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Dr.Sawhney
Dr.Sawhney, Doctor
Category: Medical
Satisfied Customers: 7112
Experience:  MBBS,MS
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Two year history of hot, swollen left hand. Long term

Customer Question

Two year history of hot, swollen left hand. Long term computer gamer, martial artist, and had taken up piano about a year prior. EMG clear, no signs of carpal tunnel, week of oral steroids and no work didn't help. NSAIDS and pain killers don't help. Tendons tight and visibly bulging. Sore all the way up to armpit. Is always swollen and hot but significantly worse after any use (typing, piano etc). Have given up all fine motor movement activities and still not resolved. Icing does nothing. Rads normal. MRI showed "inflammation" but nothing else. Blood work normal. Had elevated RA level but per rheumatologist not worth pursuing. 6 months of PT did nothing but make it flare up. Not sure what to do but need to find an answer.
JA: Any recent injuries? How long have you been dealing with the swelling?
Customer: No injuries. This has been going on for at least two years.
JA: Anything else in your medical history you think the doctor should know?
Customer: No
Submitted: 1 month ago.
Category: Medical
Expert:  Dr.Sawhney replied 1 month ago.
Thanks for your question.
I am Dr Sawhney and I am reviewing your question.
I will respond shortly.
Expert:  Dr.Sawhney replied 1 month ago.
Couple of possibilities need further exploration.
You need to look into possibility of thoracic outlet obstruction syndrome causing the issue. Duplex ultrasonography study of the vessels coming out from thoracic outlet should be done. MRI of the thoracic outlet may also help.
Another possibility worth considering is this being a complex regional pain syndrome.
There are no diagnostic tests which can conclusively prove but any relief with sympathetic block may indicate the pathology as complex regional pain syndrome.
I understand that there are no easy answers to the condition but based on the history you have provided you need to consider these possibilities.
Feel free to ask any follow up questions.
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