Dr. Aida Abaz Quka
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am writing this to inform you that I have had a crushing/pressured injury in my hands while I was at work three weeks ago as I was pushing set of 10 chairs with the chair trolly and they were quite heavy as I was pushing the trolly forward it managed to almost lean towards me in other words it pressed on my right hand underneath my knuckles (back hand to be specific) for at least seven seconds. My colleague and I managed to push the chairs away from me. Eventually my right hand was sore causing me to hand tingling feels and irritation to cold weather which I did not have before but no pain.
This Monday that had gone by it started causing me burning sensations on both my back hand including the one that has not been injured. It was extremely discomfortable and unpleasant feeling. I even found it hard to sleep at night. By Tuesday and Wednesday it began to slowly progress the burning sensations, inflammation towards my wrist and towards my arms through the biceps and even towards my neck.
I have started taking Amitriptyline, and anti inflammatory medicines which have slightly helped but not much. I did see an emergency doctor in between and suggested that it could be potentially CRPS or nerve irritation but they cannot know for certain. Due to the pandemic of Covid-19 it is very difficult to see any doctors at this present moment and I am self-isolating myself at home. Having said that I am very worried about my situation and would like to get more clarity to this situation. Is this a continuous problem that will go on? Is this CRPS and if so can I recover? Can it be a nerve compression and is my nerves misfiring or is this a sign of recovery? Currently, these are the following feelings I currently experience burning sensations in my hands and neck now, hypersensitivity skin irritations wearing clothes using blankets, etc., affected areas feel weak and sore.
Hello,
Welcome to icliniq.com.
I read carefully your question and would explain that your symptoms are suggestive of a pinched nerve (nerve compression). The nerve compression could be on the wrist (carpal tunnel or) or in the neck (a possible bulging intervertebral disk), which is causing radicular nerve pain in the arm and hand.
For this reason, it would be necessary consulting with a neurologist for a physical exam, a cervical spine x-ray study and nerve conduction studies. Anyway, considering the virus infection, I think that all these tests can wait as it is not a serious medical condition.
I would recommend avoiding weight loss and wearing a splint in the hand during the night (wrist splint for carpal tunnel syndrome), which you can find in the drug store. If it helps improve your situation, it would indicate carpal tunnel syndrome as the main cause underlying your complaints.
I would also recommend taking Gabapentin, to help relieve the burning sensation.
I hope this helps.
Patient's Query
Thank you doctor,
From the initial injury that happened in on the right hand just below the knuckles where the heavy chairs weight pressed on. It could then cause my symptoms to move from my right hand to other parts of my body which did not experience any injuries such as the whole of my left hand, biceps, and neck causing it to experience burning sensations.
Could this be a sign of CRPS? In terms of the medications, I have been using besides Amitriptyline I have also been using Etoricoxib anti inflammatory which has helped a lot in decreasing the burning sensations. I wanted to know what this medicine Etoricoxib works on and whether it is an ideal medication for my condition?
Also during the course of injury that I encountered could I have caused an injury toward blood vessels? And what symptoms blood vessel injury consists of and if it is having to cause my nerves to misfire and feeling hypersensitivity and burning sensations.
Hello,
Welcome back to icliniq.com.
I cannot explain the connection between this trauma and the pain irradiation, because the trauma that you describe is really distal and should not cause such pain. We cannot exclude CRPS (complex regional pain syndrome), although you should know that the pain in CRPS is excruciating and it does not improve from any treatment.
As the pain involves the back of the hand, the biceps muscle, and the neck, it is very suggestive of C6 nerve radiculopathy.
Anyway, nerve conduction studies would help determine the location of the nerve damage and suggest further tests (cervical spine MRI, etc.).
It does not seem to be vessel damage, as it would cause other symptoms like changes in the color of the hand and arm (discoloration), cold hand, weak pulse or swelling and bluish color in case of a vein issue.
Regarding Etoricoxib, it is an anti-inflammatory drug, specific for arthritis or pain and inflammation. It can help improve pain and reduce inflammation. Amitriptyline is an antidepressant which can help improve chronic nerve pain. I would also suggest trying Gabapentin, which is an anti-epileptic drug, helpful to reduce the chronic pain and the burning sensation.
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Neurology
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