Finger joint lump

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.

Click here: Second Opinion Arthritis Treatment Kit

Many rheumatic conditions and diseases may cause finger lumps.

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 squared 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. These are called "tophi". 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. Inflammation may lead to lumpiness. 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.

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. The ganglion may be aspirated using ultrasound guidance and injected with steroid if painful. Sometimes surgery is required if very symptomatic.

Soft tissue swelling due to blisters and calluses are not difficult to diagnose.

Plant thorn synovitis is a problem that may occur in people who grow rose bushes. 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 causes 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, 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 occurs later in 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 appears as a small, deep indentation in the skin.

The pit usually is located in the palm. This indentation occurs due to a contraction of the connective tissue fibers.

The connective tissue fibers form a thick cord extending from the palm into the finger or fingers. The cord pulls the finger(s) into a bent position. The problem may proceed to severe deformity of one or several fingers.

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.

A progressive contracture was regarded as an indicator for surgery in the past.

Most people nowadays don't have to undergo open surgery. They can either have the Depuytren's release with a small needle (needle aponeurotomy) or get an injection of Xiaflex - an enzyme that "dissolves " the connective tissue causing the contracture.

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