"Patients presenting with pain in the hand are often anxious. The hands are so important for daily activities and for communication and contact that any actual or perceived threat to their normal function is worrying. For those whose livings are made by intricate use of their hands,... the threat is often greater..." (Shipley, 2005).

Yes I am anxious. I NEED my hand. I REALLY NEED my left hand, a.k.a. dominant hand. How?! Hmm.. lets see. I was once certified "loose" (loose ligaments) so technically my joints can go into hyperexention etc. But then... have been feeling a lot of discomfort at the thumb area on and off, and yesterday the pain was... very irritable (still within tolerance level). I am worried. I am anxious. Help!

Initial Dx: DeQuervain's Tenosynovitis (Data Trace Publishing, 2005).

• Stenosing tenosynovitis of APL & EPB tendons at the styloid process of the radius
• Inflammation causes thickening and stenosis of synovial sheath of first compartment and pain with tendon movement
• Most common in women betwen 30 to 50 years *im not even 21!*
• Patients develop pain over radial styloid process (and sometimes forearm and thumb) *yes. pain in the thumb. sometimes forearm. but not over radial styloid so far.*

Examination:

• Swelling and palpable thickening of the fibrous sheath *nope. not that I can see/feel*
• Sharp tenderness over styloid process of radius *nope. tenderness over dorsum of thumb seems more accurate*
• Positive Finkelstein's Test *yes. pain at anatomical snuff box*

Differential Dx:

• DJD of CMC Joint [CMC Joint/ CMC Arthritis] *possible*
• Intersection Syndrome *unlikely*
• Wartenberg's Syndrome * I don't think so*
• Differential Diagnosis of Radial Wrist Pain *possible*

Possible Dx: CMC Joint/ CMC Arthritis (Data Trace Publishing, 2005).

• Most commonly involved arthritic joint in the hand *i've got no arthritis. at least I don't think so*
• More common in women (upto 1/3 of women over age 40, will have x-ray changes) *i'm not even 21!*
• May exist in a localized form or may exists as a systemic form of arthritis *no*
• Primary form is most common in post-menopausal women *NO NO NO*
• Systemic form may be due to RA or Gout *nope*

Differential Dx:

• DeQuervian's Tenosynovitis *as mentioned above.. sigh`*
• FCR Tendinitis *possible?*
• Stenosing Flexor Tenosynovitis of FPL *argh. another tenosynovitis*

Associated Disorders:

• Carpal Tunnel Syndrome *unlikely*
• DeQuervain's Tenosynovitis *not again.....*

Examination:

• Axial compression of metacarpal on trapezium gives painful grinding sensation *can't perform on myself*
• Attempt to determine whether pain is related to instability vs arthrosis *??*
• Thumb may have adduction deformity (web space contracture) *nope*
• Hyperextension deformity of MCP joint often follows adduction contracture *hyperextention premorbidly; but no contracture as yet*
• Localized tenderness over volar aspect of thumb *YES YES YES YES YES. Esp at the trapeziometacarpal joint*
• No triggering during thumb flexion *no pain*
• No pain w/ forced wrist flexion *no pain*
• When in doubt, a small amount of local anesthetic injected into CMC joint with a resolution of pain will confirm the dx *dunno. can't try on myself*

Other Differential Dx that I suspect:

• Trapezium #
• Thumb CMCJ instability
• Rupture of FCR tendon

Help.... help.... help.... *sobs*

"Patients presenting with pain in the hand are often anxious. The hands are so important for daily activities and for communication and contact that any actual or perceived threat to their normal function is worrying. For those whose livings are made by intricate use of their hands,... the threat is often greater..." (Shipley, 2005).

Yes I am anxious. I NEED my hand. I REALLY NEED my left hand, a.k.a. dominant hand. How?! Hmm.. lets see. I was once certified "loose" (loose ligaments) so technically my joints can go into hyperexention etc. But then... have been feeling a lot of discomfort at the thumb area on and off, and yesterday the pain was... very irritable (still within tolerance level). I am worried. I am anxious. Help!

Initial Dx: DeQuervain's Tenosynovitis (Data Trace Publishing, 2005).

• Stenosing tenosynovitis of APL & EPB tendons at the styloid process of the radius
• Inflammation causes thickening and stenosis of synovial sheath of first compartment and pain with tendon movement
• Most common in women betwen 30 to 50 years *im not even 21!*
• Patients develop pain over radial styloid process (and sometimes forearm and thumb) *yes. pain in the thumb. sometimes forearm. but not over radial styloid so far.*

Examination:

• Swelling and palpable thickening of the fibrous sheath *nope. not that I can see/feel*
• Sharp tenderness over styloid process of radius *nope. tenderness over dorsum of thumb seems more accurate*
• Positive Finkelstein's Test *yes. pain at anatomical snuff box*

Differential Dx:

• DJD of CMC Joint [CMC Joint/ CMC Arthritis] *possible*
• Intersection Syndrome *unlikely*
• Wartenberg's Syndrome * I don't think so*
• Differential Diagnosis of Radial Wrist Pain *possible*

Possible Dx: CMC Joint/ CMC Arthritis (Data Trace Publishing, 2005).

• Most commonly involved arthritic joint in the hand *i've got no arthritis. at least I don't think so*
• More common in women (upto 1/3 of women over age 40, will have x-ray changes) *i'm not even 21!*
• May exist in a localized form or may exists as a systemic form of arthritis *no*
• Primary form is most common in post-menopausal women *NO NO NO*
• Systemic form may be due to RA or Gout *nope*

Differential Dx:

• DeQuervian's Tenosynovitis *as mentioned above.. sigh`*
• FCR Tendinitis *possible?*
• Stenosing Flexor Tenosynovitis of FPL *argh. another tenosynovitis*

Associated Disorders:

• Carpal Tunnel Syndrome *unlikely*
• DeQuervain's Tenosynovitis *not again.....*

Examination:

• Axial compression of metacarpal on trapezium gives painful grinding sensation *can't perform on myself*
• Attempt to determine whether pain is related to instability vs arthrosis *??*
• Thumb may have adduction deformity (web space contracture) *nope*
• Hyperextension deformity of MCP joint often follows adduction contracture *hyperextention premorbidly; but no contracture as yet*
• Localized tenderness over volar aspect of thumb *YES YES YES YES YES. Esp at the trapeziometacarpal joint*
• No triggering during thumb flexion *no pain*
• No pain w/ forced wrist flexion *no pain*
• When in doubt, a small amount of local anesthetic injected into CMC joint with a resolution of pain will confirm the dx *dunno. can't try on myself*

Other Differential Dx that I suspect:

• Trapezium #
• Thumb CMCJ instability
• Rupture of FCR tendon

Help.... help.... help.... *sobs*