Discussions By Condition: I cannot get a diagnosis.

3 Female Athletes--Same Symptoms

Posted In: I cannot get a diagnosis. 10 Replies
  • Posted By: coachdr
  • November 11, 2007
  • 01:01 AM

I am an indoor rock climbing coach who has been working with young female climbers for many years. Over the past few years, 3 of my climbers, all strong competitors, have begun to manifest the same set of symptoms, all with onset about the same age--13 to 14 years. One climber had been climbing for 6 years prior to onset, the other 2 for less than 3. What is most interesting is that the 1st climber is now nearly 18, and has been suffering from these symptoms for 4 years, with no cessation or improvement. She has seen 3 hand doctors, had surgery and been prescribed multiple treatments with no success.

All 3 girls have "loose joints" of varying degrees, though only one--the first--has been diagnosed with Hypermobility Syndrome. All 3 have had occasional problems as a result--sprains, a dislocation or two (wrist and shoulder)--but these injuries are not the real problem.

The puzzling symptoms are:

1. Tingling, numbness and eventual pain starting in the hands, spreading rapidly to the wrists and forearms. These symptoms worsen while climbing, but also affect some day to day activities, including writing, typing, even opening school lockers.
2. Muscle freezing, normally in the thumb. Certain activities, including but not limited to climbing, will result in a situation where the girls cannot move their thumb (wiggling or closing). Usually this is accompanied by pain and numbness, but not always.
3. Rapid muscle fatigue, coupled with reduced muscle strength in hands and forearms.

I know much of this sounds similar to Carpal Tunnel or Cubital Tunnel disorder. However, all 3 girls have been to hand specialists, have been diagnosed with either mild carpal tunnel or cubital tunnel (or both), and been prescribed therapy. One girl was even diagnosed with DeCuervane's syndrome and had surgery (at 15!). No physical therapy (including wrist braces) or the surgery has resulted in even minor improvement. The older girl has been through more diagnostics than the other two, and her last specialist--supposedly the best hand specialist in the East--suggested that she had Erlos-Danlos syndrome Type IV. He suggested that there was no good treatment other than physical therapy. That was 2 years ago and therapy has so far produced no results. Her symptoms remain virtually unchanged.

In her case, I have the most data, since she has had the symptoms the longest. Her symptoms have remained consistent even though she has taken extended periods off from climbing (her most recent break was more than 3 months). She cannot climb long or at high difficulty even when she wants to. More bizarre, even when she does not climb at all, her symptoms remain, though the pain is slightly less. She has additional problems as well: If she engages in non-climbing vigorous activity (such as running), she has increased pain in multiple areas (wrists, elbows, shoulders, back), as well as in ankles and knees. These areas also become sensitive to the touch (especially the shoulders). If she climbs, even at moderate difficulty and for a short duration (equivalent of a 30 minute workout), she has pain in other joints that are not used to a great extent in climbing (knees, especially). This pain and increased sensitivity can last for days following a workout, even if she refrains from non-routine physical activity.

At least one of the other girls has manifested these extended symptoms. In particular, the sensitivity in her shoulders after even a mild workout. This sensitivity is accompanied by severe tightness as well.

Since the symptoms of the other 2 girls are extremely similar, and this type of Erlos-Danlos is fairly uncommon as well as apparently genetically based, it seems statistically unlikely that all 3 of these girls on the same climbing team just happen to have it. I am not at all convinced that this is mere carpal or cubital tunnel, since standard therapies (including time off) have failed to produce more than transient and minor improvement. Further, none of the hand specialists have landed on these conditions as being responsible for all of the symptoms.

My suspicion is that this condition is related to nerve impingement in the shoulder. All 3 girls have "loose shoulders" which can move or sag during climbing. That is as far as I have gotten.

Any suggestions would be a great help.

DR

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10 Replies:

  • Climbing puts repetitive strain on the wrists and hands. Some people just have a weaker muscular structure than others. They're fine unless they engage in repetitive motion that puts strain on the weakened areas. Sorry to disappoint you, but I think the activity is the cause, and that there's nothing to link the three women together such as transmissible disease. It's a shame that the 15 year old had surgery. I had DeQuervan's tendinitis and by meticulously splinting, using hot/cold therapy and resting it up for a very long time it has pretty much gone away. Your women should give up climbing until they're all healed up.
    aquila 1,263 Replies
    • November 16, 2007
    • 08:59 PM
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  • I agree with the previous poster that these girls injuries are from a repetitive strain. Sounds more like tendonitis than carpal tunnel to me. I also agree that only a 3 month hiatus from climbing is not going to be enough for them to heal. I highly recommend them trying acupuncture. A good Oriental Medical practitioner will be able to treat each of these girls and their unique problems. Pain can be caused by many things according to Traditional Chinese Medicine. Please have them try it - it works! Do any of these girls have poor nutrition/diets? Any issues with anemia, whether iron or B12? Do they take nutritional supplements? Please look into the many benefits of Traditional Chinese Medicine by visiting www.acufinder.com or www.nccaom.org. Best wishesDOM
    acuann 3,080 Replies
    • November 16, 2007
    • 09:53 PM
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  • I appreciate your responses, however I must respectfully disagree.I have been a coach and trainer for 20 years. I have seen dozens of athletes in climbing and swimming who have had tendonitis in elbow, wrist and shoulder--I have had it myself. All 3 girls have been to hand doctors and orthopedists, some of whom have initially tried to diagnose these girls with some form of tendonitis or similar disorder. Upon hearing the symptoms I decribed, no doctor has stuck with that diagnosis. Tendonitis will not cause the neurological symptoms--tingling, numbness and pain (different from localized RSD pain common to tendonitis). Furthmore, at least two of the girls have had multiple MRI's which have not shown typical inflamation. If they have a common form of RSD, then their orthopedic surgeons and hand doctors have missed it.As to the suggestion that 3 months is not enough time off of climbing I would humbly disagree as well. 12 weeks of rest is generally more than enough to alleviate RSD symptoms, with a slow transition back to activity. Furthermore, this particular problem has remained the same or gotten worse for the older girl over the past 4 years. This has taken up to 5 months off from climbing, and now limits her climbing to once or twice a week, less than 30 minutes at a stretch. For her to have an immediae recurrence of identical symptoms in this pattern does not indicate tendonitis.As for Carpal Tunnel or Cubital Tunnel, again, each doctor has given a different opinion. I do not know which one to believe--the supposed best hand doctor in the East has ruled out both these diagnoses in the oldest girl. And, he also ruled out DeCurveins (after she had already had surgery!), on the basis that the motion required to lead to it was not present in this girls activities, and the extraordinary rareness of the disorder in teenage girls. Finally, the surgery (done by a different doctor) has not produced positive results--recovery, 2.5 years.Also, I now have 2 additional symptoms which no doctor even checked for:All 3 grils report cold fingers after any acitivity with their arms. All 3 girls report numbness in the shoulders when performing ANY lifting or hanging or similar activity (including, on occasion, typing).Whatever else may be involved, anatomically speaking nerve compression in the elbow or wrist cannot cause numbness in the shoulders. Nerve compression in the shoulders, however, could easily cause problems lower down in the extremity. Finally, cold fingers is not typically a symptom of nerve disorder, but rather vascular disorder (lowered blood flow). I have no doubt that climbing is a common link for these girls, as is shoulder laxity; it is what that link is that I do not know.Again, I appreciate your thoughts, but if it were something simple and obvious, I think the treatments tried so far would have shown at least positive results--certainly not continued decline. Further, I would find it difficult to believe that all of the specialists we have been to would miss tendonitis, or that the months of PT these girls have done, would again, have made them worse. One responent suggested that I wait until the girl's symptoms go away--in the case of the first girl, it has been 4 years.I am not sure how much longer we should wait.
    coachdr 2 Replies
    • November 18, 2007
    • 05:25 PM
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  • I appreciate your responses, however I must respectfully disagree. I have been a coach and trainer for 20 years. I have seen dozens of athletes in climbing and swimming who have had tendonitis in elbow, wrist and shoulder--I have had it myself. All 3 girls have been to hand doctors and orthopedists, some of whom have initially tried to diagnose these girls with some form of tendonitis or similar disorder. Upon hearing the symptoms I decribed, no doctor has stuck with that diagnosis. Tendonitis will not cause the neurological symptoms--tingling, numbness and pain (different from localized RSD pain common to tendonitis). Furthmore, at least two of the girls have had multiple MRI's which have not shown typical inflamation. If they have a common form of RSD, then their orthopedic surgeons and hand doctors have missed it. As to the suggestion that 3 months is not enough time off of climbing I would humbly disagree as well. 12 weeks of rest is generally more than enough to alleviate RSD symptoms, with a slow transition back to activity. Furthermore, this particular problem has remained the same or gotten worse for the older girl over the past 4 years. This has taken up to 5 months off from climbing, and now limits her climbing to once or twice a week, less than 30 minutes at a stretch. For her to have an immediae recurrence of identical symptoms in this pattern does not indicate tendonitis. As for Carpal Tunnel or Cubital Tunnel, again, each doctor has given a different opinion. I do not know which one to believe--the supposed best hand doctor in the East has ruled out both these diagnoses in the oldest girl. And, he also ruled out DeCurveins (after she had already had surgery!), on the basis that the motion required to lead to it was not present in this girls activities, and the extraordinary rareness of the disorder in teenage girls. Finally, the surgery (done by a different doctor) has not produced positive results--recovery, 2.5 years. Also, I now have 2 additional symptoms which no doctor even checked for:All 3 grils report cold fingers after any acitivity with their arms. All 3 girls report numbness in the shoulders when performing ANY lifting or hanging or similar activity (including, on occasion, typing). Whatever else may be involved, anatomically speaking nerve compression in the elbow or wrist cannot cause numbness in the shoulders. Nerve compression in the shoulders, however, could easily cause problems lower down in the extremity. Finally, cold fingers is not typically a symptom of nerve disorder, but rather vascular disorder (lowered blood flow). I have no doubt that climbing is a common link for these girls, as is shoulder laxity; it is what that link is that I do not know. Again, I appreciate your thoughts, but if it were something simple and obvious, I think the treatments tried so far would have shown at least positive results--certainly not continued decline. Further, I would find it difficult to believe that all of the specialists we have been to would miss tendonitis, or that the months of PT these girls have done, would again, have made them worse. One responent suggested that I wait until the girl's symptoms go away--in the case of the first girl, it has been 4 years. I am not sure how much longer we should wait. Well, okay, I see your point. But keep in mind that even the best hand "specialists" can make mistakes. I didn't mean to imply that your climbers' symptoms were simple or obvious - there are perhaps several things going on here. Please respond on my suggestion for acupuncture - has this been considered or tried? I still think it would help. Have these girls had blood tests to determine any nutritional deficiencies like anemia? The reason I ask is that this could be contributing to the numbness and coldness sensations there are experiencing. Best wishesDOM
    acuann 3,080 Replies
    • November 19, 2007
    • 06:32 PM
    • 0
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  • Thank you again for your reply.And I am quite sure the doctors involved in these cases have made mistakes. The oldest girl has been tested for nutritional issues--no anemia, but 2 years ago she had a mild zinc deficiency. That was addressed and has gone away, no cessation in symptoms.As for accupuncture, with all due respect, I am unconvinced by the data supporting its efficacy. Perhaps that is just my prejudice.Thanks!
    coachdr 2 Replies
    • November 19, 2007
    • 06:51 PM
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  • As for accupuncture, with all due respect, I am unconvinced by the data supporting its efficacy. Perhaps that is just my prejudice. Aah. Please visit www.nccaom.org and also google the National Institutes of Health study of acupuncture for osteoarthritis of the knee. This NIH study was the biggest study done to date on acupuncture in this country. It showed that it was very effective for osteoarthritis of the knee. This is only one of many studies that have been done. Acupuncture/Traditional Chinese Medicine is over three thousand years old. It cannot be compared to Western allopathic medicine. It is a viable and extremely effective treatment. Please address your "prejudice" and understand that ALL of the top medical schools in the country - Tufts, Harvard, Yale, Johns Hopkins, U of Ariz, Columbia...these medical schools have incorporated Traditional Chinese Medicine in their curriculums, or have created a relationship with TCM schools. It is very hard to do a double blind, placebo controlled study of acupuncture. This form of medicine is specific to the individual, which is why it is so effective. I believe the future of medicine will be a true incorporation of CAM (Complimentary and Alternative Medicine) medicine. Allopathic medicine has its place, but so do other modalities, including Traditional Chinese Medicine. Okay, I am done with my rant! Seriously, as a Doctor of Oriental Medicine, I have treated countless people with all sorts of complaints. I am often a practitioner of last resort, as patients have tried everything else. They are usually very happy with the results of acupuncture. It works. Best wishesDOM
    acuann 3,080 Replies
    • November 19, 2007
    • 07:26 PM
    • 0
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  • Check for thoracic outlet syndrome - or inlet as they are calling it now. If this is the third reply you get from me - excuse my internet user ignorance. If not - sorry, the first reply was more elaborate. If you want more info - please let me know.
    Anonymous 42,789 Replies
    • November 19, 2007
    • 07:43 PM
    • 0
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  • I will thus take a big jump and suggest testing for an ailment that often affects the nervous system. Lyme does love the joints and it may be a possibility. It often likes the heart, joints and nervous system. The only labs that are reliable are Igenex in CA and Bowen in FL. I suggest this as the rest did not help much and RSD may be caused by Lyme. Traditional tests are not accurate at all. Anyway, a path to explore if you are seeking an answer. May not be right but actually may be. Dr. Gus
    Anonymous 42,789 Replies
    • November 20, 2007
    • 02:34 AM
    • 0
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  • I am a massage therapist in California and was researching vascular disorders in high preformance athletes when I ran across this blog. I am interested in the outcome of your cases as this is the sort of obscure synptoms I am presented with from time to time. It has been a year since the last post so I hope you are still checking in.
    Anonymous 42,789 Replies
    • January 28, 2009
    • 06:26 AM
    • 0
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  • Have any of the physicians performed lactic acid tests to determine the levels being produced in these girls both in the absence of any exercise and afterwards? I would also question specifically why one girl was diagnosed with DeQuervain's and yet all of the girls reportedly demonstrate quite similar features? DeQuervain's typically produces pain at the base of the thumb extending downward to the ipsolateral area of the wrist. I would be surprised that in a girl so young that the degree of inflammation would necessitate surgical intervention and would consider such a decision to be unwarranted even in the absence of direct evaluation. In order to rule out whether sharing the same activity and motion regimen would be causative in nature, it would be necessary to determine whether seemingly unrelated factors, ie serum lactic acid, would be consistent among the girls. Tests looking for correlation would either establish a common premise in the girls or the activity they share. Based upon the constellation of symptoms described, Causalgia Minor would be among the differential diagnoses to consider. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 29, 2009
    • 02:21 AM
    • 0
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