3 year old injury, a couple questions

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Becky77
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Date Joined Dec 2005
Total Posts : 1768
   Posted 4/15/2011 7:44 PM (GMT -6)   
A little background about myself. I am not new to HW, but usually post on the Crohn's forum. about 3 1/2 years ago I was in a car accident and tore ligaments in my right hand. I continued to see an orthopedic and he did steroid injections which helped substantially. Since the swelling and pain have persisted and spread across the hand, the ortho thought that maybe I have another auto-immune issue going on that is causing damage in my hand. I have not seen a rheumatologist yet.

My insurance has changed and I had to start seeing a new ortho. The appointment was today, and was horrible. He asked twice within a 10 minute span if I had Crohn's, then dismissed the suggestion that this might be crohn's related, or arthritis, and not an injury causing the pain anymore. He then said I should have PT before he would inject my hand again. (Though I stated that using my hand causes it to swell even more and hurt worse) Next, he left and sent a nurse in who informed me that he wanted xrays (which were done only 3 weeks ago and I refused to have done) and prescribed and anti-inflammatory which I cannot take because of the Crohn's.

My questions:
Have any of you had PT long after an injury and found that it helped?

Can an old injury be helped with physical therapy if using the joint causes pain and swelling? I understand that PT can be painful, but don't know how my hand would be changed by motion as using it thus far has not strengthened it, but made it worse.

How many injections can be done in a joint before joint damage can be done by the steroid? (I've read that after a while that small joints can have damage from repeated steroid injections)

If this might be arthritis, what other meds (besides NSAIDS, because I cannot take them) could be used to control the pain? I don't want to continue taking lortab in order to use my hand, which is why I made the appointment and wanted the injection. Are there medicines doctors will try for arthritis without going through the process of seeing a rheumatologist?

Thanks for the time you took to read this (my posts always end up longer than I intend them to be). I appreciate your help and support, and wish you all well. Many hugs!
Becky

Crohn's since 1997
Surgeries: 2 Bowel resections, appendix & gallbladder removed
Pulmonary Emboli & Pneumonia 2009
Currently on Humira, Omeprazole, Prozac, Seroquel, Calcium, Vit D, Aspirin, B12 shots

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16295
   Posted 4/15/2011 8:33 PM (GMT -6)   
Hi Becky and welcome to the CP forum. I have crohns & UC and know about the NSAIDS being out of question. What did your first dr think the problem is with your hand. You mentioned he thought it was another auto- immune disease, what one?

If this were me, I would kick that new ortho to the curb and start all over. He is not willing to listen to you and apparently nothing any of your previous drs have said that is a big red flag in my book. Sometimes PT can help even this late in the game. I know I have done a lot of PT over the years and if it helps me I stay with it. If it doesn't then we stop it. You read correctly about the potential damage to small joints, you can also build up scar tissue from repeated injections.

Something I use at home for my hands is a hot parafin wax machine that I just love. There is a Volten (not sure of the spelling)gel that is an rx that can be used on the hands. None of us want to be on pain medication but many times there is no other choice. Some of the other will pop on and I am sure give some more suggestions.

Anyway, welcome aboard and I hope you can get something done to help you out.
Moderator Chronic Pain Forum

purplereading
Regular Member


Date Joined Nov 2010
Total Posts : 108
   Posted 4/15/2011 9:52 PM (GMT -6)   
I was just going to suggest something similar to the wax, and PT has similar therapies. They can use heat, and gentle massage to stretch and strengthen. It is worth a try.

CRPSpatient
Forum Moderator


Date Joined Mar 2011
Total Posts : 1276
   Posted 4/15/2011 10:06 PM (GMT -6)   
Hi Becky, and welcome to the CP forum.

Has anyone ever mentioned Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD) to you?

What are the characteristics of the pain? E.g aching, burning, throbbing, etc?
Have you got any visible changes to your hand, other than the swelling?
- Is it a different colour to your other hand?
- It is hotter or colder than your other hand?
- Any differences in hair or nail growth?

I might be way off, but your persistent pain and swelling raise a bit of a red flag with me, especially given that you say it's spread across your hand. A diagnosis and good pain management is obviously important regardless of what's going on, but if you've got any of the additional changes I've just described, you really need to push hard for diagnosis and treatment (of which PT is one).

Take care, and good luck.

Laura
CRPS since 1999, diagnosed in 2005 and since spread to full body, spasms, dystonia & contractures, gastroparesis, orthostatic hypotension, bursitis, carpal tunnel syndrome.

On Oxycontin/Endone, Topamax, Mobic, Magnesium, Florinef, Somac, Cipramil. Have a spinal cord stimulator, intrathecal pump with baclofen & bupivacaine and doing physio.

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 4/16/2011 8:24 AM (GMT -6)   

 

   

     Good Morning Beckey!

   *hugg* I was floored last night when you told us in chat. If I were in your shoes.. I would seek a second opinion. He obviously spent no time going over your history. Prescribing you NSAIDs even though you told them you cannot take them is ridiculous. I am not against PT, not at all. I get a new at home program designed for me each year. I just think that handing you a referral to PT and walking out the door is careless. I am so sorry he treated you that you. Now, you have to go through the entire new patient process all over again  sad   I hope you can find a new one quickly. You have been in way too much pain for far too long.

*warm hugg*
       dani


TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

Chronic Pain Moderator
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Becky77
Veteran Member


Date Joined Dec 2005
Total Posts : 1768
   Posted 4/16/2011 11:44 AM (GMT -6)   
I did ask about prescription gels to use difectly on my hand, and they are not covered by my insurance, and I was told they are quite pricey. Parrafin wax is a good idea though, I'll look into that.

Straydog, he didn't have an opinion on what exactly he though was going on, just indicated that it seems to be a connective tissue disorder rather than the initial injury still causing the pain.

Dani, I should get a referral to another ortho group, which I seem to be a better fit based on their website. They promote educating their patients, and suggest bringing a list of questions, which is a good sign to me.

CRPSpatient, other than the persistant swelling, there aren't any other symptoms that suggest CRPS. I googled it and it doesn't sound like what's going on.

Thanks everyone for your input!
Becky

Crohn's since 1997
Surgeries: 2 Bowel resections, appendix & gallbladder removed
Pulmonary Emboli & Pneumonia 2009
Currently on Humira, Omeprazole, Prozac, Seroquel, Calcium, Vit D, Aspirin, B12 shots

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5004
   Posted 4/16/2011 1:18 PM (GMT -6)   
Hi Becky -

I have a slightly different point of view from having wreck-related injuries, also arthritis, bursitis and tendonitis,and have had hand surgery. I absolutely am not disagreeing with the other respondents, only teling my own individual experiences. I tend to believe doctors until they are proven wrong. It's usually my preconceived notions that are off base.

I get copies of all my MRIs, CTs, x-rays on disks and make copies of them for the next doctor. I also make copies of the written reports. I agree with refusing more x-rays, but suggest going back to the first doc and asking for a disk of the previous x-rays. You have a right to your records! They are usually free if you are taking them to another doctor, but they can charge a reasonable fee if they are just for your own files. I just got copies of my shoulder x-rays so I can get a second opinion about proposed surgery.

I don't have Cronhns or any autoimmune problems that I know of, and I've been tested. I do have pain in my knee which was injured in the accident and was operated arthroscopically. The original injury was corrected, but there's a tendon popping, or letting the kneecap slip back and forth. I think more PT will be prescribed. It didn't help with the torn cartilage, but it might be able to tighten up or strengthen the tendon.

I had hand surgery for trigger fingers related to taking a cancer med. This was last summer and I still have a lot of pain, have to keep working the tendons and the scars several times a day. The gentle PT helped a lot for a while, then the insurance covered visits ran out and it wasn't helping much anyway. I was not getting better as fast as I thought I should. In fact progress was not happening at all. My doc told me I needed to be more vigorous with my stretching and pushing on the scars to keep the tissue from reforming too tight. I have to push and stretch to the point it hurts quite a bit - which I was not told I needed to do when I was in therapy. Working the hand in fairly hot water or at least in my hot tub works fastest and relieves pain the best. I was told it can take a year or more to recover. I have one spot that clicks quite a bit and may need a further brief surgical release.

I've had injections for my hand (they have to try that first before surgery), for my knee, my slipping ribs, and a whole bunch for my spine. I've read and been told it's true that you can usually only have 3 in one area in a year or the tendons and cartilege break down.

Arthritis starts up where you've had an injury. That's what's wrong with my spine. Fell of horses for a start, but the wreck seems to have really done me in. It got worse fast and now causes a lot of pain. My shoulder has only a tiny bit of arthritis, but there's tendonitis and bursitis (aka impingement syndrome) causing pain too. That's pretty well controlled for now with injections, but I can't have any more and the next treatment is surgery to remove a couple of tiny bone spurs and the bursa that's inflamed. Sometimes a tiny bit of arthritis or inflamation can cause debilitating pain!

For pain I can only take tramadol or vicodin, the latter I save for after surgeries. I get away with Tylenol, but need the max dose to notice any relief, and I'd rather save my liver. My little bitty hot tub helps a lot too. It fits in the space of a closet.
Alcie
 
 
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