Tenosynovitis/tendenitis...??

[AllisonB aka Sweet Reed]

I have been having a lot of pain in my hands and have had to quit playing for awhile. Yesterday my doctor diagnosed me as having flexor tenosynovitis. :( I have been on celebrex for quite a while so he switched me to something new called Bextra. In addition to that I am using a parafin bath, keeping gloves on my hands to keep them warm and also using a heating pad. I was just wondering if any other folks out there have had this or a similar problem with their hands and what type of treatment worked. If I am not better in a month the doctor wants to try cortisone injections in my hands :eek: which he says is rather painful. Surgery is the last resort....the VERY last resort as far as I'm concerned! Second opinions...or any opinions!...tips and suggestions are most welcome!

[Ken MacKenzie]

Hi AllisonB,

Follow this link to a discussion on hand problems that went on for a time on this forum. <a href="http://www.bobdunsire.com/CGI-BIN/ultimatebb.cgi?ubb=get_topic;f=6;t=000003" rel="nofollow" target="_blank">
Stiff Hands</a> It may or may not provide you with useful information in your particular case but it demonstrates that you aren't alone.

Ken :(

[Late Start]

I too am taking a couple of days off to rest my hands and wrists. I believe most of my trouble came from bad mechanics and gripping the chanter too tight. A smaller bag may be in order as well.

Have you seen a Physical Therapist yet? I have the benefit of a friend who is one and I believe they are a better choice for this kind of thing than a doctor. The traditional medicine approach is often drugs and surgery. Many times the problem lies with us, we are hurting ourselves, and can be taught to unlearn some of this.

Thanks for the link Ken.

[Netsloth]

Allison,

FWIW, my wife had some pretty severe pain from carpal tunnel stemming from keyboard use. She tried physical therapy without much relief and her doctor suggested cortisone shots. She was reluctant since she dislikes needles. Now that she had them done, however, she wishes she had tried it before. She is completely pain free. She did say that the needle hurt a little, but the relief was immediate, and it's been 8 months since she's had the shots, with no pain or reduction of mobility.

[Lyle Walker]

Have you seen a Physical Therapist yet? I have the benefit of a friend who is one and I believe they are a better choice for this kind of thing than a doctor. The traditional medicine approach is often drugs and surgery. Many times the problem lies with us, we are hurting ourselves, and can be taught to unlearn some of this.
Allison,
I'm not an MD, but flexor tenosynovitis is usually caused by an infection or immune response. Physical therapy would be a bad choice.
Since you've been on Celebrex, I'll "assume" you're being treated for arthritis, as I am. Flexor tenosynovitis is not uncommon among arthritis patients. I've had several occasions where I was treated with cortisone injections. Heating pads, e.t.c. helped short term, but didn't do much in the long run. Injections are painful since there's not a whole lot of room inside your fingers for extra fluids, but they do help. Within hours for me. Injection in the afternoon, playing pipes by evening. My understanding is that if the cortison injections don't work, surgery is indicated to scrape off the nodules on the tendons. It doesn't go away by itself. fwiw..injections have been about a year apart. Hope you do ok.
cheers,
Lyle Walker

[AllisonB aka Sweet Reed]

My thanks to everyone for all the great tips. I picked up a lot of good info from the link Ken sent too! Yes, Lyle, I do have arthritis in my hands...probably from years of doing chest physiotherapy on kids with cystic fibrosis! :(

It is very good to know that some folks out there have been thru the injections and they helped. I was a bit reluctant to endure something painful without even knowing if it would help! :shrug: But it looks like I may end up going that route. After minimal playing at practice last night my hands are killing me! And that was after NO practicing for almost 3 weeks, parafin dips 3 times a day, wearing gloves around the house and using a heating pad to keep my hands warm! Not to mention the celebrex and bextra...and the MSM with glucosamine I have been on for several months. I think I have tried just about everything!

Once again I have gotten great tips and advice here! The people here are the best! :thumb: But has anyone noticed that all the physical ailments discussed here are always under "Adult Pipers"? :lol: Maybe Bob should change it to "Old Decrepit Pipers" :lol: :lol:

[Lyle Walker]

Another thought struck me...I've noticed that when I'm taking Allegra for allergies, my hands are not as swollen and painful. The rhumatalogist doesn't think there is any relationship, but he says if it works, it works. Allergies are immuno diseases too. It might be worth looking in to.
cheers,
L. Walker

[HotScot]

Hi, Allison, I am an Internal Medicine doctor, piper, and I, too, have tenosynovitis &amp; a lot of hand pain (rheumatoid arthritis, too). Anyway, several years ago my r. thumb developed a nasty case of tenosynovitis caused by long hours of doing procedures on patients (especially putting in central lines), anyway, I let a rheumatologist inject my thumb with steroids (NEVER AGAIN!!!!!)- hurt like BLOODY HECK- and aggravated the condition. When I say it hurt, it wasn't for a few minutes, could have cried for a couple of days it hurt so bad, then I splinted the hand &amp; after about 3 months, the pain calmed down. Now it flairs up if I grip the chanter too hard or play too much, &amp; when it flairs I don't push it. The celebrex doesn't help all that much, but I've found that Aleve, does.

Not to discourage you from the steroid injection, different folks have different results. It's well publicized, though, that only about 1/3 of patients get a good result from the injections. Splinting definitely helps, as do the parafin dips, and I use those little heat packs you can put in your gloves when you go camping. I'll put one inside a glove &amp; sleep with it if my hand is really hurting.

hope your hand heals soon

[Taoralurath]

I got a bunch of repetitive motion injuries in my hands a couple of years ago, including tenosynovitis, not involving my thumbs though. The treatment that worked best for me was the injections, of which I've had them in a couple of fingers and a wrist. I didnt find the injections to be particularly painful at all, just mildly uncomfortable when the needle was going in. Perhaps the expertise of the doctor makes a difference (mine was a hand specialist).
If it was me, I'd go for the injection...

[B McCarthy]

I am a practising Surgical Board Certified Podiatrist. Hands and feet are very similar in anatomy and associated afflictions. I see an endless number of patients with Tendonitis/ tenosynovitis. The 'standard of care' treatments for such acute conditions usually involve the R.I.C.E. therapy. Which stands for rest, ice, elevation and compression. Very much like an acute injury. Heat therapy is usually counter productive as it increases inflammation. In more chronic conditions anti inflammatory medications (NSAID's) are used with possible immobilization (casts,splints,braces). In the most severe cases injection therapy is used. The injection of steroids is very effective, however, the possibility of tissue atrophy(weakening), further scarring and possible 'steroid flares'(reaction to the steroid crystals) are all possible. I use steroid injections for these types of conditions on a daily basis. I am very cautious, however, to avoid injecting into the tendon. In the case of large tendons (IE:Achilles) it can cause complete rupture. Injections should be performed by physicians most familiar with the particular anatomy and condition (IE:Hand surgeon). Physical therapy may be beneficial in cases were contracture of the tendons/ligaments are suspected (IE stenosing tenosynovitis). This condition involves scarring of the tendon to the surrounding tissue. This may also require surgery to free the adhesions. Sorry about the long winded explanation, but I didn't want you to do yourself any harm.
Brian Mc Carthy, DPM

[AllisonB aka Sweet Reed]

Just thought I would post an update on the tenosynovitis thing. I finally broke down and asked my rheumatologist to do the injections. I went expecting to get both hands done but he would only do the right one. He wants to wait and see if it works before doing the left one! Well, it did hurt and I have a bruise in the palm of my hand from one of the injections but I have to say that my hand feels 100% better! :thumb: I'm ready to have the other hand done now! Its a couple of more weeks until my next appt. but I think I'm going to call and beg to get in sooner!
Elaine, I'm sorry to hear that you had such a bad experience with your hands and injections! :( I hope you are doing ok now and able to play without too much pain. Did you have any problems after St. Andrews this summer? I think that might have been the start of my flare up. :lol:

[Scott Russell]

I suffered for a year as well with tendon pain in my middle finger on my left hand. Had a coritsone shot by a plastic surgeon, and have had no pain since. For me it was the best treatment because I did not want to rest it until the inflamation subsided. I do warm up better now before a hard day of playing, than I did before the shot. Scott

[HotScot]

Hi, Allison,

Glad to hear your rheumatologist helped your pain. Yes, my hands hurt like heck after St. Andrews (especially after Willie McCallum's classes- he wouldn't let up on me, even after I whined about my hands hurting- no special concessions for old broads)- after playing Ewe w/ the crookit horn about l000 times, my hands had to rest for a couple of weeks. I did enjoy working with Willie &amp; Bruce Gandy- and now Willie's pocketed another win at Oban. Of course, nobody in band even knows who Willie is, so I don't get to impress them by saying I got to work with him for a week at St. Andrew's.

Take care of your hands,

Elaine :lol: