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Thumb pain lasting over a year

Hello,

I've been unable to get a unanimous decision from doctors so thought I'd see if anyone here can help.

I've been experiencing thumb pain on both hands, spurred on by bending or pinching with the finger. The pain is focused on two areas on each thumb, highlighted in the pictures below.

One doctor suggested Sesamoiditis and thought surgery to remove the bones would be the best idea, not sure it would explain the pain in the circled parts of the hand in my images. Though it would explain the X section in the pictures.

Cortisone shots have not helped, nor icing or rest. It's incredibly frustrating, I just want to be able to use my hands freely again. But don't know what action to take without an accurate diagnosis. 

Any thoughts? I won't take it as gospel but any ideas would be appreciated to bring to my doctor. 

(IMAGES MIGHT BE POTENTIALLY DISTURBING, CLICK TO REMOVE BLUR)

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Dr. Dinesh G
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Hi @Steve sorry to hear about your predicament! Sesamoiditis is inflammation of sesamoid bones at their attachments. Sesamoids are unique in that they connect with muscles via tendons, unlike most other bones that connect with each other at joints. Sesamoiditis is more common at the knee (patella/knee cap which is technically a Sesamoid, but sometimes also called tendinitis) and the bottom of the foot, although the hand has sesamoids in the region called the "Volar plate".

There are several possible causes of pain in the region you describe, apart from bony disorders like Sesamoiditis, there can also be soft tissue disorders (e.g. affecting muscle tendons or their protective layer/"tendon sheath") in the area. Common examples for the latter include trigger finger and De Quervains tenosynovitis, although one would expect the shots to have at least provided some temporary relief. You can read more about them here: https://www.health.harvard.edu/diseases-and-conditions/tendon-trouble-in-the-hands-de-quervains-tenosynovitis-and-trigger-finger

Unfortunately, it would not be possible to distinguish between them without first finding out more about your lifestyle, circumstances surrounding the start of your symptoms, aggravating factors, as well as performing an examination in-person of the affected area. However, these are fairly standard assessments and I trust your provider would already have done them, and likely came to the conclusion of sesmoiditis based on these and has offered surgery due to the lack of response to the shots.

Perhaps if there is still uncertainty surrounding this, you may want to discuss with your physician the option of performing an imaging scan such as an MRI to evaluate further. Hope this helps!
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@Steve
Thanks for your detailed answer. Yes we originally thought it was De Quervains but PT and shots didn't improve it at all. It really is focused on the two sides of the thumb (both of them).

I thought there was only sesamoid bones on the inside of the thumb though, near the webbing that connects to the index finger.

The outside of the thumb, directly opposite of it, hurts a lot too. Is there a sesamoid bone there as well? On the outside of the MCP? It feels bony at that area and is very painful.

X-rays didnt show anything, an MRI would? Also if its arthritis would that show up on either an x-ray or MRI? 

Thank you!