Finger joint lump
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). This inflammation causes the joints to swell and hurt. The lumps that form are called Heberden’s nodes (DIP) and Bouchard’s nodes (PIP). Involvement of the base of the thumb may also cause a lumpiness or square off appearance. Gout also causes lumps 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 lumps. 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.
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 lumpy. Sometimes the fingers begin to trigger or catch. Ganglion cysts may affect the wrist. 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 cause of finger lumps 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. Painful lumps 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.” Dupuytren's contracture is a condition presenting as a "lump" or nodule in the palm near the flexion crease, most often at the base of the ring or small finger. This lump or nodule may also occur at the base of the thumb. Although the appearance of these nodules in the finger usually occur within the course of the disease, these nodules may be evident as the very first symptom. Another sign or symptom of Dupuytren's contracture is known as a dermal pit. The pit may be single or multiple, and appears as a small, local, deep indentation of the skin. This may be the first finding, it may come later, or it may never appear at all. The pit usually is located in the palm but also can be in the fingers. This indentation occurs due to a contraction of the connective tissue fibers from the palmar fascia to the skin. The skin is drawn down to form the pit.
The cord is a longitudinal fibrous band, which extends from the palm into the finger(s). It most often appears with a nodule, but it can be separate. It may appear as a single or multiple band. The cord or band creates a flexion contracture at the finger joints as it crosses the joints; or, in other words, the cord pulls the finger into a bent position. Once the contracture has started, the process may proceed (either slowly or rapidly) to a severe deformity of one or several fingers. Even if only one or two fingers are involved, this condition may become so advanced that daily activities are embarrassingly awkward. The ring and small fingers are the most frequently affected, the long finger is next, followed by the thumb. The index finger is seldom involved. Your Indiana Hand Center physician will further explain these causes to you during your appointment.
A few details about Depuytrens… • The process is not malignant. The aim of surgery in Dupuytren's contracture is to regain maximum hand function, rather than totally cure the disease. If there is no present deformity and no loss of hand function, surgery may be delayed until significant deformity has developed. Therefore, the small palmar nodule rarely requires surgery unless it is sufficiently tender as to interfere with activities. A progressive contracture is regarded as an indicator for surgery and is best demonstrated when the hand can no longer be placed flat on a table top. At this stage, there is sufficient deformity to demonstrate that hand function will eventually be threatened. A flexion deformity at the first finger joint (MCP) is usually correctable with surgery. A deformity at the second finger joint (PIP) is not always fully correctable, and sometimes can recur.
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