Medical question - possible nerve pain in arm?

[Slipper]

First, I realize that the internet doesn't replace a doctor. Unfortunately, my daughter is non-verbal and I only suspect nerve pain but it might be something else. Or, it might be nothing. I need brainstorming to determine a plan.

 

My daughter is 15 years old, autistic, non-verbal. She isn't typically aggressive, but lately this has been a problem. She will self-injure quite a bit, but typically doesn't hurt anyone else. A few months ago, she bit my mother in law, her teacher, two paraprofessionals and myself. I noticed that everyone complained of the same thing, she grabbed their pointer finger, placed it in the back of her mouth and bit hard. I couldn't see anything, but took her to the dentist just to check things out. The dentist located an ulcer in the very back of her mouth that we couldn't see without laying her on her back. We started treating it and she quit biting other people. So, when she started hitting, I have to wonder if I'm missing something that hurts her. 

 

About a month ago, she hit her teacher in the eye (possibly accidental while flailing during a tantrum). This was her first time to hit anyone. She hit her hard and her hand was swollen and bruised for a couple of weeks. (The teacher had a mild black eye and was incredibly understanding). Since then, she keeps antagonizing the injury. She will tap and thump it with her right hand. Her paraprofessional noted that she seems to want to keep it injured because she continuously taps/hits it. She will scratch herself to the point of leaving marks from her wrist to elbow. She will hit the back of her hand with her other hand. She also hit me and dd13, both with her left hand. (She is right-handed). Last night she started hitting the walls with that hand. On Friday night, she hit it so hard that a large lump appeared on the back of her hand (but went down the following morning). When she went to school this morning, that hand is still bruised and the knuckles are so bruised they are almost black. I started wondering if perhaps she has damaged a nerve or that her hand is tingling?

 

I had already taken her to get an x-ray of her hand and it came back fine. We have given ibuprofen (which was their suggestion). She cannot communicate if something hurts and her receptive skills are very low. 

 

Any suggestions or thoughts about what may be going on? If I try to have an MRI done, it will require anesthesia as she won't stay still. I also don't know that they will even do one based on maternal 'instinct' that something might be wrong. I'm thinking about trying to immobilize the hand (possibly arm) with a brace/cast of some sort that I can get at the drugstore. My pediatrician would be sympathetic, but he would want more 'proof' before prescribing anything so I am still using ibuprofen. And then I tell myself that it may just be a quirk in her autistic behaviors. 

[Pippen]

I would consider involving a chiropractor. Ask around and interview to find someone who would work well with her.

[Slipper]

Thanks. We decided to take her to an orthopedic doctor. Her appointment is tomorrow. The school called yesterday and stated that a therapist working with her and the nurse suspected that her hand was broken. I explained that we had already taken her in for x-rays but she's apparently tapping repeatedly on her hand, placing other people's hands on top of her hand and is unable to do tasks with that hand that involve pressure. So, I'm taking her in and hoping that we get someone who takes a very close look. 

[Jan in SC]

Sometimes a first X-ray will not show the broken bone. I think you are wise to have it rechecked.

 

I just want to mention how wonderful and loving you are to your sweet daughter.

[LMV]

Sometimes a first X-ray will not show the broken bone. I think you are wise to have it rechecked.

 

I just want to mention how wonderful and loving you are to your sweet daughter.

 

If the first X-ray was done right after the injury this can be the case (and even up to the first 48 hours after injury).  Generally, if the patient remains symptomatic without improvement we repeat plain films at 5-7 days post injury.  If repeat films are still negative then we look for other explanations. Plain films are good at identifying fractures, dislocations, gross joint effusions, and some soft tissue swelling.  They do not image ligaments, menisci, or fine details of joint spaces well so MRI or CT may be useful in this case.  

 

Another thought would be to look at referred pain patterns, and to consider that some of this may be self stimulating behavior.  If it is self stimulating behavior she can still injure herself in the process so that doesn't mean you shouldn't make sure she hasn't done that or that you shouldn't try to keep her from doing further damage by using a splint or brace to protect the injured hand.  That of may just cause her to injure something else but I think that is just an example of the sad situation your daughter and family are in.  In some cases medication adjustment may also help with this so that may be something to discuss with her pediatrician and/or child psychiatrist.

 

:grouphug:

[Spryte]

:grouphug: You have a plan, and great advice above from LMV, I just wanted to send  :grouphug: .

 

I opened the thread because I've had extensive nerve pain issues.  But I have no experience with a non-verbal child, and I think you are doing an amazing job tracking down the problem.  For me, who *could* articulate it, I'd sometimes just look at my hands, turning them over and over, in wonder that they could be so painful and look normal.  It was mind boggling.  I can't imagine not being able to verbalize it.  The things you are describing, though, make sense  as ways for dealing with the pain.  You're onto something.  

 

Hoping that it's not nerve pain, as that can be so hard to treat, and that it's something readily fixable.  

[Slipper]

Thank you. We saw a hand specialist today. He examined her hand and said that he suspected she had fractured something in her hand. He decided against more x-rays. He said that his treatment would be the same regardless. He suggested that we leave it alone to heal. She has full range of motion and he felt that putting a splint on it would upset her and she would not be compliant with treatment. I mentioned to him that she is self-injuring the hand and he said that this was not something under his control. He felt that during the healing process there would be times when her hand would hurt but that it would mostly be pain-free. He said to bring her back if we noticed an obvious break and disfigurement.

 

After we arrived home, she hit me on the shoulder twice with that hand and then hit the car. Her hand is swollen again and I'm a bit discouraged (although the doctor we saw is considered to be very good, I'm not upset with him). DH and I are debating whether to purchase a brace ourselves and try to immobilize it anyway. 

[Ottakee]

Can you get a second consult? Sorry to hear the doctor, while maybe very good, wasn't good with your daughter. I would want another x-ray and go from there. Maybe more/different pain meds, a brace, etc.

 

Sad to say some doctors aren't as good/caring with those with special needs. Before we adopted our son at 7 an ENT refused to remove his tonsils and adenoids as he was just a foster child. Once he moved in with us we found a different ent who did the surgery as it was very needed.... Sleep disturbances, breathing issues, etc.