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What Is The Cure For De Quervain's Tenosynovitis? What Are The Findings From The Steroid Profile Test?

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Posted on Thu, 26 Dec 2013
Question: I'm an IT consultant and I had quit smoking in Feb 2013. After few months I had the following symptoms: Severe Joint pain (especially knees/shoulders) Hive like itchy rashes Extreme fatigue and weakness de Quervain's tenosynovitis [1] [1] Based on the symptoms and test (Finkelstein's test) mentioned here WWW.WWWW.WW I consulted a GP in March and he gave me some pain killers (pills & ointment) and asked to wear a wrist brace for the tenosynovitis. He also asked for a CRP test and the CRP level was found elevated. After the symptoms got worse and started affecting my work, I consulted an immunologist and got my blood test done on 15th Nov 2013 (reports attached). The doctor concluded the following: Vitamin-D deficiency Spontaneous Urticaria Slightly elevated Cholesterol level I was recommend Uprise D3 60k once weekly for 12 weeks for joint pain and Combination of Fexofenadine & Levocetirizine for rashes. After 2 weeks of above medication, I observed the following: Knee/shoulder joint pain got a bit better No/Little rashes (Hives) when on Fexofenadine or Levocetirizine. No/Little Fatigue & Weakness However, one thing that did not improve at all is the de Quervain's tenosynovitis. Initially I had the pain in my right wrist but now I got the pain (and wear braces) on both wrists. The pain is very severe and prevents me from working on computer, lifting weights, holding things etc.. My job demands me to be on laptop for 12-14 hours a day and this condition is affecting my performance & productivity. Also, I recently got a pain in my elbow which won't go away even after taking pain killers (Ultracet, brufen, hifenac). I've observed that as if my bone,tendons have become more fragile and the injuries are taking a while to recover (or not recovering). I'm exercising daily (1 hour aerobics/yoga) but these conditions get worse during/after exercise. I'm aware that for tendinitis the following are suggested: Painkillers Wrist Braces Corticosteroid injections (Oral ?) Surgery But I believe, that's like suppressing the symptoms than fixing the root cause. I got a steroid profile test done on 27 Nov 2013 (Reports attached) to check the cortisol/dhea levels. I want your help figuring out the root cause and how we can fix it. I've attached all the reports for your reference. Few quick questions : Looking at the report,could it be related to Osteoporosis as Vitamin-D deficiency is involved ? Does DHEA & Cortisol levels look ok ?. Does that say anything about the condition ? Would a BMD (DEXA) scan results help ? In the report dated 27 Nov 2013, the Vitamin - D (D3+D2) levels look like back to normal. Is it possible within two weeks of 60k IU Vit-D supplementation ? What can I do for the for the tenosynovitis? It's really affecting my work. Alternative link to download reports: WWW.WWWW.WW
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Answered by Dr. Saurabh Gupta (1 hour later)
Brief Answer: Do not worry, prognosis is excellent. Detailed Answer: Hello XXXX. Thanks for your query. Cortisol level is high according to report attached. It seems to be due to stress. Prolonged stress results in a prolonged release of cortisol and higher cortisol levels, which can then, in turn, cause illness in the body. Your reports does not points towards osteoporosis. BMD(DEXA scan) will be helpful to diagnose osteoporosis. It is possible to increase the level of vit d from 20.44 ng/ml to 66.31 ng/ml with two weeks of 60k IU Vit-D supplementation. For tenosynovitis first thing is to give rest to the part. Do not worry, prognosis of tenosynovitis is excellent.You can return to full function after the inflammation quiets down with treatment as advised by your treating doctor. I do hope that you have found something helpful and I will be glad to answer any further query. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Saurabh Gupta (38 hours later)
Thanks XXXXXXX Here are few follow-up questions: Could you please tell me the normal cortisol range in the AM (10-11 AM) and above which level you would consider it high? Could you please define "stress" and what could be the possibly causing it ? How would I lower down the cortisol level ? You did not relate the low DHEA level with High cortisol level. Could you please explain why ? Are you suggesting I should go for a BMD scan or it's not required ? **One thing I missed adding in the initial data: I took dexamethasone (1 tab a day) for around 2 years (2002-2004) during sports training (martial arts). I was not informed then and started taking it by following suggestion of one of my team mates. I do have stretch marks similar to Cushing's_syndrome in my shoulders and thighs since then. After I stopped taking it I did not observe any other symptoms (bone/muscle weakness etc.) until recently when I'd quit smoking. Could it be the cause of high cortisol ? What should I do to balance it ?
doctor
Answered by Dr. Saurabh Gupta (26 hours later)
Brief Answer: I suggest you to go for BMD. Detailed Answer: Hi XXXX, Sorry for late reply. Normal cortisol range may vary from lab to lab. Normal range in morning according to your lab is 0.07 to 0.93 microgram/ dl. Above this level it considered high. Stress could be physical or emotional. Cortisol level can also be affected by sternous activity, infection or injury. Dexamethasone is a corticosteroid similar to one produced naturally by your adrenal glands. Taking it for long time could be the cause of high cortisol . Your DHEA level is not low. It is 5.5 ng/ml which is in normal limit (<13 ng/ml) First thing do not worry to much. Try to reduce any stress. Do relaxation exercises. It is good that you had already quit the smoking.I suggest you to go for BMD to diagnose osteoporosis. According to that we can discuss further treatment. Hope this helps you. Warm Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Saurabh Gupta (20 hours later)
Thanks for the answers, really appreciate. I'll get the BMD done and get back to you.
doctor
Answered by Dr. Saurabh Gupta (8 hours later)
Brief Answer: You are most welcome. Detailed Answer: Hi XXXX I am glad to know that I could address your concern. You are most welcome, after BMD you can consult me again directly through my profile.
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Saurabh Gupta

Orthopaedic Surgeon, Joint Replacement

Practicing since :2004

Answered : 5930 Questions

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What Is The Cure For De Quervain's Tenosynovitis? What Are The Findings From The Steroid Profile Test?

Brief Answer: Do not worry, prognosis is excellent. Detailed Answer: Hello XXXX. Thanks for your query. Cortisol level is high according to report attached. It seems to be due to stress. Prolonged stress results in a prolonged release of cortisol and higher cortisol levels, which can then, in turn, cause illness in the body. Your reports does not points towards osteoporosis. BMD(DEXA scan) will be helpful to diagnose osteoporosis. It is possible to increase the level of vit d from 20.44 ng/ml to 66.31 ng/ml with two weeks of 60k IU Vit-D supplementation. For tenosynovitis first thing is to give rest to the part. Do not worry, prognosis of tenosynovitis is excellent.You can return to full function after the inflammation quiets down with treatment as advised by your treating doctor. I do hope that you have found something helpful and I will be glad to answer any further query. Take care