With lupus there are many common symptoms most patients can routinely expect to experience. Perhaps most mornings it is normal to awaken with joint pain and stiffness, a sense of fatigue that sleep did not relieve, and a good dose of brain fog or general slowness in cognition or mental processing time. But, then there are the times when lupus strikes out randomly, as is it’s nature, and attacks something unique and unexpected. For me, the latest development in the symptom adventure is extreme inflammation two years after a severe sprain of the ligaments and muscles of my left forearm and wrist.
Lupus is opportunistic, and when it attacks in a way that singles out something on one side of the body, but not the corresponding opposite side there is usually a history to the area being previously injured or weakened. In my own experience, there were several interesting complications from sudden onset connective tissue attack around old previously healed injuries.
Several years ago, undue inflammation and tendon attack developed around an old gymnastics ankle injury from my teen years. This resulted in a quick onset of sudden breakdown in foot ligaments, ankle connective tissue, and undermined ligaments that hold the tibia and fibula calf bones together, allowing these leg bones to separate and slide down around both sides of my ankle. When lupus was in flare, the joint became its extra special target, so a cast was required for months while the ligaments repaired in the weird and unusual aftermath to an old ankle strain. Thank you, lupus!
Another time, when I was in a prolonged severe lupus flare that eventually began its first diagnosed attack on my central nervous system, my old neck injury became the target of a special battle. Inexplicably, one morning 15 years after my head-first flight through a car windshield, I woke up in excruciating neck pain and unable to move my neck or lift my chin. After many x-rays, CT scans, MRIs and bone scans, the diagnosis was that ligaments and muscles in my cervical spine were suddenly weakened and had loosened, resulting in spinal instability. Diagnostic tests showed that there were three severely herniated disks in my cervical spine, and one of these was indenting into the sheath of my spinal cord. Spinal stenosis and other arthritic problems in these three vertebrae were also diagnosed, involving areas in my neck that were previously stable for the 15 years since the car accident. Although my doctors did not all agree that lupus was to blame, it was clear to me, my physical therapists and some of my physicians that the weakness and breakdown of the stability of my spine was too coincidental with the lupus flare to be unrelated. After two extended courses of neurological rehabilitation, followed by a slow, several years-long restrengthening program to rebuild my neck tendons and musculature, this area now is no longer severely symptomatic. Thank you again, lupus!
Now, my left hand and wrist is acting up in an area that I sprained over two years ago. While walking through an airport during a trip to visit my father, the wheel broke on my suitcase and severely wrenched my wrist as the luggage twisted and pulled its weight against the hand pulling it. As a result, I had a painful acute sprain of my wrist. I iced the injury on the airplane, but proceeded to spend the next few days scrubbing and cleaning out my father’s house in preparations for its sale. Meanwhile, my father was hospitalized for eight weeks trying to stabilize his health enough to allow for him to fly home with me to move into an appropriate level of senior care. For the past two years, this injury has plagued me with swelling and pain in the wrist, and now is getting even worse. After two years, several x-rays, three different doctors, three different types of wrist splints and braces and four steroid injections, the ligaments are still acting up and getting worse.
A similar type of one-sided inflammation caused my plantaris tendon to rupture, ripping away from the place it branches off of the Achilles tendon in my calf. This was an unexpected and painful interruption to a great game of laser tag during a work team building event several years ago! Thanks again go to lupus!
Some of my doctors seem to agree it is not de Queverain’s tenosynovitis, since it involves the tendon beside the one that causes de Queverain’s syndrome. Also, the inflammation and injury seem to focus on the facets and connective tissue connecting the scaphoid, trapezius and trapezoid bones, forming the base of my thumb joint. In the tiny triangle space between these bones is the repeated steroid injection site. Now, the inflammation and tendon involvement has spread up the extensor pollicis brevis tendon (not the extensor pollicis longis responsible for de Queverain’s syndrome) into the top of my forearm above my wrist. I have painful swelling in this defined muscle and tendon that starts on the top of my mid-forearm, and terminates on the top of my index and middle finger. Once yet again, thank you lupus!
Perhaps as my Benlysta infusions bring about improvement in my overall lupus symptoms, this newest tendon inflammation problem will resolve itself. However, if not, the doctors all are expecting that I will need hand surgery sometime in the spring. In the meantime, I hope and pray that this latest of lupus’ “special attention” to an old injury will quiet down as my health improves in the coming weeks of treatment.