Expert: Dr. Paul Newhart - 2/2/2008

Question
Hello Dr. Newhart,
Signalment: 21y/o, male, 80kg, 6ft 6", No long term medication.
History: Chronic back pain level of l5/s1 for 5 years with narrowing of said disc space, partial protrusion of disc with no nerve root impingement, active climber and badminton player, veterinary surgery student.

About 2 months ago I woke up and quite spontaneously the medial aspect of the right ring finger in the area of p1/p2 joint to the metacarpophalangeal joint was hyperalgesic and also painful without stimulus. No noticeable swelling of the area, no lumps of bumbs anywhere to indicate tendon injuries  etc. Focal point of the pain is centred at the joints themselves with the interlying space being painful but to a lesser degree. Pain is intensified by stabilising in place p1 of the finger and adducting both p2 and p3 together in a medial direction. Pain is felt very sharply at the p1/p2 joint but not due to the adduction as it is painless on the same finger in the same way on the left hand. NSAIDs have no effect on controlling the pain, doctors have so far failed to refer me for any testing but I am very worried as I am starting surgical rotations in 3 weeks time and will be needing full and unimpeded use of both hands. 'Buddy splinting' the finger to the 5th phalanx did nothing, splint was kept in place for 3 weeks to no effect. It is crucial to note the little finger is not involved in any way, nor is any other part of the hand besides the medial aspect of the 4th phalanx.
Please help me if you can,
Many thanks,
Tom

Answer
You may have a repetitive motion injury involving the right wrist out to the MCP joint.  You say you are an active climber and badminton player, so this type of injury is quite possible.  Misalignment of one of the carpals can cause an increase in pressure in the Carpal Tunnel, and may lead to the hyperalgia.