I need HELP with my Chronic Wrist and Elbow Tendonitis.
I am a respiratory therapist and have been for 31 yrs. I do the motions day in-day out with my hands, wrists,fingers and arms.
If it helps to say I squeeze pediatric ambu bags, resuscitation devices, against stiff tight resistant chests all day to manually ventilate the patients.
I use my whole hand with this motion but the ambu bag size can vary from infant to adult...meaning the grip diameter of what I am gripping varies with the age and size of the patient.
The resistance I encounter in this task is varied with the compliance of the patient's chest wall/lungs.
I accentuate the medication dose inhalers (think asthma inhaler/albuterol puffer) the majority of the time while ventilating the patient as well..
I can easily repeat these motions several thousand times/day in a 12 hr shift.
I see no other ergonomic way to do my job and believe me I have tried to vary my routine but the needs of the sick kids tend to dictate things..
I am busier in the winter months from late Sept to April of each year...so the use is constant for both arms on-going and daily but about 8 mos/year there is increased stress and overuse.. no resting and actual increased use during this time.
I have developed tendonitis in my elbows from overuse and stress. I got my first steroid injection 3 years ago in the left elbow, which is more painful than the right...one year later to the day, I got my second injection to the left elbow again.. and a year later, the third year, I got injections in both elbows.
The injections worked fine again for the right but not for the left. I have loss of strength and grip and movement in my fingers...greater on the left.
I have the muscle cramping and my hand draws inward at times in a spasm. I was given bilateral braces and yes, it is just a bandage not a cure... I can do the job with it on but it remains painful and I know it is damaging the area regardless of the spints.
NSAIDS prescribed and over the counter do little at this point. Simply having my arm hang for longer than a few mins is difficult, swinging with walking is eventually very uncomfortable too.
I would say I have a 6 pain scale, difficult, chronic ache and spasm measurement with aids to daily living compromised.
I must add that about 8 yrs ago I had a pisiformectomy on the left hand at the wrist because I popped a tendon off the bone moving a patient up in the bed (you could hear it across the room!) I could not flex or turn a door knob due to increasing arthritis in the bone/joint so it had to be removed for the left had to function.
I recovered really well afterwards. No pain all symptoms gone except for a little tightness at times on the underside of the forearm from the wrist under the little finger to the elbow. I was told I can have no more steroid injections, they are not working anyway..neither is the brace.
I was told my only option is surgery. I trust my doc.. he is a hand and upper extermity specialist here in Houston and world renown at that.. I am not thrilled about this option, but I do know how much I improved after the first surgery. Do you think I can be helped without surgery or is it impossible to avoid?
Is it wrong to think that because I already have had my anatomy and physiology to a small extent altered and compromised and weakened on the left arm from the first surgery that there is little chance of recovering without surgery?
Also, am I at the point where I DO need surgery? Would delaying do more harm than good or am I too damaged right now to fix?
I have to have the surgery done now to prevent I have 13 more yrs to work and I will be needing my hand and fingers and I will be required to continue the same motions until I can retire!
Please tell what you think...I need help! At this point what can I do to heal and continue with my career?
Hello Sandee. Thank you for asking for help, and thanks for sending such a long detailed explanation. That saved us a lot of time back and forth getting me necessary information.
You are a classic case of the far extreme end of the Tendonitis spectrum. What you describe is -exactly- what happens with time and overuse of a muscle group.
Usually my answers are rather wordy. I'm going to keep these answers to your questions short and sweet, and will elaborate more later.
1. Do you need surgery? In my opinion, no. No -if- you do the self care I tell you to do, how I tell you to do it.
'I' am not important in that equation, you doing the -RIGHT- self care the right way, is.
2. No I do not believe that you are too damaged to fix.
It will take some time and some effort and some diligence. But we can get you back to something close to pain free, and if you are willing to do the work, pain free.
I think you are motivated.
Having said that, you have 13 years left at that job, so you may not be totally pain free, but we can keep you working at the rate you have been -and- have tolerable pain levels or much better.
I believe 'better' is entirely possible.
3. That 'weakness' you describe is totally reversible. Unless a nerve was damaged with the surgery, we can get that strength back.
4. I challenge the statements that the corticosteroid shots 'worked fine' and that you 'got better' after your surgery. If I read what you said correctly, the pain went away for a while. But you are in a world of hurt right now.
Maybe you meant that surgery spot is way better and you can now move your hand where you couldn't before. Fair enough. We're both right in that case.
Let's go with 'you had shots and surgery, now you're at where you're at' and move on.
5. With all due respect, when doctors (even the best doctors) say that surgery is your only option, what they are really saying is that it is the only tool they have left in their tool bag.
They are not saying that surgery will fix you. They are saying that's the only option left that they know of.
Surgery does not and will not counteract all the thousands of squeezes you will need to be doing over the next 13 years, much less next week.
I'm totally willing to help you through this. To the very end.
I promise that if you do exactly as I say you will get results.
1. Get The Tennis Elbow Treatment That Works.
It has the bulk of and basis of what you need to know and do. Watch it and start doing the protocol.
2. Go to the How To Reduce Inflammation page and start doing the Ice Dipping exactly as I describe until the DVD gets there.
3. In the meantime, read through all the pages on the Ask The Tendonitis Expert page. You will start to see the pattern of what you have going on, and on the one with 'Clutch Pain' in the title, there is a conversation that you and I will be having about how and when the pain will go away, and what to expect.
4. Also, read through the pages on this website on Carpal Tunnel, Tennis Elbow, Inflammation, Pain Causing Dynamic, and Corticosteroid Injections. This will help your brain understand what is going on, why it is hurting, and how it is going to get better.
It is very important for the brain to have a better path to go down than confusion and 'I'm screwed'.
5. I'll say more later, but A. start increasing your protein intake, and B. if you aren't already, start taking a calcium/magnesium supplement.
It's safe to say that you aren't eating enough protein. Your body needs it.
If you have been in pain a long time, and your muscles work so hard and so much, and you have spasm and such, you are using a lot of calcium and magnesium. Getting your fill of those two nutrients can and does help significantly in various ways.
I can't emphasize enough #1 and #2.
I look forward to talking with you soon.
Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert