Pain after cast removed after surgery, could this be lupus or something else? Any ideas?

[Roanna]

Hey all, happy holidays to you all. I had right hand surgery in October. Crossed intrinsic transfer and stabilization with tendon reconstruction to index, middle and ring fingers. I tripped over a strap at work. So I decided to do surgery, I could have left it with fingers hanging but who wants to stand out more... So 1st cast off in 2 weeks, stitches removed, then new cast base with tensor wrap to be held for 4 weeks. Pain started there where tensor sat on fingers. Feels like 3rd degree burn with any friction making it unbearable. Impossible to sleep from pain. Was on hydro-morphine but was given a limit which didn’t touch pain, so stopped after a few days of nasty side effects. I kept thinking this will get better but the surgeon couldn’t explain it and ‘tis the season so see GP on Friday. I think it is a lupus reaction to being in a cast and friction like a pressure hive only not. Has anyone else had this symptom after a cast? I’ve noticed now since starting physio, my joints started to hurt more, feet, other hand so this must be a flare but the burning is my main concern. My skin looks good but feels burnt. It is slowly improving but very slow. Most creams I’ve tried burn my skin. Even heat from other hand placed on area causes burn feeling. I went to Emergency for pain a few weeks back and he told me all looks good and to try Hydro- morphine again. Which I no longer am on. Anyone??? I saw Rhumy a few weeks back and he didn’t linger on my hand because another dr was dealing with it. Is this just another lupus oddity?

[honeybug]

Ohhh poor you Roanna.

😊🌿🌸🦋

That looks terribly painful to me. I cannot offer any advice etc. But I do send you my love 💗 gentle hugs 🤗 and prayers 🙏 to get it sorted soon.

Take care & abundant blessings sweetie.

EJ 😊🌿🌸🦋🙏🤗💗😘😇🕊✝️🎄🦌🎅🤶🎁❄️☃️

[Roanna in reply to honeybug]

Thank you for the support, it helps.

[honeybug in reply to Roanna]

Xxx

[Lupiknits]

That looks really unpleasant. I can’t suggest anything to help and have no experience, but I do hope it improves soon.

[Hidden]

It does look so painful - could it be that it’s become infected - like cellulitis or ulcers perhaps? I have had lots of skin burning invisibly over the years so I can at least empathise.

It is at its worse when I have other problems such as post op wound sepsis and pancreatitis, dental abscesses etc. In my case it’s small fibre neuropathy (SFN) which can be part of autoimmune diseases such as Sjögren’s and Lupus.

The only pain treatments for SFN are the antidepressant and anti convulsant family. Opioids, morphine etc won’t touch this kind of pain unfortunately. I hope the neuropathic pain eases as your hand heals.

[Roanna in reply to Hidden]

Twitchytoes, that makes a lot of sense to me so I will ask dr on Friday and look more into SNF. Thank you for your reply. What med names have you seen used for this so I can be more prepared when I see Dr.? I’ve taken anti-depressants specific for things like Paxil. Thanks again

[Hidden in reply to Roanna]

Amitriptyline, Pregabalin - these 2 families although Ami is easier to get off and doesn’t cause the weight gain of Pregabalin. If that’s an issue for you then just watch out or warn GP. Best of luck. TX

[Roanna in reply to Hidden]

Thank you again. Happy holidays.

[Hidden]

Ditto to what everyone else said. I’m so sorry you’re going through this.

[NeuronerdDoaty]

Pustules with red surrounding skin can be quite common after a cast/tape is removed. It is more common with certain skin types. Tell your doctor but they should go away on their own within a month if not sooner. Sometimes they hurt. If you have an AI be careful if they open up. There is risk for infection. Just keep your doctor informed.

[Roanna in reply to NeuronerdDoaty]

Thanks for the info. The large knuckle is sore but it was pretty well rubbed raw when cast came off and at this point not infected, just tender from surgery which only twinges now and then. My worse pain is where it looks normal on the fingers where no surgery took place and below the cut. How do you explain that to a Dr. when it looks fine to the naked eye? They assume you want drugs.

[Hidden in reply to Roanna]

Nerve pain/ neuropathy is always invisible and doctors know about it - it affects many from diabetes to alcoholics to those with autoimmune diseases.

[happytulip]

As an ex A&E nurse I would be concerned to see that and level of inflammation after a cast removal. Usually there is a lot of flaky skin and muscle loss but there shouldn't be that level of redness, pain and what looks like a collection under the skin but it is difficult to tell from the photo if the swelling and white/yellow area on the first knuckle on the left is tought skin and 'tenting' over a joint or if it is a palpable collection of fluid/infection.

If it is not the normal shape of your knuckle and is swollen and you have reddness, pain, its hot to touch, you have loss of function that all points to infection. If that is the case then you need to be followed up pronto because you have recently had surgery and you don't want any infection spreading to the incision site as this can make things worse.

I don't mean to be alarmist but if it were me I would get it checked out today. You are especially at risk if you are on any form of immunosuppression.

It sounds very painful and pain after surgery should improve not worsen.

I'm not giving medical advice (because we're not allowed), just saying if that was me I wouldn't wait until Friday. It were me and I noticed the reddness spreading I would draw a line around the area making a border, note the time and see if it spreads whilst seeking medical advice. If you do decide to draw around it only ever use a felt tip as a biro can puncture the skin and introduce infection.

Good luck and let us know how you get on. X

[Roanna in reply to happytulip]

Happytulip, thank you for your response. That is an old injury with the size of the 1st knuckle, the redness I keep asking about and may be raw from cast friction and removal of dead skin, but doesn’t feel like any fluid. I was gentle removing the dead skin, but it continues to stay red. I am pretty limited to Drs where I live (small town up north in BC Canada). I keep asking the drs and they look and say it is fine. I’m getting more confused by the day from not sleeping. I keep hoping physio will do miracles but... My med history is such that I prefer to see someone who knows me better than a 5 min appointment. My pain isn’t as intense today , about a continual 6 out of ten but I have to move my hand all day to calm the pain. Same at night. Having lupus makes this harder because you never know if it’s the lupus or just normal healing process that is a bit out of whack. I’m neutropenic, but I’m stable enough to only be on BP pills which my Rhumy would love to change but my kidney guy is comfortable with it. I heal well usually and work around a lot of sick people and manage to stay healthy . Wish me luck.

[Oshgosh]

I don’t know anything about Hands.but when I was having problems with a sore prior to lupus diagnosis,all the creams stung plus plus.

My GP said that O needed ointment.

She prescribed Prednisolone cream ,which didn’t sting and helped.

I don’t know if it will apply to you. Hope this helps.

[Roanna in reply to Oshgosh]

Thanks Oshgosh, , I will add that to my GP list for tomorrow, I have used it in the distant past but can’t remember if it helped. I’m getting nervous because my GP is pretty stiff on his scripts when it comes to the stronger meds for pain. I think he thinks my goal in life is to be an Addict.