Thenar Eminence Pain

[John Knab]

Dear Stephen,

First of all, as a subscriber to your educational website — THANK YOU! It has been incredibly helpful…

Second, Dave Smith said to say hi!

I just posted this case on LinkedIn he suggested that I run it by you…. I’m not sure if I have the diagnosis right….Its near and dear to my heart since the patient is me!!

Here is the case:

RH Dominant male 50 y.o. was taking off an extremely thick/non-compliant pair of socks and while the left thumb was engaged in the process a sudden sharp pain was felt (during hyperextension/abduction). The top scan is the unaffected side. The bottom is the affected (LEFT) side.

Current symptoms include waxing/waning pain only. ROM normal. No instability/loss of strength. No sensory deficits. No muscle wasting/atrophy. Minimal effect on ADL’s QOL. Xrays benign. No MRI. I am still able to play guitar (heavy use of Left thumb) although it is somewhat painful to play.

I have attached the videos.

My guess is that I ruptured the tendon of the superficial head of the FPB — since the bright white structure seen on the TOP PANEL (unaffected side) is completely absent on the LOWER PANEL (affected side).

I cannot find the “stump” of the possibly ruptured tendon, due to my skill level, or the passage of time since the injury. (Like Dave I am an anesthesiologist who learned too late in life that I am an MSK nerd. He’s light years ahead of me!

The injury was probably 6 or 7 years ago. Sx’s no better/No worse since then.

Thanks again for any insight and I look forward to learning more from you as I evolve!

Best Regards,

John

John H. Knab MD
Medical Director
Center for Pain Management
1602 Physicians Dr. Suite 103
Wilmington, NC 28401
(910) 442-1200
http://www.portcitypain.com

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