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Old 10-17-2016, 12:38 PM #1
bestbob bestbob is offline
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Default Index/Long finger pain, & Palm/Wrist

Hello Everyone - It's been awhile since I posted anything, and thought that maybe someone can add some input/different view to my scenario. Long story short, June 2010 fell and lacerated the palm of my right hand. Surgeon repaired it and have had very little numbing on index/long finger for 5 1/2 years. Jan of this year index, long finger pain has increased greatly, and scar on palm is very sensitive(see pic attached). Was diagnosed with Carpal Tunnel Syndrome, but have very little wrist pain and not all fingers and thumb affected. Anyway, not wanting to get surgery for CTS because I really believe the pain is from the scar and possibly pinching the median nerve, I begun a search to hopefully reduce this pain.

Current med is 300 mg Gabapentin daily, every other day take 2 Gabapentin. If pain becomes to unbearable I will take 50 mg Tramadol, and if having anxiety will take Diazapam. I just started Cymbalta last Fri, and by the third day (yesterday) the side effects were too much for me and doctor said to stop taking Cymbalta.

So my questions are many, but first, does anyone have any input on Lyrica, and/or other medicines/supplements? Or maybe, breaking up a Scar with ultrasoud, or possibly getting the Carpal Tunnel Surgery and see if that resolves the palm and finger pain.

You input is appreciated.

Respectfully Submitted,

Bob
Attached Thumbnails
Index/Long finger pain, & Palm/Wrist-hand-17-oct-2016-scar-jpg  
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Currently being diagnosed as to type of Neuropathy
- Had accident in July 2010, lacerated right palm,
median nerve damage
- No pain for 5 1/2 years
- starting Jan. 2016 right index & long finger tingling,
numbness, burning, pins-n-needles
- Pain more prevalent at night
- Starting end of Feb, tingling in right wrist and forearm, usually once or twice a day for 30 min. or so

Taking
Daily - Aspercreme with 4% Lidocaine
Daily - Gabapentin 300mg bedtime, and every other day an additional 300mg Gabapentin
Daily - Atorvastatin for high cholesterol
Daily - Multi vitamins
Daily - Aspirin regime 81mg
Every once in awhile for pain take Tramadol
If anxiety, take Diazapam
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Old 10-17-2016, 04:29 PM #2
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Welcome to NeuroTalk!

I have some questions and comments.

1) Where are you applying the Aspercreme/Lidocaine?
To test yourself about carpal tunnel compression, doing a Tinel sign test on your inner wrist will elicit tingling and electrical zaps. Take a wooden spoon and tap your inner wrist...heavy hitting is not necessary. If there is compression there you will feel it. This location is one spot the Lidocaine lotion works well. I use it there myself! There are Tinel Sign videos on YouTube.

2) often when there is surgery, the nerves are severed so there can be little pain at first. Then the nerves start to grow back, and then strange or painful sensations return. Also some people have a genetic tendency to form fibrosis at injury sites. I have experience with this, when I had tumor removed on my left instep many years ago... it was pretty numb for many years, but those nerves grew back and I do have pain where that long scar remains, occasionally.

3) there are nerves in the tendons so if you overuse or extend that hand, you can irritate those nerves.

I see you use a statin. Do you know that new research shows that statins prevent nerve growth factors that help remyelinate the axons which then do not work properly.

Statins in general do cause some forms of neuropathy. You can Google their effects yourself and discuss this with your doctor. If you are only borderline like many others, doctors push statins for those patients who are not having dangerous levels.

Try some cold pack compresses on your inner wrist before bedtime. This may help too. Use of a carpal tunnel splint at night might help too. Just don't use one that is too tight.
20 minutes is long enough to calm the nerves down, and use a thin cloth between the cold and your wrist.

You can try soaking the hand in warm water with some epsom salts in it... an ounce or so of salts to a gallon of lukewarm water for 1/2 hour at night might help your hand nerves.

There is a medication for fibrosis. It was designed for Peyronie's disease..and it is called Xiaflex and is also sometimes used for Dupuytren’s contracture of the fingers.
It helps remove excess scar tissue that causes compressions.
You might consult a hand specialist if you haven't already done so, if you continue to progress with pain, and that doctor could decide if it would be helpful for your scar.
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Old 10-17-2016, 11:35 PM #3
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You might look into low level laser therapy, also called cold or soft laser.
Ultrasound may help also, with qualified & skilled providers.
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Old 10-18-2016, 05:13 AM #4
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Thannks mrsD and Jo*mar for the reply, hopefully I answer your questions, and will also research statins, low level therapy and Ultrasound.

- Regarding Aspercreme, I apply to my wrist, palm, and a little on the index finger, and agree it does help.
- Cold compress on wrist, don't know why I didn't think of this before , and started last night. It does provide relief even if temporary. But relief is relief.
- I do use night splint/brace, it helps some but it does put a little pressure on the palm scar
- Have not tried the warm water with Epsom salt, and will
- Have been to 4 surgeons and none will operate on my palm, they say it is too delicate/complex of an area, and I could end up with scar tissue again.

Following are my thoughts, as he pain has slowly gotten worse since Jan.
- Will decide on Endoscopic Carpal Tunnel surgery, this way the palm will not have that long scar. If that doesn't work, either continue to look for a surgeon to operate on Palm, or I end up taking nerve pain medicine the rest of my life for the palm, index & long finger

Thanks for the replies.

All the best,

Bob
__________________
Currently being diagnosed as to type of Neuropathy
- Had accident in July 2010, lacerated right palm,
median nerve damage
- No pain for 5 1/2 years
- starting Jan. 2016 right index & long finger tingling,
numbness, burning, pins-n-needles
- Pain more prevalent at night
- Starting end of Feb, tingling in right wrist and forearm, usually once or twice a day for 30 min. or so

Taking
Daily - Aspercreme with 4% Lidocaine
Daily - Gabapentin 300mg bedtime, and every other day an additional 300mg Gabapentin
Daily - Atorvastatin for high cholesterol
Daily - Multi vitamins
Daily - Aspirin regime 81mg
Every once in awhile for pain take Tramadol
If anxiety, take Diazapam
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Old 10-18-2016, 05:21 AM #5
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Bob, I know that this is not the same as your hand but a friend of mine has fairly severe osteoarthritic pain in both knees.

Echoing what Jo*mar has suggested, she has found that ultrasound treatment from her physiotherapist helps - maybe worth checking out for you?
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Old 10-18-2016, 10:02 AM #6
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Thanks for your reply, Bob.

Watch what you are doing with that hand. We've had men on this forum who have hurt their palms/hands, lifting weights, and doing pushups.

I had my foot surgery when I was 12.. I am almost 70 today.
There were no lasers then, or gamma knife, and the doctors were adamant about me understanding the fact that they insisted I never have surgery there again. That instep never bothered me for years after that unless I laced a shoe over the scar too tightly. They had to dig deeply to get most of the vascular tissue out, but it was not 100% done. They said too much scar tissue remains and may never heal again, if touched surgically.

Then the nerves finally grew back and for the last 20 yrs, I have had swelling and pain in that foot and toes every since.
The color of the long S shaped scar has faded from bright red to mostly white. 4 of the stitches are still purple, but at least it doesn't bleed every day like it did then. The tumor I was born with is called a cavernous hemangioma. For some reason as I have aged, it now swells up, and when it does, I have pain there that radiates to the ankle (compressive). It has been not progressing, and if it does, my podiatrist said he will order an MRI of it.

I am telling you this because I think surgeries in delicate places like your palm and my instep are just not perfect, and residual damage can occur.

This link shows the anatomy of your hand/palm and shows
the carpal tunnel. In people with low thyroid functions, the carpal tunnel gets deposits of a mucoid type of tissue which can lead to compressions. Diabetics also get compressions there.
Nerve Compression Syndromes of the Hand: Overview, Anatomy, Pathophysiology

There are carpal tunnel splints made of softer neoprene and not so stiff.

This is the type I wear (I have had carpal tunnel since I was about 30, due to hypothyroidsim)... I don't wear it every night, but only when I flare. It is soft and does not put pressure on the hand like the stiff types. But it does prevent flexing the wrist during sleep.
Amazon.com: Futuro Energizing Wrist Support, Left, Small/Medium: Health & Personal Care
It is important to not limit all movement, for some people.
There is a fine line between causing more compression and preventing unwanted flexing.

I'd suggest using the Lidocaine lotion every day, concentrating on the inner wrist area. Lidocaine for me at least put my irritated hip MP nerve, into a remission, after 14 days, which I did not expect, as I was using it only for symptom relief. I used the Lidoderm patch form, when it first came on the market. I had damage to the lateral femoral sensory nerve from a C-section.

I'd also suggest you avoid heat on that wrist/hand as heat can stimulate nerves that are irritated. The magnesium in the epsom salts, is very useful for nerve pain also...as it helps with healing and proper nerve functions. If you use heat, only use for 10 minutes or less. My chiropractor was very emphatic about that. She said many people use heat because it feels good, but that it is counterproductive long term... as it ends up stimulating sensory nerves and pain.
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These forums are for mutual support and information sharing only. The forums are not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. Always consult your doctor before trying anything you read here.
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bestbob (10-19-2016)
Old 10-19-2016, 12:34 PM #7
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Thanks kiwi33 and mrsD for the feedback.

@kiwi33 - I will look into the Therapeutuc Ultrasound, as I also have read articles with positive results.

@mrsD - Holy Cow, thumbs up to you for what you have been dealing with for many years. My main take away in reading your appreciative comments is, it's probably too risky to have any surgery done on my palm, which is what 4 surgeons have told me. So now I look for pain relief vs pain resolution. It was interesting to read what Aspercreme did for you, maybe I will be as lucky. I do have a Futuro wrist splint, and because it goes around my palm and if I wear it too long it aggravates the scar and causes a bit more pain in the palm.

What's been happening lately is, and welcome comments, because this is considered chronic pain now, every once in awhile my emotions take a turn for the worse and I have some anxiety attacks. I get overwhelmed and feel helpless, which then makes matter worse. So I look to the doctor for anxiety AND pain management, hence the Cymbalta which did NOT work. I really don't want to take any medicine, but it seems I need to resolve myself to the fact and own up to it.Lyrica (for nerve pain not anxiety) was discussed with me, but that seems more for Fibromyalga vs what I have. Again, welcome comments on this point.

Last point, my wrist pain has become more frequent, and I may discuss getting Carpal Tunnel Surgery via Endoscopic, vs open surgery which potentially will end up with more scar tissue in the hand. Maybe it will releive some of the pain, TBD.

Thanks all for your replies.

All the best!

Bob
__________________
Currently being diagnosed as to type of Neuropathy
- Had accident in July 2010, lacerated right palm,
median nerve damage
- No pain for 5 1/2 years
- starting Jan. 2016 right index & long finger tingling,
numbness, burning, pins-n-needles
- Pain more prevalent at night
- Starting end of Feb, tingling in right wrist and forearm, usually once or twice a day for 30 min. or so

Taking
Daily - Aspercreme with 4% Lidocaine
Daily - Gabapentin 300mg bedtime, and every other day an additional 300mg Gabapentin
Daily - Atorvastatin for high cholesterol
Daily - Multi vitamins
Daily - Aspirin regime 81mg
Every once in awhile for pain take Tramadol
If anxiety, take Diazapam
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Old 10-20-2016, 11:29 AM #8
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Hi Bob,

Sorry to hear what you're going through.

Revisional surgeries do tend to be more complicated and prior scarring can certainly be a problem. That said, endoscopic surgeries carry higher risk of nerve injury than open ones, by nature of the field being practically invisible. Choose a surgeon who has "many" of them if you go this route.

Have you seen a peripheral nerve surgeon or one who can do a "scratch collapse" test to verify the problem area? They don't always recommend surgery, sometimes other treatments are adequate. Scratch collapse testing will verify progress.

The other possibility is to see a Physical Medicine and Rehabilitation doctor who is certified in musculoskeletal sonography. These doctors can look at the nerve under ultrasound and potentially treat without surgery if scar tissue is tethering or compressing the nerve. Google "hydrodissection" for carpal tunnel in your city or state. There are not a lot of these specialists out there so you may have to hunt for one but they are well worth it.

I hope you find relief soon!
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