Mrs Hizkiah, a beautiful nurse, funny, always smile.
She feels pain, aggravated by movement on the wrist and thumb. Dear Hiskiah, it is call De Quervein's Diseases. Characteristic symptoms can be reproduced by flexing the thumb and cupping it under the fingers, than flexing the wrist in an ulnar direction which stretches the thumb tendons. Lovely Hizkiah, that is the reasoning, why your pain exaggerated after your therapist asked you to made a fist, forcing flex the thumb.
Pity Hizkiah, you also has another problem, trigger thumb. In this condition your thumb snaps as it flexes and may become locked in flexion or in extension. He didn't want to harm you, just did not knoe that you have another problem.
The pathology of De Quervein's Diseases is an increased vascularity of the outer sheath that, coupled with edema, thickens the sheath and constricts the enclosed tendon. Treatment requires immobilization with injections of cortisone into the sheath.
My regiment for you is low level laser. Please, no heat modality, due to edema. Low level laser will not increase the temperature above body temperature. It is to reduce the pain and the edema. I am going to immobilize your thumb. But if during four weeks of treatment, there is no relief, maybe our surgeon will help you.
The trigger thumb, occurs from thickening of the sheath or the tendon or both which prevents gliding of the tendon within the sheath. Local injections of cortisone into the sheath may result in good recovery. if locking persists, excision of the thickened is performed. That is not my competency. I told you, my first concern is your pain due to De Quervein's. I use low level laser AMM50, about 830 nm, probe 50 mW, The dose 30 Youles. It is big enough. I am going to decreases the dose if your pain and edema decrease.
(Hand pain and impairment, Rene Cailliet)
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