The Difference between CTS and Tendinitis

On Wednesday, May 1, my therapist cancelled both my private session and group session, so I saved money! Yay. ‘Cept I didn’t actually get to do any therapy, so… Boo.

But then I went to work on Thursday and at around 6 PM my lower right arm started really hurting. With my palm down on the counter, I could feel the swelling in the lower left part of the top of my arm, situated just above my wrist. The wrist itself didn’t hurt, and I could move my hand in a circle motion back and forth, but when ever I tried to use my thumb to grip, turn a page, pick up equipment, or anything related to having opposable thumbs, my entire arm gave way to a sharp pain that went from the tip of my thumb all the way to my shoulder blade. After a while of abusing my ability to ignore the pain (at least ignore it enough to do my job, which requires the use of both hands), my arm began to hurt even while at rest: a dull, broad ache focused in my lower arm, where it had begun swelling.

I figured it was something like food poisoning—not like food poisoning, exactly, but that it would heal itself within 24 hours if I rested and didn’t do anything extra stupid during that time—so when I got off work, I went home and worked around the pain gingerly, complaining to my mother about possibly having pulled a muscle or pinching a nerve or something but hopefully having it feel better in the morning. The next morning, the pain hadn’t lessened any, so I took some OTC medicine for headaches and pain (a combination of Tylenol—that is, acetaminophen—aspirin, and caffeine)… and then I hauled ass to work. And I was in pain the entire day. I even complained about the pain, which I’m not used to doing with people not closely related to me. I had a full up shift: eight hours of walking, lifting, and acting genially toward customers… and by my last break time, I was practically in tears.

I called my mother, a registered nurse, and asked what I should do. She didn’t know, but erred on the side of “If it’s really that bad, go to urgent care.” I finished out my work day (finally) and sat in my boiling car in the sun and called the Kaiser Permanente nursing/medical questions hotline to ask what I should do. After chatting with three separate people—a connecting agent, a registered nurse (not my mother, though she’d have given me the same advice), and a young man who made an appointment with the urgent care doctor for me for later that day—I managed to get an appointment with a doctor at the Sunset Blvd. urgent care clinic. My primary physician with Kaiser is in Glendale, and the appointment guy wanted to send me there, which would’ve been fine with me, but they’d closed for the day, and I just wanted to see a doctor before the pain got any worse.

So, I was set up with an appointment for 4:20 at the Kaiser urgent care facility on Sunset Blvd. I drove home in pain, explained to my dad what I’d be doing, took a shower, and started out the door. My father stopped me, saying, “The 2 Freeway is closed.”

What?”

“There’s a brush fire; the police have closed the 2 Freeway South at the 134 interchange.”

Well, shit. No way I’d get to my appointment on time then. I live at the intersection of the 210 and 2 Freeways, and I normally, I’d drive down the 2 all the way to Alvarado Street, through Silver Lake, and onto Sunset Blvd. The 2/134 interchange is on the 2 between me and Alvarado, so taking that freeway was out. My dad and I strategized for a few moments, and I decided to take the 210 East all the way down to the 710 and then to the 110 South. A roundabout way to get to Sunset, but at least at that moment it was possible, unlike my regular route.

I arrived at the urgent care facility on the corner of Sunset and Edgemont twenty minutes late. After parking on the street, I headed inside, signed in at one of the main desks, and paid the $30 copay. The receptionist who checked me in told me that the doctors were running late, too, so I shouldn’t worry about missing my appointment, especially because I’d made one ahead of time. (“Ahead of time”, I guess, being just over an hour, but I suppose that’s neither here nor there.)

I waited. I waited more. I listened to a man trying to get out of paying for a prescription arguing with another receptionist. I half-watched the progress of the workers fighting the brush fire on the TV that was across the room. I half-listened to the two women nearby speaking to each other relatively quietly in Spanish or Portuguese. Holding my right arm up in a lackluster attempt to keep the swelling down, I waited for one of the nurses or attendants to call my name.

“Vee-ah-nah Doon-can?” I sighed. I can count the number of times on one time that anyone has correctly pronounced my name the first time. I stood up.

“I’m coming. Give me a second,” I called to the woman standing at the door. I hefted my bag gently over my hurt arm and walked past the two Spanish/Portuguese women, being careful not to step on any feet.

“How are you, ma’am?” the woman asked, leading me down the hall into a tiny room with a computer console, a weight scale (that showed weight in Imperial units, of course), and a blood pressure cuff and machine.

“What’s the problem?” she asked, bringing up my chart on the computer. I explained the situation, showed her my swollen arm, and showed my other arm for comparison. She nodded, made a few notes in my chart, and asked me to step onto the scale. She noted my weight (to my silent shame, I’d gained almost twenty pounds since the last time I’d been weighed at Kaiser in March 2012), and then sat me down again to take my blood pressure on my good arm. So, even though I was overweight (especially compared to the last time I was weighed), my blood pressure reading was 115/59, which is to say, really good.

“On a scale of zero to ten—zero being no pain at all, and ten being the worst pain you can imagine—how much pain are you in right now?” she asked, motioning toward my swollen arm and then to a pain scale chart pinned to the wall across from my seat. Ah, the one-to-ten question. How completely unhelpful the doctors’ pain charts are. I thought about it for a minute. What was the worst pain I could imagine? Compared to what I could imagine, this pain was negligible.

“Uh… four?” I said, my voice turning up at the end of the statement like a question. She looked at me. I stumbled over my next words. “Well, what’s the worst pain you can imagine?” I asked defensively.

She turned back to the computer monitor. “How about if the scale was relative to the pain you’ve already experienced?” she clarified, sounding slightly irritated.

I was silent for a minute more, studying my swollen arm, before answering. “I guess… seven or eight, then.”

She made an “ah” shape with her mouth and made some more notes in my chart. Then, she led me to another, slightly larger room to wait for the doctor. “The doctor will be with you in a minute.”

I waited. I read the “You cannot kill viruses with antibiotics!” posters on the wall across the room. There were three of four different versions, all warning against super-viruses and why patients should not take antibiotics except under specific circumstances, none of which include having the flu or a head cold.

Darien and SerenaFinally, the doctor arrived. He was a bald man shorter than me in Darien’s clothes (see also: “Meatball head”, Serena, and the Moon Kingdom). I was a little surprised he wasn’t wearing a white lab coat, but I suppose there’s no rule that says that anyone (doctors or otherwise) have to wear lab coats, so. Of course, he said…

“So what’s the problem?”

I made an irritated movement toward my right arm with my left hand. “My arm hurts. I don’t know why. I don’t think anything is broken, but I can’t work with only one hand. Fix it.”

He gave me a Well, let me just see for myself look, pulled on some blue plastic gloves and took my arm to inspect it. Turning it this way and that, he asked periodically, “Does that hurt? Does it hurt when I move it this way?”

I nodded or shook my head, as appropriate, and finally he pulled off the gloves, made some notes in my electronic chart, and asked, “Do you remember hitting your arm at all? Physical trauma often causes swelling.”

“No, I don’t think so,” I replied. “I’ve hit my hands and arms at work before, though, so I suppose it’s possible.”

“I’m going to send you for a few x-rays just to be sure.” He explained how to get to the x-ray laboratory (across the street on the corner in the basement) and sent me on my way. I followed his directions and found myself paying a copay for every single x-ray that was to be taken (five in all: three of my forearm and two of my wrist). I gulped at the total cost, frowning because I knew nothing was broken or fractured. (So much for saving any money. /sigh)

Then, I was in a room in the basement of the building alone with the x-ray technician. I couldn’t breathe. Alone with another woman I could’ve handled relatively well, but this man was larger than me, and he was touching me. It wasn’t anything inappropriate, I kept telling myself, since he had to adjust my arm for a good x-ray; he was completely genial and professional. Nevertheless, my heart rate spiked, my tongue seemed like it had turned to lead in my mouth, and my throat closed up, making it difficult to breathe. The room shrunk around me and I barely heard anything the technician was saying because I was focusing so hard on not just flipping out right there in the chair.

As soon as he was done and had added the x-rays to my electronic chart (they got back to my doctor before I did), I was out the door and up the stairs. I sat with my head between my legs on the curb outside the building, the blood rushing to my head, until I could think straight again and I wasn’t in danger of bolting on the spot.

I’m sure I drew some stares, but acting a bit strange wasn’t all that out of place in the three-block radius from where I stood—two separate hospital complexes and two separate new-age church buildings (including the main Scientology branch in Los Angeles) made it so that odd people were actually more the norm than average people. When I managed to stand again, I crossed the street slowly and headed back to the urgent care office.

I was led to a second room, where the doctor returned to diagnose the pain in my arm. “Your bones look fine,” he said, and I nodded. “It seems like you’ve got tendinitis.”

“Tendinitis?” I repeated, turning the word into a question.

“It’s like Carpal Tunnel Syndrome, but it can happen anywhere in your body, not just in your wrist.”

According to Yahoo!:

The difference between tendinitis and Carpal Tunnel Syndrome is indicated primarily by the location of the pain in your wrist. If the pain or numbness occurs in the palms and inner side of your wrist, then you are experiencing Carpal Tunnel Syndrome. If the pain is primarily in the top of your wrist, then it is probably tendinitis.

“Ah, I see,” I said. “So what’s the treatment? I’m not used to being below par, so to speak, so I’m a terrible patient.”

The doctor’s lips quirked into a half-grin. “I’ve seen better patients,” he agreed. “But trust me, ma’am: I’ve also seen worse.”

He cleared his throat and continued. “Aggressive icing—I’d say four times a day for ten to twenty minutes each time—will bring down the swelling. I’m going to give you two prescriptions: one for naproxen, which should help with the swelling; and one for Tylenol 3, which you should take as needed for pain.

“I’m putting you on medical work leave until next Wednesday. Ask one of the nurses at the desk for a wrist brace before you leave, okay?” he asked. I nodded. “Do you have any questions?” I shook my head. “All right, then I hope I don’t see you back here any time soon.” I nodded again, and then he was gone.

I trudged up to the nurses’ desk and requested a brace, which was provided to me in short order. I trudged over to the pharmacy (across the street catty-corner), handed over more money, and picked up the prescriptions he’d written for me. Finally, I trudged back to my car (at least I hadn’t also had to pay for parking, I decided later), got in and pulled the door closed, put my head on the steering wheel, and cried.

It was difficult driving with the brace, but without it it was near impossible. I set my jaw and managed to make it to my best friend’s graduation ceremony (which had been in my evening plans all along, and which I had thought I might not make because I was sitting in urgent care being a whiny patient), where I watched him walk across the stage and accept his Associate of Arts Degree. I tried to stay for the whole ceremony, but there were too many people there, I was already shocked from dealing with so many people at the hospital, and everything was just so loud that I ended up bolting back to my car shortly after my best friend returned to his seat.

I went home. I had to talk to my parents about what had happened, even though the last thing I really wanted to do was do more talking. My mother was concerned, of course, but she agreed that I’d done the right thing and wasn’t it also great that I managed to see my best friend walk at his graduation, too? Yes, of course it was. Things started getting blurry, and I went up stairs and closed the door to my room.

My cat, sitting on my bed, looked at me like, “What are you doing here?” like she always does, and I couldn’t help but laugh. I flopped face first down onto my bed, buried my face in my pillow, and screamed.

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