We often take the simple things in life for granted -- until they are no longer simple to enjoy. As illustration, consider a patient of mine who complained about severe pain in her hands. As is typically the case, I began the hunt for a diagnosis by investigating her behavior just before her initial observation of hand pain symptoms.
As we talked, she recounted a particularly busy weekend some five weeks earlier that included dinner preparation. Calzones, she recalled. The dinner was more involved than a few calzones for the family that night. Rather, she had baked 40 of the folded pizzas to sustain her daughter while she and her husband fasted in observation of Lent.
Once her daughter’s sustenance was neatly packed in the freezer, she returned her attention to the heavy shawl she was knitting for her friend. She had loved to knit ever since her grandmother first taught her the craft as a little girl. This time was different, though, as hand pain made the intricate needle work a laborious task.
She first noticed pain in her left hand, originating between her index and middle finger. The sensation washed over her wrists and crept along the pinky-side muscles of her forearm (what physicians refer to as the ulnar side). I asked if she had any swelling in her wrist, hand, or fingers. There was none. She also did not notice any redness (erythema) or weakness with use.
As we continued to delve deeper into her symptoms, I was curious why she had silently endured her hand pain for weeks before calling me. She said the pain was improving until recently, when she tripped and used her left hand to catch herself from falling. That incident brought the hand pain back and she wanted to know if she should make an appointment with her doctor for an evaluation or perhaps get x-rays.
After carefully considering all her symptoms, my phone diagnosis was overuse of the muscles controlling her left hand. As a right-handed person, her calzone bake-a-thon had required more use of her left hand than was typical. Normally, people use their non-dominate hand to stabilize, leaving the dominant side to do more of the fine motor work.
My suggested treatment was self-massage of all her hand intrinsic muscles. While muscles in the forearm give us strength in grip, our hand intrinsic muscles originate and insert into places in our hand to fine tune and stabilize the different joints. With all the work that she had done, she had overused these muscles.
After only one day of self-massage, she reported significant improvement in her symptoms. Had she not improved, I would have recommended an evaluation by her doctor. She continued her treatment and was soon taking pain-free knitting for granted once again.