Post-Partum Knuckle Pain with Localized Swelling
Case at a Glance
A 36-year-old postpartum woman presents with a one-week history of localized pain and swelling over the middle finger metacarpophalangeal joint of her right hand.
Patient's Story
The patient reports experiencing pain in her right middle finger knuckle for approximately one week. She describes the pain as localized to the lateral aspect of the metacarpophalangeal joint, with associated tenderness to palpation. She has noticed a small, palpable bump in the same area. The patient is currently 5.5 months postpartum and has no significant past medical history of joint problems or trauma to the hand.
Initial Assessment
Physical examination reveals localized swelling and tenderness over the lateral aspect of the right middle finger metacarpophalangeal joint. A small, firm nodule is palpable in the affected area. The patient demonstrates normal range of motion in the finger, though with some discomfort during flexion. No signs of infection, erythema, or systemic symptoms are present.
The Diagnostic Journey
Given the patient's postpartum status and the clinical presentation, differential diagnoses include De Quervain's tenosynovitis, trigger finger, ganglion cyst, or postpartum-related joint changes due to hormonal fluctuations. The localized nature of the swelling and the presence of a palpable nodule suggest a possible ganglion cyst or localized inflammatory process.
Final Diagnosis
Pending orthopedic evaluation scheduled for early August. Clinical presentation most consistent with a small ganglion cyst or localized tenosynovitis of the metacarpophalangeal joint.
Treatment Plan
Conservative management with rest, ice application, and over-the-counter anti-inflammatory medication as tolerated while breastfeeding. Patient advised to avoid repetitive gripping motions and to monitor for any worsening of symptoms. Orthopedic consultation scheduled for definitive diagnosis and treatment planning.
Outcome and Follow-up
Patient scheduled for orthopedic evaluation in early August for definitive diagnosis and treatment recommendations. Advised to seek earlier medical attention if symptoms worsen, signs of infection develop, or if pain becomes severe enough to interfere with daily activities or infant care.