will involve the wrist and the lower side of the palmar aspect of the hand.Some tips to reduce such pain will include-using wrist and elbow supports while using the mouse,taking frequent breaks(every 30-40 minutes) while using the computer,braces or splints at night for the forearm and wrist,seeking advice from a professional who specialises in hand problems, gentle stretching and strengthening exercises of the fingers,wrist and forearms,ergonometric review of the positioning of the chair/mouse/computer/keyboard at the work place.Use of NSAIDs like ibubrufen may help.

Customer: replied 1 year ago.

I only had mri on my hand so far. I had a neck xray that showed a forward curve with some stage 1/2 compression. I have had no luck with ibuprofen and cortisone shots, I read that do not help with tendonosis(I thought I may have this) and in fact may affect negatively.

Expert:  Vakul Aren replied 1 year ago.
Perhaps a MRI scan of the cervical spine would show any spinal nerve root compression which would help diagnose any radiculitis.or the Tendonosis,stopping the use of computer for some time,physiotherapy and strengthening exercises of the finger,wrist and forearm muscles accompanied by gentle stretching would help.Supports and braces would also help.
http://ergonomics.ucla.edu/homepage/injuries-and-prevention/107-musculoskeletal-disorders.html is a site of interest.
Customer: replied 1 year ago.

No doctors seem to be willing to recommend disability, even though my job requires both hands they just say don't use the hand. Any particular branch of doctor more willing to do that?

Expert:  Vakul Aren replied 1 year ago.

The pain caused by computer overuse is a soft tissue injury caused by repititive strain while at work.You need to discuss this with your doctor and request for a EMG(Electromyography) test be done to check for nerve damage.Repititive Strain Injury(RSI) occurring need to be evaluated by your doctor and then reported to the employer.

http://www.wcb.ab.ca/providers/medref10.asp is a site of interest.

Customer: replied 1 year ago.
Have you ever heard of Nitroglycerin prescriptions to help with this?

http://www.medscape.com/viewarticle/482820
Expert:  Vakul Aren replied 1 year ago.
THe GTN in this article is specifically for Supraspinatus tendinopathy.It is not recommended for computer related injuries due to repititive strain.
A very good article on this is
http://web.eecs.umich.edu/~cscott/rsi.html.THis should be of help to you.
Customer: replied 1 year ago.

Well, I've done a lot of research on Tendinosis(I believe I have Tendinosis rather than Tendinitis after comparison of symptoms - Anti-Inflammitories/NSAID/Cortizone Shots have zero effect on my hands, and they do not hurt unless they are being used)


I linked a wrong article..
Here's more:
http://www.ncbi.nlm.nih.gov/pubmed/14623657


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658939/


http://ebm.bmj.com/content/9/3/87.full

Expert:  Vakul Aren replied 1 year ago.

There are many modes of therapy which are considered for treating Tendinosis,many are still considered experimental though many trials and reports suggest that these methods have been found helpful.Nitric oxide by using GTN/Nitrate is one of these therapies. http://www.news-medical.net/health/Tendinosis-Treatments.aspx http://www.tendinosis.org/current.shtml You may consider using GTN along with the more conservative and established lines of therapy which include rest,physiotherapy modalities like Inferential current therapy and stretching/massage along with rest and bracing.Vitamin E therapy has also been around in Tendinosis for a long time.THe trreatment and recovery will take a few months and involve rest and physiotherapy,drug treatment is only partially effective.

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Customer: replied 1 year ago.

Okay, I have an appointment with a hand specialist physiotherapist Tuesday. Also someone mentioned trying "Graston Technique"?

I was trying some stretches earlier and noticed if I lay flat on my back on the floor, and my arms out straight palms up, my right hand/arm starts going to sleep after a minute, whereas my left arm does not. Also, my hands always seem to be much colder than the rest of my body, my core is usually burning up.

Expert:  Vakul Aren replied 1 year ago.
THe Graston technique is massage of the soft tissues with a hard edged tools made of steel or ceramic and are based on the theory of scraping away the scar tissue and fascial penetration by deeper penetration of the tissues.There is no clinical evidence of any benefit by this process also called Instrument Assisted Soft Tissue Mobilisation(IASTM) in clinical trials.Gentle stretches of the fingers and arms would be more helpful and can be done repeatedly.

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Vakul Aren
Vakul Aren
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MBBS,DTM&H,34 years of experience