What is the best course of treatment for a 35-year-old male patient with left hand pain after a weightlifting injury?

Management of Left Hand Pain After Weightlifting Injury

For a 35-year-old male with left hand pain following a weightlifting injury, the recommended treatment is a wrist brace that includes both wrist and thumb support, continued ibuprofen at the lowest effective dose, topical NSAIDs, and physical therapy, with ultrasound evaluation to guide further management. 1

Diagnostic Approach

The ultrasound (US) ordered is appropriate as it provides several advantages:

• High accuracy in diagnosing flexor tendon injuries with 100% sensitivity and specificity for full-thickness tears 2
• Ability to identify soft tissue injuries, effusions, and tenosynovitis 3
• Helps establish an appropriate treatment plan and predict functional outcomes 2

Treatment Algorithm

First-line Treatment

1. Orthosis/Bracing

   • Full wrist splint (covering both thumb base and wrist) is superior to partial splints with an effect size of 0.64 1
   • Custom-made orthosis that maintains the wrist in neutral position is preferred 1
   • Limit bracing to periods of no to light activity to avoid increasing extensor muscle activity 1

2. Pharmacological Management

   • Topical NSAIDs (particularly diclofenac gel) as first-line treatment 1
   • Continue oral ibuprofen at the lowest effective dose for the shortest duration possible 4
     • Do not exceed 3200mg total daily dose 4
     • Take with meals or milk if gastrointestinal complaints occur 4
   • Biofreeze cream (as prescribed) is appropriate as a complementary topical analgesic

3. Physical Therapy

   • Range of motion exercises
   • Strengthening exercises
   • Joint protection education 5

Second-line Treatment (if inadequate response)

• Consider oral NSAIDs at a higher dose if needed, but maintain the lowest effective dose 1, 4
• Consider ultrasound-guided therapeutic intervention if indicated by imaging findings 3

Special Considerations

Monitoring and Follow-up

• The three-month follow-up plan is appropriate
• Regular assessment of:
  • Range of motion
  • Pain levels
  • Functional improvement in activities of daily living 1

Cautions and Pitfalls

1. Bracing Considerations

   • Using a brace that's too restrictive during activities requiring fine motor skills can be counterproductive 1
   • Evaluation by an occupational therapist for proper fitting and selection of the most appropriate orthosis is beneficial 1

2. Medication Considerations

   • Ibuprofen should be used at the lowest effective dose to minimize gastrointestinal risk 4
   • Monitor for gastrointestinal side effects, especially with prolonged use 5

3. Activity Modification

   • Patient should avoid continuing workouts that cause significant discomfort
   • Gradual return to weightlifting should be guided by physical therapy progress and pain levels

Therapeutic Ultrasound Considerations

While ultrasound as a diagnostic tool is valuable, the evidence for therapeutic ultrasound is limited:

• There is little evidence that therapeutic ultrasound is more effective than placebo for treating musculoskeletal injuries or promoting soft tissue healing 6
• Ultrasound-guided interventional procedures (if needed based on diagnostic findings) have shown better outcomes than procedures performed without imaging guidance 3

The current treatment plan with bracing, NSAIDs, and physical therapy represents the best evidence-based approach for managing this patient's weightlifting-related hand injury.