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B. 3rd MCP joint pain

Exit forum ID Forum Discussion B. 3rd MCP joint pain

This topic contains 4 replies, has 3 voices, and was last updated by   Brandon Cohen DC, CSCS July 12, 2019 at 3:15 pm.

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    Brandon Cohen DC, CSCS

      68 yr old Male
      Location: B. 3rd posterior MCP joint
      quality: Heat, burning, “red hot”
      Intensity: 3-9/10
      Provocative: unknown, sometimes a lot of gripping, Golf (most of the time)…nothing really
      Palliative: relieved post cervical spine work with massage. Finger extension stretches (temporarily)…nothing really.
      Dx with djd 10 years ago by his primary care and ortho. Referred to rheumatologist 10 years ago ran a bunch of blood work reported nothing remarkable. Diagnosed again wih DJD.
      Severe cervical disc injury 25 years ago reports disc bulge at C4-5 (?)
      Has been managing pain in hand with weekly DNFT chiropractor, massage, and acupuncture. (It’s a pretty busy week)
      No swelling or redness in his hands. No other similar pain in any other joints.
      Chef at a restaurant, other fingers have no pain.

      Diagnostic list…
      I really don’t know. The location, intensity, provocative, palliative all don’t add up very much for me. The bilateral nature is just another piece of confusion.

      If it was just on one side, I might lean towards degeneration and overloaded tissue, but that doesn’t even get me passed the quality of pain.

      What else might cause local pain? I have the exam scheduled for tomorrow. I plan on running through wrist and forearm and cervical spine, but in the absense of a significant limitation with a reproduction of symptoms, I want to send him to the rheumaologist and be re-evaluated for an inflammatory arthritic condidtion.

      My other concern is that I don’t know what king of inflammatory condition would stay basically the same for 10+ years no better or worse.

      Any thoughts or things I might want to consider?


      Scott Glidden

        The only thing that comes to mind would be a C7 disc injury leading to bilateral nerve root compression. I’m considering his job (looking down and prepping food all day), his hobby (more looking down–is he a tall guy? If his clubs are too short and he really “give it his all” during a swing I could see a swing act as a valsalva maneuver on an injured disc), and the fact that the 3rd MCP matches up with the C7 dermatome. The quality of the pain doesn’t really match up, but that’s my ddx with the info provided.


        Drew Ruebbelke

          Did you have a chance to run through the prior results from the rheumatologist. If not, I definitely wouldn’t take the patient’s word for it regarding any test results. This seems more like a metabolic/inflammatory condition to me. I would get updated tests from a different rheumatologist to confirm/deny rheumatoid arthritis, and potentially dig a bit deeper on metabolic to see who he needs to see. The fact that he doesn’t seem very clear on provocative and palliative and there’s no smoking gun, it looks like it’s not primarily MSK. OA is on the list due to age, but the big fluctuations in pain don’t add up to me.


          Brandon Cohen DC, CSCS

            Thank you both for the feedback. He was supposed to come in for his exam, but he had an electrical fire in his restaurant and cancelled. He has rescheduled for next week.

            Scott, He is tall but I don’t quite see the C7 disc adding up considering location and quality. He doesn’t always have symptoms with golf, and reports playing generally the same each time.

            Plan is still the same. Get eyes on the images, Rheumatologist, but unfortunately, there is only one in the area. The best service I might be able to be is to help him understand if this is musculoskeletal or not.


            Brandon Cohen DC, CSCS

              Brief follow up: (This is not intended to be diagnostic, just informative. I don’t have the exact numbers in front of me)

              He has a ton of adhesion in the anterior and posterior forearm. Radial nerve entrapment is the worst spot bilaterally. He also has degeneration on the 2nd digit on his left hand. This limits flexibility on that side. He has been referred to rheumatologist and will be going to a specialist a couple of hours from here in a couple of months. Cervical ranges were limited, but did not produce any of his complaint.

              Diagnosis is: metabolic disorder, nerve entrpament/adhesion, degeneration (hand and cervical spine)

              Communication has been very good with him. He understands that there is something going on we can’t explain and that he has problems that we can fix. We have done 2 treatments and he reports relief. Range is improving. We will see how a short trial goes for him.

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