Swelling Of The Left Long Finger In A Middle School Recreational Athlete

HISTORY: A 14 year old female recreational athlete with no pertinent past medical history presents to the clinic for a mass on left long finger. The lesion has been present since around age 1-2 yrs old. Mom says that the lesion seems to grow as she has grown older but denies rapid expansion. The patient denies associated pain, itching, drainage though it does bother her when she grips objects or performs push ups and handstands. She denies any pain or swelling of other joints. PHYSICAL EXAMINATION: Approximately 0.5 by 0.5 cm area of swelling on the palmar aspect radial side of the left long finger approximating the distal interphalangeal joint. The lesion is soft, non-tender but immobile. There is no redness, warmth, or fluctuance. Range of motion in flexion and extension is full and painless. Sensation is intact. Capillary refill is less than 2 seconds. DIFFERENTIAL DIAGNOSIS: 1. Ganglion cyst 2. Dermoid cyst 3. Tenosynovial giant cell tumor TEST AND RESULTS: X-ray of left hand posterior-anterior, oblique and lateral: —- there is mild soft tissue swelling at the distal interphalangeal joint of the left long finger along with chronic remodeling of the cortex of the distal phalanx MRI of left hand and fingers with and without contrast:—- T1/T2 isointense lesion with minimal postcontrast enhancement along the distal interphalangeal joint of the middle finger with benign features highly suggestive of a tenosynovial giant cell tumor FINAL WORKING DIAGNOSIS: Tenosynovial giant cell tumor of left long finger TREATMENT AND OUTCOMES: She was instructed to continue physical activity and exercise as tolerated without restrictions.The patient was referred to orthopedic hand surgery for consideration of primary resection.