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SEEING THINGS IN THE FLESH AGAIN – THE CASE OF THE CARPENTER’S THUMB

N. Kelly¹, D. P. Natin¹, S. Potter²

¹Department of Occupational Medicine, Mater Misercordiae University Hospital, Dublin, Ireland

²Department of Plastic Surgery, Mater Misercordiae University Hospital, Dublin, Ireland

Case Presentation:

A 66 year old carpenter presented with a lump at the base of his right thumb (right handed).  He had removed a splinter (raw white deal/spruce) at that site a week before.  The lump grew rapidly, looked alarming and was prone to bleeding. He bandaged the lesion, adjusted tool use and delegated tasks to take it into account. He used vibrating tools and commuted over an hour daily on a 1000cc sports motor-cycle.

Investigations & Treatment:

Clinical examination revealed a firm, friable, pedunculated lesion ~2 cm x 1cm x 1 cm high.  Range of motion, power and digit function were ok, with no sensory deficits. Grip, lift, push, pull, writing and typing were impaired.

A pyogenic granuloma was suspected, the differential ranging from a foreign body granulomatous reaction to malignancy. A shave excision was undertaken and the wound closed with steri-strips.  Histology confirmed a pyogenic granuloma, 2.2 cm x 1.6 cm x 1.2cm by that point.

Outcome & Follow up:

The wound healed fully in 10 days, with no recurrence.  The carpenter was advised to wear the work gloves provided.

Discussion:

Pyogenic granulomas can occur at any age, predominating in children and young adults; trauma is present in the minority.  The carpenter had many splinters over the years but never had a reaction like this.  No other aetiological factors were identified on current or past medical history.  We wonder whether the exposure to hand vibration from commuting on the 1000cc sports motor-cycle may have contributed in this case.

References:

1. British Association of Dermtologists (2022). Pyogenic Granulomas. British Association of Dermatologits. [Online]. Available from: https://www.bad.org.uk/pils/pyogenic-granulomas/ [Accessed 16 February 2024].
2. Lawley, L. “Pyogenic granuloma (lobular capillary hemagnioma.” UpToDate, January 2024.
3. Faculty of Occupational Medicine (2020) COVID-19: Guidance for Occupational Medicine Trainees, Faculty of Occupational Medicine website, accessed 09 February 2024, https://www.fom.ac.uk/covid-19/covid-19-letter-to-trainees
4. Jayne Moore, The effects of the COVID pandemic on the process of training in Occupational Medicine, Occupational Medicine, Volume 70, Issue 5, July 2020, Pages 347–348, https://doi.org/10.1093/occmed/kqaa071 .