Do I need treatment for hand and wrist swelling for 8 weeks?

Question

Hi doctor,

For about eight weeks, I have been experiencing a sudden onset of inflammation, swelling, and pain in my right hand. It started in my thumb, but now my index finger, other fingers, and wrist are also swollen and tender. The pain is so severe that I cannot use my right hand for anything, not even to hold a spoon.

I have been resting, icing the area, and using a splint for almost eight weeks. The pain in my thumb has improved slightly, but movement remains severely restricted, and the thumb remains swollen. My index finger, the palm of my hand, and my wrist are also swollen, making it difficult to flex or bend my wrist.

The Finkelstein test has been positive since the beginning, and I suspect that at least the tendon in my index finger may be affected, along with possibly something in my wrist.

I am uncertain about what may have caused this issue. I would like to know whether you think this condition will resolve on its own or if more urgent treatment is necessary.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I understand both of your concerns.

Thanks for your query. I have seen the attached images (attachment removed to protect the patient's identity). The Finkelstein test is positive in De Quervain's tenosynovitis, but this amount of swelling is uncommon.

It is definitely tenosynovitis, but we need to rule out two things: infection or any unusual inflammation. To do that, I would suggest getting a few blood tests, including a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), thyroid profile, and hemoglobin A1c (HbA1c).

If these blood tests are normal, then it would be advisable to get a local steroid injection at the site of inflammation. If not, then treatment will need to be tailored accordingly.

Another possibility is complex regional pain syndrome (CRPS). This condition is characterized by severe pain and swelling, usually seen after trauma, but can occur without any injury as well.

The diagnosis can be supported by an X-ray showing local osteoporosis. However, except in cases of infection, the treatment will be the same: anti-inflammatory drugs and local steroids. If there is an infection, then antibiotics will need to be added.

I hope this guidance proves helpful. I appreciate any feedback you have for better patient care, and if you have any further concerns, feel free to contact me anytime.

Thank you so much for reaching out.