5+ Years of Tendons/Joint swelling from slight overuse, doctors clueless

Hey guys, I honestly can't seem to understand what's happening with my hands, neither can this medical system full of incompetent doctors in Canada. I don't do rock climbing, but I was scouring the internet to find anybody with a similar issue and was led to this forum. I'll consider getting into this sport if I can get my hands fixed, so please hear me out.

in 2019 I got a job as a pizza delivery boy, I also had to wash tons of dishes. It was a stressful job, I'd barely sleep. We had these dough trays and I'd clean the corners with with my right index finger, kind of curve it like a hook and run it through the corners with a cleaning cloth to get the excess oil out of there. My PIP joint started to swell mysteriously and wouldn't go down, it was really painful. The people there thought it was arthritis. I ended up going to a walk in clinic after about a week because it didn't go away and they did an ultrasound and x ray, they didn't come up with anything conclusive and didn't follow up with me. A while later doing this job, the side of my left hand's index finger (towards the thumb) started to hurt when pressed, again, gripping these trays I'd hold them with my left hand. A year and a half into the job (April 2020) I quit, I finally could pay off my student loans, and my hands were the same, no changes. I visited many doctors during this time period, had blood tests, more x rays, ultrasounds, they couldn't diagnose anything. Went to 2 rheumatologists that just said I have arthritis, some undiagnosed form.

Fast forward to 2021 my left hand's pain evolves, the MCP joint area swells up and there is a lot more pain, randomly happened when I woke up one day. It hurts to lift stuff like dishes. I keep trying to get it checked out, but again, idiot doctors are incompetent and won't diagnose me properly, medical system here has been getting worse by the year. My rheumatologist refers me for a synovial biopsy to a hand surgeon, hand surgeon is an idiot and ends up doing a biopsy of the tendon sheath instead of what's in the notes, also cuts my a1 pully. Biopsy comes out negative for any problems a month later, scar is healing but my MCP area is swelling more than before, the pain is getting worse. 3 months after it fully heals, this surgery was in November 2022. The pain got way worse than pre op though and friends were telling me my hand looked really bad, like a gold ball was stuck inside it. One day I just couldn't take it anymore and went to the ER with my dad, I couldn't tolerate the pain anymore. Doctor was telling me he couldn't do anything (most doctors tell me this at walk in clinics), I begged for an MRI and pleaded, he said it looked bad, and finally was able to get one with lots of hesitation from him (chronic issues are less important than emergencies) for 3 months later lol. I get the MRI done, I've attached a picture of the problem point, not sure what it is, but a friend in the US who's a radiologist told me it's some form of tenosynovitis. For all my tests there is no bone degeneration, none of it is arthritic. I also could not strain my hands, they were resting for years as I was unable to use them properly anyways.

Before I get the MRI done, I beg my rheumatologist to try aspirating the joint in my palm, I told him way before the surgery to try it but he didn't and told me to have the surgery first. He finally agrees, puts the needle in the MCP area, the swelling goes down maybe 40%, the pain goes down 50%, but there's still a section he didn't get, and he won't attempt anything more. It's so weird. So the radiating pain is reduced greatly, but I'm still in pain, a lot less than before though, and no fluid came out. I've been finally able to go to the gym, it's been 5 or so months now, finally put on about 10 pounds of muscle, lost some fat, but this pain is still a barrier to me in getting in even better shape; before that it just wasn't possible to lift dishes some days. A while before that I told him to try aspirating the right hand finger's PIP joint, pain reduced by 80%, swelling is still there, but it doesn't bother me enough anymore to care, there's still pain if I push on it.

Moving forward again, about 2 months ago my left hand's middle finger PIP starts to swell up. It hurts to the touch, again from some slight overuse, but my body just won't recover from these.

About a week ago I had another x ray and ultrasound recommended by, you guessed it, another idiot doctor that rushes you out cause they don't want to help you anymore. They looked at the report, everything came out negative for both. I pleaded with the doc and told her I have pain in my hands, I've tried so much to get it diagnosed, what else possibly can I do? She said "I can't do anything more for you, go find another doctor" I've been to maybe 40 doctors over the past 5 years for these issues. null

I'm so sick of this, I want this to end. I want to use my hands again, I want to work a decent job and not have to worry about this pain. I want to cook, clean, do carpentry, all the things normal people can do, get married and provide for my family. Has anybody gone through something like this? Please help. I've attached pictures too. My body seems to over react to small strain in the tendons or tissues only in my hands.

Thank you

post op, healed, chevron-shaped scar with severe swelling and pain

After attempted aspiration from Rheumatologist. swelling went down, point of needle insertion visible.

MRI for left hand

pip right hand index finger swelling

left hand mcp swelling today

left hand middle finger PIP swollen today

Have you been tested for rheumatoid arthritis or other disorders like that? This screams auto immune to me.

My second guess would be repetitive strain/stress injury but seems a bit too all over the map. Could give you some good leads but probably just a distraction

Musicians also have similar injuries sometimes, that might help with your internet search.

I wouldnt discount standard ice/massage/pt, as repetitive injuries sometimes takes months and even years to respond to those modalities, but they are sometimes the only approach.

I spent multiple years barely able to use my hands due to overuse, so I know your desperation but hang in there and find better doctors and PTs.

Good luck!

Hi there! It sounds like you have a complex case and I can see how frustrating it is for you to work so hard to find answers. I'm a physical therapist in the US so while I can't treat you directly, I can help offer resources and guidance to get this figured out. I will attach a few articles from The Climbing Doctor blog about different hand conditions that sound similar to what you have going on. If you read through them you may find that your symptoms align with what is being discussed and you can bring this information forward to your healthcare team. My other advice would be to find one solid primary care provider (MD, DO, NP, or PA) that supports and understands what you've been through. Having one go-to person can help put puzzle pieces together. Another piece of advice would be to ask for a referral to a physiotherapist (or occupational therapist) that is a hand specialist, and bonus points if they're familiar with climbing. I think this would be the type of provider that has the best knowledge to help you get where you want to be. My last piece of advice is to be patient with yourself. With something that has been going on for so long, it can take a long time to get where you want to be. Also, having discomfort for so long can change the way your brain interprets pain so at this point it will take more than a surgery alone to completely resolve your symptoms. Even if you do end up having another surgery, it is essential to work closely with a physiotherapist or occupational therapist to retrain your mind-body connection too. 

Here are a few articles to look over and there are more on the blog if you want more information! This blog is run by Dr. Jared Vagy, a physical therapist and climbing specialist from California. 

Finger joint swelling: https://theclimbingdoctor.com/dipcapsulitis/

More finger joint swelling/Synovitis: https://theclimbingdoctor.com/swelling-of-the-finger-joints/

Finger Tenosynovitis: https://theclimbingdoctor.com/rock-climbing-finger-tenosynovitis/

There is also a list of physical therapists on the website that are rock climbing specialists, you may be able to locate one in your area. Other physios may offer virtual assessments if there is not one close to you. In addition to Jared Vagy, another physio that is a climbing specialist but based out of Canada is Julien Descheneaux. He provides resources on social media in French if you need them.

Don't hesitate to reach out with any other questions! I'm rooting for you and am hopeful you can find some relief! 

In addition to everything else stated above, have you tried cutting gluten and excess sugar out of your diet?

I’m a retired physician. The presence of multiple swollen joints in your hands over a long period of time is strongly suggestive of an autoimmune rheumatologic disorder. No one can diagnose you on-line, and I am no exception.
I suggest the following general plan: 1) Find a good primary care physician. 2) Get a referral to a University Medical School based Rheumatology Clinic. 3) Do exactly what they tell you to do. 4) Resist temptation to see multiple physicians. Work with your primary care doctor and rheumatologist. Call them when things go wrong; don’t doctor shop. Multiple uncoordinated imaging studies are not likely to be helpful.
This is likely to be a chronic or at least semi long term condition, without an easy cure, but that doesn’t mean you won’t improve, and it doesn’t mean you won’t be able to climb.
The key points here 1) you need a good primary care provider 2) You probably need a referral to a rheumatologist 3) You need to be patient and do what the doctors advise 4) Multiple repeated imaging studies are not likely to be helpful. 5) You must be patient, and understand that this is going to take time to properly diagnose and treat. 6) You don’t state where you live in Canada, but if possible, try to see a rheumatologist at a medical school. Here is the reason: if your case was simple, you’d be diagnosed by now. Medical schools usually have a Rheumatology Department. Your case can be discussed by multiple rheumatologists. More heads are usually better than one.
Good luck! I hope this helps. Your case sounds painful and frustrating.

One wonders why you have such an adversarial relationship towards physicians, when you go around calling them idiots and incompetent.

3 months for an MRI is quite good. You're free to go down south and pay through the nose for an MRI (it might also be 3 months down there too).

Lastly your doctors might think you're shopping for opioids. Happens more often than you think.

J L wrote:

One wonders why you have such an adversarial relationship towards physicians, when you go around calling them idiots and incompetent.

3 months for an MRI is quite good. You're free to go down south and pay through the nose for an MRI (it might also be 3 months down there too).

Lastly your doctors might think you're shopping for opioids. Happens more often than you think.

If I went to a physician, having the OP's problem, and were treated like I was shopping for opioids I'd call them idiots and incompetent. And three months is a very long wait for an MRI. 

From an interesting article on an effort to reduce MRI wait times: "In the United States, patients must wait two to four weeks to get an MRI even though the U.S. has the second highest number of MRI machines in the world."

https://cornellsun.com/2018/02/08/mri-wait-times-must-be-shortened-to-improve-health-care-cornell-researchers-say/