D: What brings you here today?

P: Um I'm here because my left hand, kind of just like at the base of my thumb, has been hurting for the past two days and it seems to be getting worse, um and I'm left handed so it's really hard for me to write or do anything um where I have to like, clench or grip things.

D: OK, and how long has this been going on for?

P: Uhm, so for the past two days, but it's got, it got bad yesterday.

D: OK, and have you had any, uh if you were to describe the pain, where is it located exactly?

P: It's just at the base of my thumb. Uh you know where the fleshy part of your hand is?

D: OK yeah yeah.

P: Yeah, so just just over there.

D: OK, and what kind of pain is it? Is it sharp or is it aching?

P: Uhm, it's it's like a um, at baseline it's an achy pain, but if I try to move it or um try to write or you know, use a computer or anything like that, it becomes sharp. 

D: OK, Um and on a scale of uh zero to 10, 10 being the worst pain you've felt in your life, how much would you rate it?

P: I'd say like a 6.

D: OK, and does this pain move anywhere else in your hand, or does it just stay where you described?

P: Um it just stays there. 

D: OK, and what kind of motions uh cause the most pain?

P: I'd say like um you know, trying to touch my pinky with my thumb, that that hurts. Um just like trying to rotate it hurts.

D: OK, um have you tried anything for the pain that has helped? 

P: Uhm, no, I haven't really tried too much. I've just I just tried not to use it as much.

D: I see. OK. And um, has this ever like, have you ever had any injuries to this hand? Any trauma either recently or in the past?

P: No, no, nothing like that.

D: OK. Alright, and is there any, do you do any kind of repetitive work that requires gripping or lifting um with that hand, anything repetitive?

P: So I do a lot of work at the computer. And um I guess I tend to type a lot with my left hand, so maybe that.

D: OK.

P: And sorry I also take lots of notes, like handwritten notes with my left hand.

D: OK, so are you left handed? 

P: Yes.

D: OK. Alright. Have you been diagnosed with any medical conditions in the past?

P: No. 

D: No, so you're healthy?

P: Yes.

D: Um do you take any medications on a regular basis? 

P: Uh no, no.

D: No, OK. Any allergies to any medications?

P: Um no allergies.

D: OK, um any previous surgeries or hospitalizations?

P: No.

D: No, any family history of any medical conditions, whether it's musculoskeletal, rheumatological, any conditions?

P: Uh no, nothing like that.

D: OK, um any cancers in the family?

P: Um I know there's, yeah there's a lot of cancer in the family. There's colon cancer, breast cancer, ovarian cancer. 

D: OK. And are they first degree relatives who had those cancers?

P: Uh no first degree relatives, just like aunts and uncles. 

D: OK. Uh alright, and currently are you working right now or have you had any time off work or any modified duties?

P: Um so I'm still working online, I've just um haven't been taking notes by hand anymore.

D: I see, and does that help though? 

P: Uh yeah it it has helped a little bit because I'm not moving my hand as much so it helps with the pain. 

D: OK. Have you taken any uh Tylenol, Advil, anything for the pain? 

P: No, I haven't.

D: OK. Alright. And currently right now, what is your living situation like?

P: Uh I live in an apartment by myself.

D: OK, and um, do you currently uh smoke cigarettes? 

P: Um I smoke, I used to smoke like five years ago, and I only did that for like a year or two, um and it wasn't very much. But I don't smoke anymore.

D: OK, that's good. Um any alcohol?

P: Um I'll have like a beer on the weekend.

D: OK. Any recreational drugs like marijuana?

P: Um I will take an edible like once a month.

D: OK. Um and yeah, those were just some of the questions I had um and we're just going to do a few things for examining, examining uh that area. So are you able to make a fist?

P: Um I can, but it hurts.

D: OK, it hurts in that location that you mentioned?

P: Yes. 

D: How about um if you make a fist without your thumb, does it still hurt or is it just when you are moving the thumb?

P: It's just when I'm moving the thumb.

D: OK. And if you were able to, are you able to uh rotate your wrist?

P: Uh yes, I can rotate my wrist.

D: Does that hurt at all? 

P: No.

D: OK, um now I just want you to do this one test. It's called a Finkelstein test. OK so I want you to flex your thumb, press it up down against your palm.

P: OK. 

D: And then hold your hand, sorry.

P: No, go ahead.

D: Yeah, and then after you do that, um, bring your fingers above your thumb, so just cover your thumb.

P: OK.

D: Kind of like a fist, but your thumb is on the inside of your fingers.

P: OK.

D: And then bring your uh arm out.

P: OK. 

D: And with your other hand, can you, from above push your wrist downwards? So your uh pinky finger is uh pointing to the pointing to the ground.

P: OK, yep.

D: Yeah, and did that hurt at all? Like when you, so this is just called ulnar deviation or your um of your wrist. Does that hurt at all?

P: Yes, that is very painful.

D: That's very painful, OK. Alright, um and then you're also having pain with gripping and, OK, so those are kind of all the things I wanted to ask. Uh it seems that you may be having something called De Quervain's tenosynovitis. Um it's caused by some repetitive motions, uh it can be due to gripping. Sometimes it happens to new mothers who are lifting their children as well as daycare workers. It can also happen in other work environments, and so what we will first just need to do um is mainly to rule out something like osteoarthritis. You are fairly young um but if there was ever an injury in the past, it you can have early osteoarthritis in the area. So we just want to get an X-Ray. And other than that, the way we kind of deal with this issue is usually conservatively and with a splint. 

P: OK. 

D: And a sling for your thumb that uh helps relieve some of these symptoms, uh restricts some of your movements, reduces some of the swelling, and if it does get really bad and it's affecting your work and conservative management with pain and the splint don't work, and with physiotherapy, we do uh offer injecting corticosteroids into just right like in the area that you mentioned, right below the thumb.

P: OK. 

D: Um and that often has some effect as well. Um but at first, yeah, let's just do some conservative management and see if that helps. It's only been a few days, so hopefully um what we try first helps. And then we can go on from there.

P: OK yeah, that sounds great. Thank you. 

D: Welcome, take care.

P: You too.