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Have knuckle swelling. Index finger swollen and painful. No stiffness in joints. Suggestions?

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Practicing since : 1999
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I have a question about knuckle swelling. 40 yo male, excellent physical condition. No history of inflammatory issues. No immediate family history, maternal grandmother however did have RA. 9 days ago, 1 day after a workout involving rowing heavy weight from the floor, the MCP on my right index finger became mildly swollen and lightly painful when flexed beyond routine flexion and extension. Swelling seems greatest between MCP joints. I do not feel swelling of the joint itself nor to I feel any "boggy" fluid directly around the joint when palpating. Pain was about a 4 out of 10 when flexed and is now down to a 1. Joint was only mildly tender when palpated and most sensitive on the palmar side distal to joint on middle phalanx. Tenderness upon palpation has almost subsided. Prior to swelling, joint could be "popped" relatively easily but is now more difficult. There is no stiffness (morning or otherwise) in the joint and range of motion is 90% of the same joint on my other hand. I do not feel crepitus upon manual movement of the joint but I do feel a "popping" when I rotate the index finger toward the thumb in a circular motion - this popping feels like a tendon or ligament dragging over something.

All other joints of the body have been self examined with no issue save one. The ring finger PIP on the same hand is very slightly tender to palpation on the sides and very slightly painful again when extended to limits of motion. This again could have been as a result of a tight grip on a dumbbell or not.

At this point I feel this is an orthopedic injury, possibly tendonitis? However, I'd like to rule out IA / RA but do not want to go to the Dr. as I'm in the process of seeking insurance and I do not wish to risk this becoming part of my medical record.

I have attached images that will hopefully illustrate. What is your view? Without having examined me, would you suggest orthopedic or IA is the most likely culprit?

Case says I self selected lupus but I actually selected Rheumatology... Could you kindly refer there please?

Posted Tue, 23 Jul 2013 in Lupus
Answered by Dr. Divya Agarwal 59 minutes later
I went through your history and photographs.
At present, you don’t have any signs of inflammation except the pain and swelling.
And it could very well be related to overuse.
However, one of the best ways to confirm this is to run a few tests.
These are rheumatoid factor, anti ccp and inflammatory markers esr and crp.
If these are positive then it could give some indication of an inflammatory arthritis.
Other is having you taken any NSAID for the same.
If you get a good response to the drug it could be an inflammatory condition.
Above answer was peer-reviewed by
Follow-up: Have knuckle swelling. Index finger swollen and painful. No stiffness in joints. Suggestions? 52 minutes later
Thanks for your response. I will look into the possibility of running this blood work anonymously.

To your point o NSAIDs, I have been taking Naproxen (Alieve) for three days now with minimal change in swelling... Does that indicate an injury vs inflammatory process?

Many thanks
Answered by Dr. Divya Agarwal 10 hours later

There is no hard and fast rule, however NSAIDs like naproxen give very good relief in cases of inflammatory arthritis. So that again points to a non inflammatory condition like injury or overuse.

Hope this answers your query.

Above answer was peer-reviewed by
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