It's NOT carpel tunnel!

[CheekyCanuck]

Have you ever heard the like?

I've been having problems with my sword hand for the past year and I have been to my doctor and a physiotherapist. The pain is in my two middle fingers and I have been told that it’s NOT carpal tunnel. The therapy didn't seem to help much and my fencing has been getting progressively worse since it was getting harder and harder to control the blade (even non-index fingers are important for blade control). I started to fence left to alleviate my problem and allow the physio to work, but still nothing worked. My therapist started to chase my pain further up my arm to the shoulder, but still no affect. Finally I went to a chiropractor. He looked at my shoulder and back x-rays and said, yep we can adjust that. Two months later my back and shoulders feel great, but no help to my poor hand. I complained stating that I’m seeing results in my back but my hand is still in pain when I use it. I would have kept using my left, but I will only ever be a mediocre fencer with my left. To make my long story longer, the chiropractor examines my wrist and hand and discovers that my wrist clicks when it moves. He tells me that there is a hook-like bone structure in the hand located on the pinky side. The hook has nerves running through which go directly to the two fingers I was complaining about. He then told me he could adjust my hand. Yep, I had the same question, “you can adjust a hand?”
He can and did. It felt good until later, but for me that is typical from being at the chiropractor. I’m hoping that this does the trick, but until then just typing this (hunt and peck with my left) has taken me over half an hour.

[scrapinpeg]

I'm no doctor. But based on what you say here, have you considered that one or more of your metacarpal bones has been fractured or dislocated?

The ulnar nerve has a deep motor branch, which runs along the "hook of hamate" -- it sounds like this is what your chiropractor was describing.

If one of your metacarpals has been fractured or dislocated, the nerve can be traumatized as it rubs along that hooklike feature.

To diagnose, I'd need to see more than two x-rays from oblique angles, with your wrist rotated palm up and palm down. Can't really see this with a straight-on picture.

It's not so hard to fix, if that's the problem. If the dislocation isn't so bad, a little traction and immobilization should do the trick. But such dislocations are usually unstable, requiring surgery to insert a pin.

But again, I'm not a doctor. Have you seen an orthopedic specialist?

[CheekyCanuck]

Originally Posted by scrapinpeg

If the dislocation isn't so bad, a little traction and immobilization should do the trick. But such dislocations are usually unstable, requiring surgery to insert a pin.

But again, I'm not a doctor. Have you seen an orthopedic specialist?

Boy I was feeling kind of hopeful that this chiropractor was going to be able to help... was.

No I have not seen an orthopedic specialist. {Cringe} This is sounding way more painful than I was hoping to hear.

I'll have to find out more, thanks for the input.

[DonnaP]

Dear Cheeky,

I'm not a doctor either, however I am an occupational therapist and certified hand therapist - no joke. My medical specialty is rehabilitation for all forms of hand injuries and I have 18 years of specialty in the field. It is very difficult to make any diagnosis through this type of forum or from your current description. Here are some facts for you...Carpal Tunnel Syndrome is compression of the median nerve as it passes through the carpal tunnel in the palm of the hand. It provides motor control and palmar sensation to the thumb, index and middle fingers, and occasionally the thumb side of the ring finger. It is primarily noted for night time pain, and daytime numbness, tingling, decreased coordination. It is often aggrivated by sustained and prolonged gripping or fine motor (ie pinching and manipulation) activities or holding the wrists in a flexed or bent position, or by sustained use of vibrational tools. It is also commonly brought on with other diagnoses such as diabetes, thyroid disease, and others. Guyon's Canal is the area in your palm (about 3/4 inch away from the wrist crease toward your fingers and in line with the ring finger) where the "hook of Hamate" is. The "hook" is a boney structure that is part of the hamate bone in your wrist. There is a branch of the ulnar nerve that passes through there (along with the branch of the ulnar artery) that supplies both motor and sensory supply to the ring and small fingers, but would not affect the middle finger. The symptoms are typically pain, numbness and even weakness to the two fingers. The most common causes of Guyon's canal is trauma or pressure to the area, it is often called handle bar syndrome from cyclists leaning on the area during biking. I don't know what weapon you use, but I can envision your grip - particulary a pistol grip pressing into that area and compressing either the nerve, artery, or both. A fracture to the hook is possible - have you fallen or hit the hand recently? Other possibilities to this area could be a soft tissue ganglion or lipoma (fatty tumor - nothing really bad). I have not heard in my career to date of any metacarpal fractures or dislocations that caused or aggrivated Guyon's canal. In my personal opinion - if it were my hand - I'd skip the physiotherapy and chiropractor and see a "hand specialist" which is usually an orthopedic surgeon who had advanced qualifications in treating only hand injuries. General orthopedic surgeons don't typically have the expertise to rule out fine or specific diagnoses of the hand. If you tell me where you are I can give you a few names. Also - I can tell you that there is very little literature that will scientifically support conservative treatment techniques as curative for long term benefits from either physiotherapy, physical therapy, occupational therapy or chiropractics for either of thoses diagnoses. And we haven't established that you even have either of those yet. I hopefully haven't offended anyone in their particular area of medical specialty - these are just my personal and professional opinions.

Donna Pepe, OTR/L, CHT

[Feltan]

Originally Posted by DonnaP

..It is often aggrivated... by sustained use of vibrational tools...

OK, how many of the gals cringed when they read that?

Regards,
Feltan

[orrsword]

To the hand doctor....Both my wrists click when I rotate them and if you touch them you can feel the bones grinding around on each other. I frequently feel pain in my right wrist, especially if I'm putting any kind of weight on it (i.e. push-ups, or even leaning on a table). I'm only 20 and i'm not a big computer user....I don't have carpel tunnel yet do I?

[CheekyCanuck]

Originally Posted by DonnaP

Dear Cheeky,

I'm not a doctor either, however I am an occupational therapist and certified hand therapist - no joke. My medical specialty is rehabilitation for all forms of hand injuries and I have 18 years of specialty in the field. It is very difficult to make any diagnosis through this type of forum or from your current description. Here are some facts for you...Carpal Tunnel Syndrome is compression of the median nerve as it passes through the carpal tunnel in the palm of the hand. It provides motor control and palmar sensation to the thumb, index and middle fingers, and occasionally the thumb side of the ring finger. It is primarily noted for night time pain, and daytime numbness, tingling, decreased coordination. It is often aggrivated by sustained and prolonged gripping or fine motor (ie pinching and manipulation) activities or holding the wrists in a flexed or bent position, or by sustained use of vibrational tools. It is also commonly brought on with other diagnoses such as diabetes, thyroid disease, and others. Guyon's Canal is the area in your palm (about 3/4 inch away from the wrist crease toward your fingers and in line with the ring finger) where the "hook of Hamate" is. The "hook" is a boney structure that is part of the hamate bone in your wrist. There is a branch of the ulnar nerve that passes through there (along with the branch of the ulnar artery) that supplies both motor and sensory supply to the ring and small fingers, but would not affect the middle finger. The symptoms are typically pain, numbness and even weakness to the two fingers. The most common causes of Guyon's canal is trauma or pressure to the area, it is often called handle bar syndrome from cyclists leaning on the area during biking. I don't know what weapon you use, but I can envision your grip - particulary a pistol grip pressing into that area and compressing either the nerve, artery, or both. A fracture to the hook is possible - have you fallen or hit the hand recently? Other possibilities to this area could be a soft tissue ganglion or lipoma (fatty tumor - nothing really bad). I have not heard in my career to date of any metacarpal fractures or dislocations that caused or aggrivated Guyon's canal. In my personal opinion - if it were my hand - I'd skip the physiotherapy and chiropractor and see a "hand specialist" which is usually an orthopedic surgeon who had advanced qualifications in treating only hand injuries. General orthopedic surgeons don't typically have the expertise to rule out fine or specific diagnoses of the hand. If you tell me where you are I can give you a few names. Also - I can tell you that there is very little literature that will scientifically support conservative treatment techniques as curative for long term benefits from either physiotherapy, physical therapy, occupational therapy or chiropractics for either of thoses diagnoses. And we haven't established that you even have either of those yet. I hopefully haven't offended anyone in their particular area of medical specialty - these are just my personal and professional opinions.

Donna Pepe, OTR/L, CHT

Wow.
Thanks for the info Donna.

My chiropractor seems to know what he is doing and pain isn't always a bad thing. I had another appointment last night and my hand/wrist feels a lot better. Still having some pain in the two middle fingers (only the two middle) and along the pinky side of the hand (where hand meets wrist). I definitely will see an orthopedic surgeon if this doesn't work, but I want to see what the chiropractor can do. If it is as simple as some kind of misalignment then I'm all set, if not it’s off to more DR appointments.

Thanks again for the info.

[CheekyCanuck]

Originally Posted by orrsword

To the hand doctor....Both my wrists click when I rotate them and if you touch them you can feel the bones grinding around on each other. I frequently feel pain in my right wrist, especially if I'm putting any kind of weight on it (i.e. push-ups, or even leaning on a table). I'm only 20 and i'm not a big computer user....I don't have carpel tunnel yet do I?

Yeagh. That sounds painful.
The longer you wait to see someone, the worse it could get.

[jeff]

Originally Posted by DonnaP

In my personal opinion - if it were my hand - I'd skip the physiotherapy and chiropractor and see a "hand specialist" which is usually an orthopedic surgeon who had advanced qualifications in treating only hand injuries.

Donna, welcome to the board, and thanks for the excellent first post.

Folks: do what she says. If you are having persistent pain, numbness, tingling or other naughtiness in your dominant hand, which you hope to use for most of the mundane tasks of existence for the rest of your life, go see a qualified doctor who can treat it properly. Specifically, as she said, an orthopedic surgeon specializing in the hand. Preferably board certified, too.

[TLH]

Donna has given a very thorough and accurate post (well done, Donna) and I couldn't say it any better than she and Jeff.


Also to Orrsword - that doesn't sound like carpal tunnel, but it would be prudent to get an ortho/hand eval. You may need some strengthening exercises.



To Cheeky - most of the time, you would be better served making the eval jump to a hand specialist next. Hope it continues to get better. A sports related hand guy may also have some ideas on preventing recurrance - special grip padding or something else that might help. (Oh, no - not using a French grip!)

[CheekyCanuck]

Originally Posted by TLH

To Cheeky - most of the time, you would be better served making the eval jump to a hand specialist next. Hope it continues to get better. A sports related hand guy may also have some ideas on preventing recurrance - special grip padding or something else that might help. (Oh, no - not using a French grip!)

Yes, good point. I will be going to a specialist as soon as I can get on a waiting list.
I have actually switched to pistol grip from French because I find pistol hurts my hand less. Go figure {shrug}

Donna, that was your first post? That was awesome!