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Insider Arthritis Tips, January 2009
January 02, 2009
Welcome to the January 2009 edition...
New Mom's Tendonitis
Tip of the month
IntroductionLet me talk about the elephant in the room. The economy is in the tank. People are uncertain and scared. The light at the end of the tunnel still isn’t visible.
I started my practice in 1981 in the teeth of the last big recession. Double digit interest rates (I had to take out a loan at 16 per cent), double digit inflation, and long gas lines.
My parents experienced a Depression and a World War and told me stories about their tough times. So yes the economy is a big problem but not anything that hasn’t been seen and overcome before.
One thing for sure, this economic situation is not confined to this country. Despite the lumps we’ve had to take from the rest of the world, it’s pretty clear, the United States is still viewed as a leader.
In my estimation, the two greatest presidents of the twentieth century were Franklin Roosevelt and Ronald Reagan. One saw us through a bloody World War and the other ended the Cold War. What the two had in common was the ability to communicate and the ability to exhibit calm leadership.
The United States, despite its imperfections, is still the greatest country on earth. The strength of this country lies not only in the foundation laid down by the Founding Fathers but particularly by the intensely tough fabric and tapestry formed by cultural diversity. Every ethnic group has made contributions that make America unique and it is this uniqueness that makes us resilient.
The incoming administration has its work cut out for them and I think we are all hoping and praying they’ll right the ship soon.
Personally, I have no doubt we’ll recover quickly. I remain intensely optimistic. That being said, the country will be different. The individuals and institutions that created the circumstances that led to this last recession will either be gone or will have learned a bitter lesson and be relegated to a seat in the back of the auditorium. You can’t get something for nothing- greed has its price.
So that’s all I have to say about this…I’m a doctor not a politician. And I don’t understand all the intricacies of this economic problem... but that’s the other wonderful thing about this country… anybody can put in his (or her) two cents worth and not worry about going to jail.
New Mom’s TendonitisA recent visit to some friends my wife and I know reminded me of a common form of tendonitis I see.
The young couple had a three month old baby boy. Not remarkable. What was interesting though was that the young mother complained that her wrist hurt... Alot!
My diagnosis after examination was DeQuervain’s tenosynovitis. This is a type of tendonitis that affects the extensor tendons of the thumb. These tendons are located on the outside part of the thumb and run along the thumb side of the wrist. They are enclosed inside a sheath of synovium- the same tissue that lines joints. The tendons are responsible for movement of the thumb out or up.
Repetitive motion and lifting- such as lifting and carrying a an infant- leads to pain located at the base of the thumb and extending into the wrist and sometimes further up the arm. Movements such as gripping and lifting can be exquisitely painful.
While new moms often develop this, DeQuervain’s tenosynovitis can also occur in people who use their hands for any type of repetitive activity involving the thumb.
The diagnosis is made both by history as well as by physical exam. The test that clinches it is the Finkelstein maneuver. The patient brings the thumb across the palm and the rest of the fingers are folded over it. The physician then takes the hand and bends it toward the little finger – in essence stretching the thumb tendons. This reproduces the patient’s pain.
Treatment of DeQuervain’s involves immobilization of the thumb and the wrist using a splint. Topical rubs and a short course of an anti-inflammatory medicine can also help.
Physical therapy is sometimes needed. And if the pain persists, injection of glucocorticoid (“cortisone”) into the sheath of the tendons using ultrasound guidance is corticosteroid injection might be useful.
Hydrodissection of the sheath away from the tendon using ultrasound guidance is sometimes required. Tenotomy using platelet rich plasma is used for chronic cases. Surgery is rarely, if ever, required.
Arthritis Tip of the Month
Consider going to businesses that have drive-through windows. You can do a lot of things without ever leaving your car such as making withdrawals and depositing checks at a bank, picking up medications at a drive-up window, or picking up and dropping off your dry cleaning. Take advantage of as many delivery services as you can. The Internet is a powerful tool. Learn how to go on the Internet to help with your shopping needs. Catalog shopping is also an idea to consider.
Whenever possible, use paper bags. Plastic bags tend to put a lot of stress on your hands and wrists. Paper bags can be held close to your body.
That’s it for this month. Hope it’s been helpful.
I'll be back next month with more news.
Nathan Wei, MD, FACP, FACR
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Insider Arthritis Tips A monthly ezine on arthritis written by a board-certified rheumatologist with tons of excellent and useful information for anyone interested in arthritis
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