I cannot tell if the cyst is in the bone or not. It just looks like there is something more than the joint. It appears to be a build up of something and has a pointed look. It is right over the joint on the top of my thumb joint.
The thumb joint at my palm is not sore or swollen at all and I have full motion.
My thumb does not feel like it gets stuck because I cannot bend that middle joint.
My thumb is swollen about twice its size.
To the present, I am not getting any useable help from the doctors I am consulting. No one seems to know what it is.
Are you able to help?
Dear Help is exactly what I have been trying to do. It is possible that he structure you are reporting on the x ray is a sesamoid bone which has caused the joint to become stiff and swollen. Other possibility is that you had sustained a volar plate or collateral ligament injury of the joint leading to its present state. Other causes like RA, gout, pseudogout etc... seem implausible because these usually do not present with involvement of thumb joints and usually involve other and more than one joint. It would be advisable to see a hand surgeon rather than a rheumatologist as this does not seem like a rheumatologic disorder.
Okay, now I am confused. The first doctor that answered me, said to definitely go to the Rhuematologist and now you say go to a hand surgeon. You also said that gout doesn't usually affect the thumb joints. Yet I am reading on web sites where thumbs are affected by gout. The main difference is that my problem is with the middle thumb joint instead of the palm joint.
Now my problem is that with these differing viewpoints by you and Dr. Wajid and the Drs. on the web sites, how much faith could I put in one doctor's opinion if I should go see one in person? I was hoping to get a more consistent opinion so I would know whether to go to a hand specialist or a rhuematologist. I don't really think I know more now than before I wrote my original question.
I cannot say I am satisfied since I have gotten opposite opinions from the doctors on this web site. How do I know when I have received information that will really be helpful?
Yes gout can affect the thumb joint but it is much more common in great toe (called podagra) and yes it will affect the MCP joint more commonly then IP joint. Gout will usually present with multiple episodes if not treated and one episode will not lead to a stiff joint. All these features go against this being gout. I am an orthopedic surgeon and deal with joint issues on a day to day basis and feel that some of that experience should stand me in good stead in difficult clinical situations. As in real word opinions can differ between physicians in particular and people in general.You have to decide which opinion seems more plausible.
Thanks for your explanation. Please be assurred that I wasn't trying to discredit you or your opinion.
So now putting gout, pseudogout and RA out of the picture, what would you as an orthopedic surgeon be looking for if I came to you as a patient? What might be the possibilities that you would look for knowing the symptoms I have described?
I have looked up and read about the volar plate, collateral ligiment injuries and the sesamoid bones of the joints. Of these three, it seems more possible that it might be a sesamoid bone. I know you cannot make a diagnosis by just talking, so I won't ask for anymore information. I appreciate your help, Dr. Sawhney, very much. I will make an appointment with a local orthopedic doctor for further examination.