Finger joint bump
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Many rheumatic conditions and diseases may cause finger bumps.
Osteoarthritis, the most common form of arthritis, often affects the hands. When it does so it often is associated with local inflammation of the distal inter-phalangeal joints (DIP or last row) and proximal inter-phalangeal joints (PIP or next to last row). The inflammation causes the joints to swell and hurt. The bumps that form are called Heberden’s nodes (DIP) and Bouchard’s nodes (PIP). They are initially soft and painful. As time goes by, they become hard and bony and no longer hurt. They are more a cosmetic issue than anything else. Involvement of the base of the thumb may also cause a squared off appearance and a bumpy prominence.
Gout also causes bumps in the fingers. Gout may cause inflammation of the interphalangeal joints of the fingers. When this occurs, it may be indistinguishable from a flare of osteoarthritis. Middle-aged (post-menopausal) or elderly women on diuretic therapy are particularly prone to developing this. Gout may also cause soft tissue bumps. The diagnosis is made by aspiration of fluid from the affected joint or soft tissue mass with examination of the aspirated material using polarizing microscopy.
Rheumatoid arthritis causes joint swelling involving the wrists, metacarpophalangeal (MCP) joints as well as the PIP joints. Rheumatoid arthritis also causes rheumatoid nodules to develop in the finger joints. These nodules are particularly associated with long-standing and severe disease. The incidence of rheumatoid nodules appears to be decreasing as more aggressive therapies are used. The use of methotrexate seems to increase the frequency of rheumatoid nodule formation. Rheumatoid nodules may form in the absence of significant joint swelling.
Swelling of the tendon sheaths in the palm of the hand may occur with different types of arthritis. This occurs because the tendon sheaths are lined with synovial tissue which may become inflamed. When this happens, the tendon sheath may swell and become bumpy. Sometimes the fingers begin to trigger or catch. This is referred to as a trigger finger.
Ganglion cysts may affect the wrist and present as bumps. These are usually painless swellings that have a soft squishy feel to them. The old treatment used to be smashing them with the family Bible. Fortunately, this method of getting religion is rarely used anymore. The ganglion may be aspirated and injected with steroid if painful. Sometimes surgery is required if very symptomatic.
Soft tissue swelling as a result of blisters and calluses are usually not difficult to diagnose.
Plant thorn synovitis is a relatively common problem that may occur in people who grow rose bushes. Here, a thorn from a rose bush may break off in the joint and cause a localized inflammation of the finger joint. This condition often requires surgery for both diagnosis as well as treatment. Infections of the finger joints are serious causes of finger bumps and must be treated aggressively. Activities such as fist fights or animal bites may be precipitating factors.
A rare disease called histiocytosis may also cause lumps to appear in the distal row of finger joints. Diagnosis is made by biopsy. Treatment is usually symptomatic although in its severe forms histiocytosis may be treated with chemotherapeutic agents.
In the same fashion, patients with hyperlipidemia (elevated cholesterol) may also develop soft tissue bumps on the fingers.
Painful bumps on the pads of the fingers may develop as a result of bacterial endocarditis. This disease is an infection of the heart valves. The bumps are termed “Osler nodes.”
Patients with the CREST form of scleroderma will develop calcium deposits on the fingers. These deposits will often ulcerate and drain chalky material. Occasionally they may become infected. Treatment is symptomatic.
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