Metacarpal finger pain - one hand only - clean images

[metacarpalhell]

My middle knuckle on one hand only has been hurting for months. Clean xray and clean MRI. Had one cortizone injection that did help but the pain came back...not sure if I aggravated it. No idea what caused the problem to begin with. I'm at a loss, as the Dr. says there's nothing he can do except give me a shot no more than twice a year. Pain is only with motion. It's stiff as heck in the morning, can barely make a fist, but loosens up quickly after I get up. Hurts to squeeze tightly, shake someones hand, and definitely cannot move the finger side to side. Moving the finger back toward the back of my hand doesn't hurt though. NSAIDS help only a little, but they tear my stomach up. Weird thing is that hot water makes it feel about 85% better instantly every time. Ice doesn't help much. Anybody have any clue what is wrong and what I can do to fix this? Seems like since the shot helped and hot water helps, it's a soft tissue thing, right? From what I've read on the web, tendonitis and nerve issues won't show on imaging studies. But I type for a living (IT) and it's my mouse hand. I can't stop using it.

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[Dr Damien]

Hi metacarpalhell (I like your name)

From your post, the history is akin to some form of arthritis however you say the radiographs have been spotless. Do you have any other joint behaving in a similar fashion? How old are you? similar problem in the family? any neck issues? when did you first notice it...and how did it develope?

A tendinopathy shouldnt go amiss on an MRI (but then again it depends when you had these tests done)...my suggestion is a blood test to make sure its not a systemic problem, gradually emerging...moreover a tendinopathy suggests some form of degeneration, may explain why NSAIDS only help a little...

get some blood tests done first...no use undergoing any physio if the clinical picture isnt very clear...

[metacarpalhell]

I am 44 male. No other joints giving me trouble.

I went to an orthopedist and they did the x-ray and ordered the MRI study. Both within the last month. I said "clean" but they did say I had a very minor thickening of a tendon on that same hand...but the Dr. didn't think it was anything of concern.

The pain started in April of this year. The evening before I was at the gym doing some stellar pullups (3 sets of 20) and some bench press. I'm 5'10" and weigh 155. The next morning when I awoke my finger hurt badly. I ignored it for about 2 weeks, then went to see my nurse practitioner. She wrapped it up in a splint and gave me some IA cream. Didn't work. In fact, the immobility made the whole finger swell up. I gave it a few more weeks then went to see the ortho. He did the x-ray there, and then gave me a shot of cortizone in the knuckle. Painful shot...but it helped. In fact, no pain at all for about 5 months. Then recently it came back.

I do have several bulging cervical discs that do cause minor neck pain in my left trap (opposite side to this right middle finger issue). I asked that question specifically to the Dr. and he said he didn't think it was related since it was in a single joint and didn't radiate anywhere else.

My 1/2 brother has RA. I asked that question as well. He said he didn't see any evidence of RA (or any other arthritis) since I had no other related symptoms and it was affecting only the single joint. He said he thought I just injured it in my activities (gym doing pull ups, lifting, mountain biking, etc.) I suppose I may have been doing more than my middle aged body can handle...at times perhaps.

What kind of blood work are you recommending? I don't mind asking for it from my family doctor, but he's very conservative and frowns on info gathered from the web. So I'd have to bring him compelling reason to order the bloodwork.

Thanks for your thoughts on this!

[Dr Damien]

Dear Metacarpalhell

Ok, ill tell you what my thoughts are so far

First of all RA can be silent in the neck,later emerging in smaller joints of the hand...however in your case, it doesnt seem that this is the situation. For one your stiffness almost immediately goes away as you wake up and move, with RA the stiffness almost seems to last forever. You only seem to have one joint affected so that also rules RA out clinically,which I agree with your doctor.
The question to ask is why do you have several bulging discs in your neck? Are you ligaments getting weaker than the ought to be? I was going to suggest you get screened for RA. You can always suggest that he refers you for that screen, it wont hurt to rule that out completely, if this gives you some peace of mind. Besides, you are the one who is undergoing the suffering not him.lol.

If you have a minor thickening of a tendon (im unsure if its the same tendon leading into the finger that is troublesome), it can rub within its protective sheath causing some inflamation and/or over the bone it glides over. Does your finger click into correction?

Maybe physiotherapy will help, Ultrasound (in bath- I suggest this to avoid bone pains that is likely to over from using the ultrasound directly over such a bony area, your therapist will be in a better position to advice) and massage may help flatten this thickened tendon. Unfortunately, tendon thickening gets worse with more movement as in a protective mechanism it builds up scar more thickening to sorta protect itself against the overuse trauma its going through. (just imagine how the palms of men who work in factories and how thick their palms feel or the heels of ones feet after wearing some shoes for a long time). This thickening makes good tendon glide worse as the space it has to move was not built to be expandible....
tendons are meant to be strong but also retain some elasticity, abnormal thickening means they get strong but begin to lose their elasticity...immobilization is probably not the best plan, because similar to the arthritic joints, degenerative tendons want movement or else they get stiff...(catch twenty two I know)

Warming up gives some elasticity back and hence you feel better

Corrtisone injections will take care of the inflammation quickly, but they do nothing for the build in density. what seems to be a minor thickening can infact cause a lot of problems simply because like I initially said, the space the tendon has to move will almost not likely accommodate even the slightest of thickenings

In my mind, it almost certainly feels like a surgical intervention will be your best bet, however its probably more sensible to have exhausted all your options before even thinking about going for this.

Cheers

[shinsplint]

Apparently from your description, I think you have RSI (Repetitive Stress Injury) superimposed on RA.

The cause is simple .. Your use of the mouse. I guess you use that finger for right click or the scroll wheel. So that kinda work for a few years can lead to RSI especially if you are having RA which causes premature arthritis.
Its showing up in only one joint now but may involve other joints too. So I suggest you definitely get screened for RA.
The test is called 'RA Factor' and you can also do an 'HLA typing' test for the same to be more specific.
I havent seen your images, but from your description I think this is the best diagnosis that i can offer.

Dr Chris.