Obscure Painful Conditions

There are two conditions that can give rise to pain especially to the thumb and the fingertips. These conditions can be easily missed.

Sesamoiditis of the thumb

This is a condition due to the inflammation of the sesamoid bone at the base of the thumb. Pain will present with pain in only certain position of the thumb and this makes diagnosis difficult. Most of the symptoms happen when patient tries to pinch, pull up his or her pants or when thumbing. Clinical examination is usually normal and pain is only elicited when the sesamoid bone is rubbed against the metacarpal head. Radiological examination in oblique views may show erosion of the sesamoid.

Figure A: Sesamoid bone excised

Glomus tumour

This is a benign tumour. Can be found anywhere in the body but when it grows deep to the nailbed, it causes tremendous pain. Due to its very small size it can go undetected and the patient present with pain of unknown origin. Clinically it presents with pain, tenderness at the site of the growth and cold sensitivity. In my experience, very few patients have cold sensitivity. Diagnosis can be made with ultrasound but the radiologist must be aware of the site of the pain to accurately pinpoint the site. Surgical treatment is the treatment of choice and this completely relief the patient of the pain.

Patient presented with pain over his fingertip. Pain was especially worse when he hit his finger against a hard object. X-ray was normal. The glomus tumour was identified with an ultrasound and localized with a wire. This allows the surgeon to accurately localize the tumor at surgery and excise it.