Which Specialist to Consult for Neck and Hand Pain Issues?

Inquire about the department for consultation?

Hello Doctor:
1.
There is slight swelling on both sides of the neck near the trachea, with normal TSH and T4 levels, and the swelling has persisted for about eight months.

2.
Three weeks ago, my right thumb was diagnosed with tendinitis by a rehabilitation specialist, and two weeks later, the corresponding area on my left thumb also began to hurt.
This week, the pain in my right thumb has moved upward, causing discomfort when making a fist or holding a pen.
(I have been applying heat daily.)
3.
I have had a stiff neck for over a week, and I use the pain-relieving and anti-inflammatory medication prescribed by my doctor daily, along with heat therapy, which provides some relief.
However, I wake up the next day feeling more pain than the previous night (after some relief), and this cycle has continued for over a week.

I would like to ask whether I should consult a rehabilitation specialist for these symptoms or if I should be referred to another specialty.
Thank you very much!

Keisi, 20~29 year old female. Ask Date: 2021/12/07

Dr. Wang Shouji reply Orthopedics

Hello, for thumb tendonitis, it is important to reduce hand activity and consider protective splints.
If there is no improvement after a prolonged period, corticosteroid injections or surgery may be considered.
A stiff neck is a form of myofascial pain syndrome; applying heat and performing muscle stretching exercises are recommended, and avoid using a pillow that is too high.
Changhua Hospital cares about your health.
Sincerely, Wang Shou-ji.

Reply Date: 2021/12/07

More Info

Based on the symptoms you've described, it seems you are experiencing a combination of neck and hand pain that could be related to multiple underlying issues. Given the complexity of your situation, it is essential to approach this systematically.

1. Neck Pain and Swelling: The swelling you mentioned on both sides of your neck, despite normal TSH and T4 levels, could indicate a few possibilities. It might be related to lymphadenopathy, which can occur due to infections, inflammatory conditions, or other systemic issues. Since this has persisted for about eight months, it would be prudent to consult an Ear, Nose, and Throat (ENT) specialist or a general physician who can evaluate the swelling further. They may recommend imaging studies or a biopsy if necessary to rule out any serious conditions.

2. Hand Pain and Tendonitis: The pain in your thumbs, which has been diagnosed as tendonitis, suggests inflammation of the tendons in your hands. This condition can be exacerbated by repetitive use or strain. Since you are experiencing pain that is moving up your hand and affecting your ability to grip or write, it may be beneficial to continue seeing a physiatrist (rehabilitation specialist) who can provide targeted physical therapy. They can also assess your hand mechanics and suggest modifications to your activities to prevent further strain.

3. Cervical Pain and Stiffness: The persistent neck pain, especially after sleeping, could indicate a cervical spine issue, such as a herniated disc or cervical spondylosis. Since you have been using pain relief medications and heat therapy without significant improvement, it might be time to consult a neurologist or an orthopedic specialist who focuses on spine issues. They can perform a thorough examination and may recommend imaging studies like an MRI of the cervical spine to identify any structural problems.

4. Comprehensive Approach: Given the interconnected nature of your symptoms, a multidisciplinary approach may be beneficial. This could involve:
- Physical Therapy: To strengthen the muscles around your neck and hands, improve flexibility, and reduce pain.

- Occupational Therapy: To help you adapt your daily activities and find ways to manage pain while maintaining functionality.

- Pain Management Specialist: If your pain persists, a pain management specialist can offer additional interventions, such as injections or advanced pain management techniques.

5. Lifestyle Modifications: In addition to medical consultations, consider lifestyle changes that could alleviate some of your symptoms. This includes:
- Ergonomic adjustments to your workspace to reduce strain on your neck and hands.

- Regular breaks during activities that require repetitive hand movements.

- Gentle stretching and strengthening exercises for your neck and hands, as advised by your physical therapist.

In summary, I recommend starting with an ENT specialist for the neck swelling, while continuing to work with your rehabilitation specialist for the hand pain. If your neck pain persists or worsens, seeking a neurologist or orthopedic specialist's opinion would be the next step. This comprehensive approach should help address your symptoms effectively and improve your quality of life.

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