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25 year old female presenting with c/o of one month duration swelling over the
right 3 rd toe, it was initially painful.

non progressive in size ,no pain at present. no trauma.no fever.

o/e, firm swelling present plantar aspect of the 3rd toe MPX region, not warm and non tender, at present asymptomatic.
Xray 3rd toed both views normal.


?soft tissue lesion arising from tendon, nerve,

how do i proceed.

suresh

 

Hi Surish:

If the xrays are normal and assuming her history is accurate, I would suggest DD: Psoriatic arthritis, Acute tenosynovitis, ganglion, soft tissue mass, acute arthritic flareup other than psoriatic.

The picture you sent, although psoriatic classically effect the DIPJ, looks like several psoriatic toes that I've seen. I've had 3 young female patients in recent memory with soft tissue swelling very similar to your photo, non with any Hx of psorisis, all coming back from RA consult with a Dx of psoriatic arthritis.

Let us know
Steve

 

now i remeber that she gave history of using tight show for a period of time and discontinued because of pain, is that related tho that?

 

Perhaps aspiration would not be a bad idea even if it yields nothing.