Finger Pathology - Handyman

HISTORY: A 50-year-old male presents to the clinic for non-traumatic left arm pain, ongoing for 15 years, progressively worsening. He describes an aching, shocking pain in the shoulder that radiates down his arm, 8/10 in severity. Reports associated numbness and shocking pain in his left ring finger. Exacerbated by cold weather and water, and leaning on the elbow; alleviated by rest and running his finger in hot water. He has tried NSAIDs, acetaminophen and chiropractic treatment without relief. He works as a property manager and his symptoms interfere with his tasks. PHYSICAL EXAMINATION: Left Upper Extremity/Neck: Inspection: No swelling, discoloration, wounds, or muscular atrophy noted. Palpation: TTP over left supraspinatus. Exquisitely TTP over the volar aspect of the distal phalanx of the left ring finger. ROM: Decreased neck extension. Full ROM of left shoulder, wrist, and fingers/thumb. Neurovascular: 5/5 strength wrist extensors/flexors, finger extension/flexion/abduction/adduction. Median, radial and ulnar nerve intact without evidence of weakness. Sensation to light touch over C5, 6, 7 and T1 normal, but hyperalgesia over C8. Special Tests: Spurling’s negative, Neer’s/Hawkins positive. DIFFERENTIAL DIAGNOSIS:1. Cervical Radiculopathy, 2. Left Shoulder Impingement, 3.Cubital Tunnel Syndrome. TEST AND RESULTS: Cervical Spine XR: diffuse disc space narrowing, worse at C5-6, scattered degenerative changes. LEFT XR Shoulder and Hand: normal films. LEFT MRI Hand WO Contrast: Small focal mass in the ring finger nailbed. Likely glomus tumor. FINAL WORKING DIAGNOSIS: Glomus tumor of left ring finger, left shoulder impingement TREATMENT AND OUTCOMES: After a subacromial corticosteroid injection and therapy with OT, his shoulder and arm symptoms completely resolved. However the pain in ring finger was unremitting. XR of the left hand was unremarkable, but a follow up MRI revealed a glomus tumor. He was then referred to Orthopedic Surgery. Underwent a successful excision of the mass and at the post-op follow up appointment 2 weeks later his hyperalgesia and hypersensitivity to cold had resolved.