[39F] Experiencing severe joint pain with nerve entrapment symptoms

Patient Description

A 39-year-old female has been experiencing severe joint pain in her shoulders, elbows, and hands for about a year, rating the pain as 8 out of 10. The affected joints are inflamed, hot to the touch, and cause nerve entrapment leading to pins and needles, numbness, tingling, and cold hands, particularly at night and upon waking. The right side is slightly more affected, but both sides are involved. Hips and knees are also affected but to a lesser extent. The patient has a medical history of breast cancer, diagnosed in January 2022, and is currently on Zoladex. She has an allergy to Keflex. No over-the-counter medications, vitamins, or supplements are being taken.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Rheumatoid Arthritis: This is an autoimmune condition that causes inflammation in the joints, leading to pain, swelling, and stiffness. The fact that your pain is worse in the morning and affects both sides of your body is characteristic of this condition.

    • Treatment typically involves medications to reduce inflammation and slow the progression of the disease, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs).
  • Osteoarthritis: This is a degenerative joint disease that can cause pain and stiffness, particularly after periods of inactivity or overuse of the affected joint. However, this condition typically affects one side of the body more than the other, and is more common in weight-bearing joints like the knees and hips.

    • Treatment typically involves pain management with medications, physical therapy, and lifestyle modifications such as weight loss and exercise.
  • Fibromyalgia: This is a chronic condition characterized by widespread pain and tenderness to touch, and can often be accompanied by fatigue, sleep, memory and mood issues. However, fibromyalgia doesn't typically cause visible inflammation and swelling.

    • Treatment typically involves a combination of medications, exercise, stress management techniques, and healthy lifestyle habits.
  • Carpal Tunnel Syndrome: This is a condition that causes numbness, tingling, or weakness in your hand due to pressure on the median nerve in your wrist. However, this condition would not explain the joint pain in your shoulders, elbows, and knees.

    • Treatment typically involves wrist splinting, avoiding activities that worsen symptoms, and taking nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.

Please note that these are potential diagnoses based on the information you've provided, and a healthcare provider would need to evaluate you in person to make a definitive diagnosis.

What you can do

  1. Schedule an appointment with your primary care doctor or a rheumatologist to discuss your symptoms. They may order blood tests or imaging studies to help make a diagnosis.

  2. In the meantime, you can try over-the-counter pain relievers like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) to help manage your pain.

  3. Gentle exercises, such as walking or swimming, can help keep your joints flexible. However, it's important to balance rest and activity to avoid overworking your joints.

  4. Applying heat to your joints can help relieve pain and stiffness. You can use a warm towel, hot pack, or take a warm bath or shower.

What you should look out for

Seek immediate medical attention if:

  • Your joint pain is accompanied by intense redness, swelling, or a fever, as these could be signs of a joint infection.
  • You experience sudden, severe joint pain.
  • Your joint appears deformed.
  • You cannot use the joint at all.

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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8 mo ago


People Also Ask


What are the common symptoms of rheumatoid arthritis?

Common symptoms of rheumatoid arthritis include joint pain, swelling, and stiffness, particularly in the morning or after periods of inactivity. It often affects joints on both sides of the body, such as hands, wrists, and knees.


How does osteoarthritis differ from rheumatoid arthritis?

Osteoarthritis is a degenerative joint disease that typically affects one side of the body more than the other and is more common in weight-bearing joints like the knees and hips. Rheumatoid arthritis is an autoimmune condition that causes inflammation in the joints, affecting both sides of the body symmetrically.


What lifestyle changes can help manage fibromyalgia symptoms?

Lifestyle changes that can help manage fibromyalgia symptoms include regular exercise, stress management techniques, maintaining a healthy sleep routine, and eating a balanced diet. It's also important to pace activities to avoid overexertion.


What are the treatment options for carpal tunnel syndrome?

Treatment options for carpal tunnel syndrome include wrist splinting, avoiding activities that worsen symptoms, taking nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, and in some cases, surgery to relieve pressure on the median nerve.

2 Comments


Leo#3962

8 mo ago

The cold hands could be something called Raynaud's phenomenon which is pretty common among women. It involves constriction of the vessels that deliver blood to the extremities in response to triggers such as cold, or due to an underlying condition including rheumatic problems.

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Leo#3962

8 mo ago

As for the joint pain, it sounds most like rheumatoid arthritis, which is a type of inflammatory arthritis that can be diagnosed with just a clinical exam and supplemented with certain blood tests like rheumatoid factor (RF). There are now disease-modifying drugs that can dramatically improve the course of disease so it's important to get diagnosed because your symptoms sound pretty consistent. If your primary care doc is unsure ask for a referral to a rheumatologist

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