Zinger Gershon, Applbaum Yaakov, Peyser Amos
Department of Orthopedic Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel.
Department of Radiology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel.
J Clin Med. 2025 Aug 21;14(16):5916. doi: 10.3390/jcm14165916.
This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger's proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our case series and providing a structured framework for clinical reasoning, including imaging, biopsy, and laboratory assessment. Non-traumatic causes of finger swelling may include rheumatological disease, atypical infection, tumor, or metabolic conditions. Routine evaluation includes history, examination, and radiographs. Additional evaluation may include ultrasound, inflammatory screening labs, magnetic resonance imaging (MRI) and computed tomography (CT). Despite these efforts, a diagnosis may still be elusive. The objective of this study is to provide a useful clinical differential diagnosis and provide lessons learned from this unique group of patients. Starting in February 2017, patients with isolated unilateral PIP swelling were followed. Clinical information was collected, including history, examination, and laboratory and imaging studies. Patients were followed until a specific diagnosis was obtained. In addition to the series of patients, a focused literature review is given to present additional unusual causes of atraumatic isolated PIP swelling that were not found in this series. There were five cases that met the criteria. This includes two cases ultimately diagnosed with psoriatic arthritis, and one case each of osteoid osteoma, gout and palindromic rheumatoid arthritis. The single most effective test that helped to reach the final diagnosis in this series was the CT scan.
本病例系列及重点文献综述探讨了因单个手指近端指间关节（PIP）出现非创伤性、孤立性肿胀和僵硬症状的患者的诊断挑战及管理策略。重点在于综合从我们的病例系列中汲取的经验教训，并为临床推理提供一个结构化框架，包括影像学检查、活检和实验室评估。手指肿胀的非创伤性原因可能包括风湿性疾病、非典型感染、肿瘤或代谢性疾病。常规评估包括病史、体格检查和X线片。进一步评估可能包括超声检查、炎症筛查实验室检查、磁共振成像（MRI）和计算机断层扫描（CT）。尽管采取了这些措施，诊断仍可能难以明确。本研究的目的是提供一个有用的临床鉴别诊断，并分享从这一独特患者群体中获得的经验教训。从2017年2月开始，对孤立性单侧PIP肿胀的患者进行随访。收集临床信息，包括病史、体格检查以及实验室和影像学检查结果。对患者进行随访，直至获得明确诊断。除了该系列患者外，还进行了重点文献综述，以介绍本系列中未发现的非创伤性孤立性PIP肿胀的其他罕见原因。有5例患者符合标准。其中包括最终诊断为银屑病关节炎的2例，骨样骨瘤、痛风和回纹型风湿性关节炎各1例。在本系列中，有助于最终诊断的最有效单项检查是CT扫描。
