Category Archives: Finger joint bumps

Multiple types of arthritis can cause finger joint bumps.

Lump on finger joint

One of the most searched terms on the Internet is “lump on finger joint.”  This is obviously a problem that concerns many people.  Well… there’s good news and bad news about this.hand

Most lumps on finger joints are benign.  In people pas the age of thirty, lumps appearing on the middle row and last row of finger joints are called Bouchard’s and Heberden’s nodes.  These are bony swellings  due to osteoarthritis.

Osteoarthritis is the most common form of arthritis. That’s the bad news.  The good news is that while these lumps can be disturbing because of their presence as well as the fact they can be sore, these lumps usually do not cause crippling deformity.  Occasionally, particularly in the Heberden’s nodes, a gelatinous material can be expressed from the swollen joint.

Rheumatoid arthritis can also cause lumpy finger joints but here the swelling is much more evident in the joint rather than on the joint and is accompanied by significant generalized morning stiffness all over as well as fatigue. Longstanding rheumatoid arthritis causes rheumatoid nodules on the fingers.  These are collections of inflammatory cells and fibrous tissue.

Gout is another cause of lumps on the finger joints.  These lumps are called “tophi” and consist of collections of monosodium urate crystals, inflammatory cells, and fibrous tissue.

People with elevated blood lipids can develop lumps on the finger joints due to the accumulation of cholesterol.

Plant thorn synovitis is a condition caused by the puncture of a rose thron into the joint.  This leads to infection in the joint and is an unusual but dangerous cause of lumps on the finger joint.  This is considered a surgical emergency.

Unusual diseases like histiocytosis can also cause lumps.

Rarely, malignancy can do this.

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Osteoarthritis… what is it?

Osteoarthritis (OA) is the most common joint disease.  It affects approximately 28 million Americans and tends to become more common with increasing age. It is a universal condition in people past the age of 70 although not everyone is symptomatic. It is a disease that affects articular cartilage, the gristle that caps the ends of long bones.cartilage_0

There are risk factors for the disease.  Increasing age, as mentioned earlier is one.  In addition, female gender, genetic predisposition, obesity, and trauma are the other important items.

The most frequent targets for OA to strike are the neck, low back, fingers, base of the thumb, knees, and hips.

Less commonly the ankles, shoulders, and elbows are involved.  In these areas, antecedent trauma appears to be the primary cause.

knee-arthritisOA is what is called, a focal disease.  What that means is that it doesn’t affect the whole joint.  It preferentially attacks certain areas within the joint.  An example would be the knee where the medial (inside) part of the joint cartilage-defectis affected far more often than the lateral (outside) part.

In the hip, the top part of the joint tends to become involved while the rest of the joint is relatively spared.  The same is true for other joints affected by OA.

Symptoms of the condition consist of pain that is aggravated by use and relieved by rest.  Also, there is short term stiffness with inactivity. This is called “gelling.” Night time pain is also a common feature. Another common lament is crunching of the joint with movement.  This is called “crepitus.”

On exam the rheumatologist will often spot swelling due to the formation of bone spurs, called “osteophytes.”  There can be tenderness of the joint, pain with movement, swelling due to fluid accumulation, and muscle wasting around the joint.

In advanced cases, there is clear deformity and sometimes evidence of instability.

Laboratory tests are usually normal.  Imaging studies can help with the diagnosis.  Magnetic resonance imaging will pick up early changes.  X-ray findings also can help with the diagnosis.  The problem is that if x-ray changes are evident, then the disease has progressed substantially.  The primary changes seen on x-ray are narrowing of the joint, bone spurs, and changes in the bone underlying the cartilage.

Joint fluid, if present, should be aspirated.  The joint fluid is typically viscous, translucent, and has fewer than 200 white blood cells per cubic milliliter.  Occasionally the white blood cell count will be higher if a patient has a particularly inflammatory form of osteoarthritis. This is the conundrum of OA.  While the old thinking was that the condition was primarily a mechanical disease, it has become quite clear that OA has a significant inflammatory component as well.

What has been a perplexing question is, “What causes pain in OA of the knee?”  Cartilage has no blood vessels nor does it have nerves.  So the topic of pain mechanism in osteoarthritis has been the subject of intense interest.knee

There are a number of potential suspects.  For example, when osteophytes (bone spurs) develop, they can lift the periosteum (the thin top layer of the bone).  Periosteum is rich in nerve fibers and certainly can be a source of pain.

It has been noted that blood vessels in bone underlying osteoarthritic cartilage can become engorged and this may elevate the pressure inside the bone which could also, theoretically, cause pain.

The lining of the joint (synovium) becomes inflamed in OA.  Pain fibers are located within the joint capsule and these inflammatory processes could irritate them.

The joint capsule can contract or shrink leading to irritation of nerve fibers located within the capsule.

By the same token, if fluid builds up within the joint, it can stretch the joint capsule again leading to stimulation of pain fibers.

As mentioned earlier, there are two small pieces of fibrocartilage located within the knee.  These pieces of fibrocartilage (menisci) have a rich blood and nerve supply where they attach to the joint capsule.  OA often leads to tearing of these menisci. This can cause damage to the capsular attachment leading to pain.

Spasm of the muscles surrounding the knee can also lead to pain.

Finally, there is increasing interest in the role of the central nervous system- the brain- in causing the pain of knee OA.  Recent studies showing the effectiveness of drugs like Cymbalta, a drug originally prescribed for depression, but also showing beneficial effects on pain relief in patients with OA, led to FDA approval for this indication in 2011.

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Finger Joint Lump, Finger Joint Bump

Many people have lumps and bumps on their fingers as a result of arthritis.  So what are they?  And why do they occur?

Probably the most common cause of these lumps is osteoarthritis (OA).  This is a disease of cartilage, the gristle at the ends of bones. With OA, the cartilage wears away and bone spurs, called osteophytes grow.  When they occur at the fingertip joint, they are called Heberden’s nodes.  When they grow at the middle finger joint, they are referred to as Bouchard’s nodes.

Treatment includes topical anti-inflammatory medicines, splints, and injections.  Injections of steroid may provide short term relief but often the patient may require PRP (platelet-rich plasma) injections for long term help.

Another type of arthritis, rheumatoid disease, can cause lumps to appear on the fingers at points where there is pressure.  These knots are not inside the joint but are caused by the accumulation of inflammatory cells. These nodules usually improve as the disease becomes better controlled. Sometimes steroid injection helps.  Surgery may be required.

The last disease that can cause lumps and bumps on the fingers is gout.  These lumps- referred to as “tophi”-  are caused by the deposits of uric acid crystals and inflammatory cells. These tophi almost always get smaller with effective anti-gout therapy.

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