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This is a 20 year old man in good health except he has type…

This is a 20...

This is a 20 year old man in good health except he has type 1 diabetes. He hs had severe pain (mostly dull) in the pinky finger of his right hand and some pain between the pinky and ring finger. Also pain radiates down arm saometimes. prescription antiinflammatory drugs not working

Doctor's Assistant: What medications do you take daily? Are you allergic to any medications?

Insulin (humulog0 and losartin and one other blood pressure but cant remember it . Just got on some antiinfallamatores but not working

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Type 1 diabetes, slightly elevated cholesterol and blood pressure. Only a PROBLEM due to diabetes. Works constantly on computer but docotor checked and doesnt think is nerve issue

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Answered in 4 minutes by:
8/11/2017
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 9,635
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
Verified

Hi,
Welcome to JA and thanks for this question. Im sorry to hear about your symptoms. Now there are a number of conditions which can cause this sort of pain in the fingers. The most likely cause can be due to compression of the nerves in the neck or at the level of the elbow or even the wrist. the reason being that you have mentioned that the pain sometimes radiates down in the arm, that is usually an indication of compression of nerves. This would be diagnosed with the help of a simple NCS/EMG test to look at the nerves directly and if necessary a cervical spine MRI can be done. Once diagnosed the compression can be relieved with the help of a simple steroid injection, surgery or even physiotherapy or TENS therapy which involves using electrical stimulation to help relieve the pain. In the meantime using OTC vitamin B12, folate, alpha lipoic acid supplements can be helpful along with combining anti inflammatories like ibuprofen at the MAXIMUM dose of 800 mg thrice daily along with OTC tylenol 1 g thrice daily.

Another cause of this could be painful neuropathy which can be associated with diabetes commonly, it would be diagnosed on the same NCS/EMG test and can be treated with medications like lyrica or neurontin.

Apart from this the pain in the little finger and ring finger can be due to a small neuroma in the area which a benign tumor of the nerves and it could be causing the pain. A simple clinical examination and excision of the neuroma would be therapeutic here.

Do you have any more questions?

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If the doctor ruled out nerve issues on a clinical examination, i would STILL insist on a NCS/EMG test, the reason being that many a time a clinical examination would not conclusively rule out nerve problems.

But regarding muscle issues, if the pain is restricted to the fingers mostly then i would also consider tendonitis which can cause this sort of pain. This is inflammation of the tendons which would in this case would need a steroid injection as you have said that anti inflammatories are not working. Try applying OTC capsiacin gel.

Muscular issues could be in the form of muscle spasms which can be due to electrolyte imbalances or dehydration and simply using electrolyte rich fluids should help in that regard.

If there is also weakness in the fingers then myositis should be considered which is inflammation of the muscles, this would be diagnosed with a CPK, LDH and aldolase levels.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

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Customer reply replied 10 months ago
I noticed it got severe when driving so I thought maybe muscles were being pulled. after driving it was less severe. Doctor gave him muscle relaxers but dont know if they will work. Your thoughts

Muscle relaxants can definitely work when the issue is with muscle spasms, if the pain worsened on driving or in other activities where he needed to grasp objects with the two fingers, then muscle spasms can be a cause. Tendonitis can in many cases also respond to muscle relaxants as the inflammation in the tendons causes the surrounding muscles to spasm as well.

SO i think using the muscle relaxants should help, especially if you combine them with capsiacin gel and electrolyte rich fluids in case of muscle spasms. If they dont however, then go back to the doctors office and ask him for the above tests. Usually muscle spasms should respond within 1-2 days of starting therapy.

Do you have any more questions?Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 9,635
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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Customer reply replied 10 months ago
positive help. we will try this
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