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Finger lesions
Finger lesions form part of the wider subject of hand deformity. (See hand deformity chapter.) Lesions of the fingers are those which can result in hand function impairment. Painful finger lesions are dealt with on p. 147.
Causes
Congenital
See chapter on hand deformity
Acquired
Traumatic/degenerative
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Dupuytren’s contracture
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Trigger finger
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Implantation dermoid
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Pyogenic granuloma
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Mallet finger
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Swan-neck deformity
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Boutonnière deformity ( Fig. 21 )
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Heberden’s/Bouchard’s nodes
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Mucous cyst
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Calluses over knuckles (bulimia)
Metabolic
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Gouty tophi
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Ectopic calcification
Connective tissue disease
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Calcinosis in CREST (Calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, and telangiectasia) syndrome
Neoplastic
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Subungual melanoma
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Chondroma
History
Congenital
These lesions will be recognisable at birth. They may be associated with other congenital abnormalities.
Acquired
Traumatic/degenerative
Dupuytren’s contracture
In the early phases, the patient may merely complain of a nodule in the palm near the base of the ring finger. Eventually, the patient complains of being unable to extend fully the metacarpophalangeal (MCP) joint at the ring, and later, the little finger. It affects the patient’s grip. The patient complains of difficulty dressing – either poking themselves in the eye while brushing hair or catch the finger on a trouser pocket. There may be a family history. Check also for a history of epilepsy, alcoholic liver disease or diabetes.
Implantation dermoid
Cysts occur where skin is forcibly implanted into the subcutaneous tissue as a result of injury. There is likely to be a history of injury, often minor, e.g. pinprick. Implantation dermoid used to be common in women who sewed – hence the use of protective thimbles. The patient complains of small painful swellings on the finger tips.
Pyogenic granuloma
Pyogenic granuloma is a common inflammatory lesion of the skin, which arises in response to minor penetrating foreign bodies such as splinters or thorns. Pyogenic granulomas are solitary, reddish-blue, fleshy nodules. The surface may be ulcerated, in which case, the lesion may be clinically indistinguishable from amelanotic malignant melanoma.
Trigger finger
The patient complains that the finger ‘jumps’ or ‘clicks’ as it moves. It may get stuck in the flexed position. There is usually no history of injury.
Mallet finger
This results from injury to the extensor tendon of the terminal phalanx. There is usually a history of injury. It occurs if the tip of the finger is forcibly flexed during active extension (stubbed).
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