Back of hand tendonitis(?)

[marshvet]

I thought I would re-post this so I can get more coverage than in the Diving Medicine forum:


I am a new diver with an apparent recurrent scuba injury. Last year on one of my dives, I noted shortly afterwards a pain in the back (Not palm) of my hand. It was severe enough that I had trouble putting gloves on for a subsequent dive. I had no idea how it happened. It slowly dissipated and since I did no more diving for the season, it slowly went away never to return. This past weekend I went diving for the first time this season (I had heart surgery) and again without any known cause, the back of my hand did the same but much worse. I have significant swelling this time. I did dive dry both times; it is only on my right hand (both times) and I have absolutely no clue. Anyone out there with an answer or similar occurrence?

Thanks,

Marshall

 

[Duke Dive Medicine]

Marshall,
Sorry, this one passed me by in the Diving Medicine forum. DiveAssure emailed me about your post. A few questions for you:
1. How many times have you used the drysuit, other than the times you had the hand pain?
2. Which hand is it? Is this your dominant hand? Did you notice any rash or discoloration?
3. Regarding the pain: can you tell me exactly when you noticed it, i.e. during the dive, after the dive, etc? Were you doing anything specific at the time, possibly removing fins, weights, tanks, etc? Does/did anything make it better or worse?
4. Please describe the pain as best you can, i.e. what kind of pain was it (dull, sharp, throbbing, etc) and tell me exactly where the pain was located.
5. On a scale of 1-10, how bad was the pain?
6. Was the pain only in the hand, or did it radiate or move?
7. How long did it take the pain to resolve? For the second incident, how long did it take the swelling to go away?
8. Please provide dive profiles for both incidents. Were the profiles different than the way you normally dive?
9. You mentioned heart surgery. What was it for, and what kind of surgery was performed?
10. Aside from the heart issue, are you under a physician's care for anything else at all?
11. Please provide a list of your medications.

 

[marshvet]

Thanks D.D.M. in advance. Here are my answers:

1. I have used the drysuit 3-4 times without incident. Yes, it is brand new. I considered that the wrist seal was too tight but there was no pitting edema. Both wrist seals are trimmed to the same point.
2. It is my non dominant (Right in my case) hand. No rash or discoloration.
3. The pain came on slowly after the dive. I cannot even tell when. It was not related to any incident such as would be expected with a true injury. It then progressively got worse so that on a subsequent dive, I needed help getting my left glove on since I could not pull. There was only low grade pain when not used and obviously more pain when used.
4. The pain was sharp and was located on the dorsum of my hand directly over the extensor tendons. It did seem to spare the thumb and pinky. Initially there was no swelling; then there was a relatively focal area which eventually progressed broadly across most of my hand. As the swelling progressed, I also noticed crepitus when moving my fingers - as if there were tendon friction.
5. At it's worse, about an 8.
6.Only in that hand. No radiation.
7. As best as I can remember, the first incident was better in a few days. It is now 6 days since the present one and although the swelling is down (Thanks to ice, Ibuprofen and compression) it is still painful with use. Needless to say, much less so that at the outset.
8. On both occasions, the dives ranged from 30-70 feet in depth and lasted about 20-30 minutes. This weekend was the first time I got to dive this season. I did have a few rapid ascents while learning to balance my drysuit and BC. I was also learning to dive sidemount this past weekend. At most, my nitrogen loading graph was halfway up the green. These dives were similar to all that I have done, but as a new diver I have only logged 23 dives to date.
9. I had my aortic valve replaced with a bovine pericardial valve in April. At my last surgeon recheck in early June, my surgeon gave me the OK to dive with no restrictions. I have also been running, riding and hiking since without problem.
10, No other physician care.
11. Other than an 80mg aspirin in the AM and Ibupfrofen as needed, no medications.

Again, thanks so much for your time. I look forward to hearing back. Also, should we switch this to the medical forum? If so, I am not sure how to do that.

Marshall

 

[Duke Dive Medicine]

Hi Marshall,
It sounds like some kind of direct trauma. If it happens again, you may want to consider radiologic studies; an MRI would probably be appropriate. Barring that, I know this sounds overly simplistic, but if it only happens when you're in the drysuit, it's probably related to the drysuit. The cuff may not feel tight, but it may be tight enough to be causing the irritation. What type of gloves are you using? Also, do you have any prior injuries to that hand?
Best,
DDM

 

[marshvet]

Since I only dive in a drysuit, that is what it will be. I use standard neoprene 3mil gloves. I did have a trigger finger on that hand with corrective surgery about 4 years ago. I wondered if it was possibly due to spreading my fingers against the neoprene to initially put it on. I will avoid that next time and see what happens.
Once again, thanks for your efforts. If I have any updates, are there more than one of you there or are you it? Let me know if I need to direct any follow up to a specific person.
Have a great weekend.

Marshall

 

[DA Aquamaster]

It's a case study so take it for what it is worth, but I had similar issues when doing week long technical diving trips where it was common to lift and carry my BP, wing and tanks weighing about 130 pounds. And at times I would briefly lift and carry it short periods with 1 hand. Over the course of a week I would develop what felt like tendinitis and it would persist for a few weeks post trip.

I also noted that doing heavy work with cold hands seemed to precipitate the problem as well and a 2 hour dive in 70 degree water without gloves did not feel cold, but apparently was. I have noted that dives in very cold water 35-45 degrees also leave me at greater risk so I plan the post dive gear disassembly in a manner that allows me to either minimize the heavy lifting or delay it until my hands have re-warmed.

Working smarter helped (no more single hand lifts, using a cart when practical, etc) as did switching to side mount with single cylinders. The latest change has been using a loop of tubular webbing to create a carry strap to put the weight on the wrist and arm rather than the fingers.

In short, what worked for me was to figure out what caused it and then stop doing what caused it.

 

[marshvet]

Thanks Aquamaster. I have to try to figure out my situation as you did. I now know I have to evaluate every move so that I know what to avoid in the future. Your insight leads me in the right direction.

Marshall

 

[Duke Dive Medicine]

Since I only dive in a drysuit, that is what it will be. I use standard neoprene 3mil gloves. I did have a trigger finger on that hand with corrective surgery about 4 years ago. I wondered if it was possibly due to spreading my fingers against the neoprene to initially put it on. I will avoid that next time and see what happens.
Once again, thanks for your efforts. If I have any updates, are there more than one of you there or are you it? Let me know if I need to direct any follow up to a specific person.
Have a great weekend.

Marshall

Marshall, concur with your response to DA re: monitoring what you do with that hand to see if you're placing undue strain. For followup, you can send me a PM.
Best,
DDM