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Dr.Sawhney
Dr.Sawhney, Doctor
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My right thumb suddenly started swelling at the middle joint

Customer Question

My right thumb at the middle joint, suddenly started swelling and becoming very tender one day. It has been a long time now and I don't know if I injured it working in the yard or someother way. I am very active and often hurt something but don't pay much attention to it unless it developes into a prolonged painful injury. I went to see my doctor about it. He took x-rays, but he didn't know what it was so I kind of ignored it. But it has been a little over a year now and it is not getting any better. I cannot bend my thumb at the middle joint. It is still quite swollen. I had another x-ray done last week when I went ot check on the bunion on my foot. It appears to have a sharp point over the joint area. My foot doctor made an appointment for me to go see an rheumatologist but all the information I read about rheumatoid arthritis sounds like it comes on gradually. As I remember, my thumb swelled up kind of overnight. Any ideas of what it might be? Your help would be greatly appreciated.
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Wajid replied 4 years ago.

Welcome to JustAnswer.
Well to begin the discussion, from the given history your swollen joint is not rheumatoid arthritis unless proven otherwise... I say this because of the fact that rheumatoid arthritis is a disease of young females that affects multiple small joints of the hands in a symmetrical manner, joint deformities with a very strong history of morning stiffness that usually stays for more than an hour along with history of subcutaneous nodules and other systemic features... So rheumatoid arthritis is out as you have none of these features and only a single joint involvement...
Your doctor set an appointment with a rheumatologist considering other possibilities for your swollen thumb which might include the following:

  1. Thumb injury: given the history that you have had such injuries while working
  2. Gout: due to raised uric acid levels
  3. Pseudogout: due to calcium pyrophasphat dihydrate crystals
  4. Osteoarthirtis: although unlikely as it usually affects large weight bearing joints

Do discuss the above mentioned possibilities with your rheumatologist...
I hope this answers your question. Do let me know if you have any follow up questions.

Customer: replied 4 years ago.
My question now is should I go to the rheumatologist first or to a hand specialist? The expense of seeing both doctors can be an issue so I need to get as much help as possible from the doctors I go see. Do my symptoms fit into what a hand specialist would cover or a rheumatologist?
Expert:  Dr. Wajid replied 4 years ago.

A rheumatologist would be a better person to help you out with any sort of problem that you might have.

Customer: replied 4 years ago.
Thank you for your answer, but I still need to know what issues a hand specialist cover. If I had Gout in my thumb, which would I go to for help? A family M.D., a rheumatologist or a hand specialist?
Expert:  Dr.Sawhney replied 4 years ago.

I am an orthopedic surgeon and would be glad to help.
Can you tell me if the joint near the tip of thumb is involved or the joint at the base of thumb where it joins the palm is involved?

Customer: replied 4 years ago.
Thanks for answering. The thumb joint involved is on my right hand and is the middle joint..not the tip or the base. The joint is very swollen and in the xray, it looks like a cist or something that is kind of pointed right on top of the joint on the top side of my thumb. It is very painful if it gets hit or too much pressure is put on it. I cannot grip and hold anything heavy in my right hand that requires the strength of my thumb. Becuase of the swelling, I cannot bend that joint at all. It has been like this continuously for about a year now with no let up. I am a very healthy person, a vegetarian, get good exercise, do not drink or smoke. I am baffled and would like to know what it might be since I have already been to two doctors.(one was a family doctor a year ago and the other one was a foot specialist that I had look at it when I went last week.) I believe the big toe on my right foot may possibly have a similar problem but it is also mixedup with a big bunion problem so it is hard to separate the pain....Except that the toe is not swollen, just painful. Do you have any information to help me?
Expert:  Dr.Sawhney replied 4 years ago.

Is the cyst you mention present in the bone?
Is the tenderness present at the point in front area of the thumb where it just meets the palm?

Do you feel that the thumb gets stuck when you try to bend it and you are unable to bend it further from that point?

Customer: replied 4 years ago.

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.

Expert:  Dr.Sawhney replied 4 years ago.

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.

Customer: replied 4 years ago.

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, 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.

How do I know when I have received information that will really be helpful?

Expert:  Dr.Sawhney replied 4 years ago.

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.

Customer: replied 4 years ago.

Thanks for your explanation. Please be assured 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?

Expert:  Dr.Sawhney replied 4 years ago.

As I mentioned my suspicion in my previous post, it is possible that he structure you are reporting on the x ray is a sesamoid bone which has got trapped in the joint and 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.

Dr.Sawhney, Doctor
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Customer: replied 4 years ago.

I have looked up and read about the volar plate, collateral ligament 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 very much. I will make an appointment with a local orthopedic doctor for further examination.

Thanks again!

Expert:  Dr.Sawhney replied 4 years ago.

Thanks and best of luck to you.

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