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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17509
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a tennis teacher instructor I teach 50 to 60 hours a

Customer Question

Hi there I am a tennis teacher instructor I teach 50 to 60 hours a week and I'm having significant pain and swelling in my right thumb at my first knuckle joint... Flexion is extremely painful and range of motion is extremely minimized
Submitted: 8 months ago.
Category: Medical
Customer: replied 8 months ago.
I am taking 800 mg of ibuprofen every 6 to 8 hours and icing it and 15 minute intervals when I am not teaching however a gets extremely more painful and swollen when I'm sleeping... Just trying to figure out the best course of action Onviously I would say not using my hand is a hard option when this is my occupation
Customer: replied 8 months ago.
Gripping a racket is extremely painful and nearly impossible as is pressing down with the thumb as in texting or unlocking my iPhone by thumb fingerprint
Expert:  Dr. D. Love replied 8 months ago.

Hello from JustAnswer.

Pain in the knuckle can be due to arthritis or tendinitis. However, if the pain is significantly greater with flexion, it is more likely to be a tendinitis. Both can occur from overuse or wear and tear. In fact, the overuse tendinitis that most people have heard of is tennis elbow, but you are apparently experiencing it in the thumb.

Ice and ibuprofen are reasonable first steps. Although you do not say how long this has been bothering you, the ice is most important for the first couple days. After that, moist heat can also be helpful, and can also directly relieve inflammation. It also may help to provide support, such as by taping the thumb and wrist. We would usually prefer to tape the thumb in a neutral position, but if you need to continue gripping a racket, the thumb can be taped in a flexed position. An elastic bandage, such as an ACE bandage, can help support the base of the thumb, but does not provide good support for the entire thumb. A splint can provide better support, but would hamper being able to grip a racquet. It also would be good to elevate the hand above the level of the heart while applying ice or moist heat.

If these interventions are not sufficient, then it may be necessary to try a different anti-inflammatory medicine. There are only two available over the counter, with the other being naproxen. It is not that the naproxen is a better anti-inflammatory medicine than ibuprofen, but rather that different medicines may work better for different people. There are many other anti-inflammatory medicines available by prescription, including several that are in different chemical classes (while both ibuprofen and naproxen are in the same chemical class), but that would only be an option if you see your doctor.

If there is persistent inflammation, it also would be an option to use a steroid injection, but this also would require seeing your doctor.

And yes, you are correct that the more that you can rest the hand, the quicker it will improve. If you can transition as much of your instruction to the opposite hand as you can tolerate or by using different methods, such as observation and verbal instruction, it would be better.

If I can provide any additional information, please let me know.

Customer: replied 8 months ago.
Thank you very much this joint inflammation and pain really came out of nowhere about four days ago as I go through the day sometimes it loosens up and becomes a little bit less of an issue but it seems like every night it intensifies leading into the next day ...I tend to think it has to do with some soft tissue inflammation and that's why am wondering if it's even worth going into my primary care physician at this point where if I should continue to try to limit use and continue to ice and use anti-inflammatory drugs
Customer: replied 8 months ago.
The joint in question is extremely sensitive to touch... Icing has offered a little bit of relief but I'm just wondering how long I should continue to try and let this play out myself
Customer: replied 8 months ago.
At some point if I need to go on a short-term or long-term disability because I can hardly hold the racquet to feed a tennis ball or to play with some of my clients ..I'm sure I'm going to need to get evaluated and get my doctor to sign off on it
Customer: replied 8 months ago.
The joint has a level of pain when I'm not even using it similar to a dislocated finger a man when you try to flex the joint that's on the pain significantly intensifies... The first day or so I thought maybe i had accidentally bumped it while sleeping and so I tried to undislocate the joint by pulling the finger out and it seemed to her offer some relief temporarily... But it proved to be less and less effective as I continue to do it and so now I'm not even attempting so
Expert:  Dr. D. Love replied 8 months ago.

It is usually reasonable to try over the counter anti-inflammatory medicines and home interventions for a week or two before seeing your doctor, although the severity of the pain should be the primary determinant. Someone with greater pain should be seen sooner, while someone with lesser pain can try home treatment for a longer period of time.

If it is the soft tissue that is tender, that also would support that it is a tendinitis, or more specifically, it is the lining around the tendon that gets inflamed.

It is also fairly common for inflammation to get worse at night, so it may be reasonable to sleep with a splint applied to the thumb.

Expert:  Dr. D. Love replied 8 months ago.

Please let me know if I can provide any further assistance.

If you would like my assistance with any future questions, I can be reached through my profile at www.justanswer.com/medical/expert-DrDLove/

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