Painful finger joint

Patient

Q: 12 weeks ago I cut my finger deeply across the middle joint with a very sharp scythe blade but could not get to a doctor or hospital I cleaned the wound carefully which bled a lot and used stick on 'butterfly' plaster to close the wound and kept it covered for a week or more. It appeared to heal well though being on a joint it was vulnerable to knocks and kept opening so I re-plastered.
Eventually it healed completely and only a small scar c 1cm long is visible. However it is extremely tender still and if knocked it is very painful, it seems as if there is a lump on the joint that feels more boney than attached to the skin, it looks a bit odd as one side of the joint is much bigger than the other. If I catch it at a certain angle it really is very painful, at another angle there is little pain at all. It disfigures my hand and has made me cautious to use my right hand. I lead an active outdoor life and play several sports. I asked my Dr isf it was infected or what I should do but she recommended Ibuprofen gel which makes no difference at all.
What is it and what should I do to get rid of it?

Doctor

A:   Your complaint about a painful lump on hand after healed cut on your finger mostly suggests that it could have been infected or involved nerve plane which might be the reason for pain. Since your wound was not attended by a doctor or sutured, it would have healed by secondary intention leading to formation of irregular scar, with lot of fibrosis underneath the scar. This causes limitations of movement of the joint and since the joint was active one, healing was delayed due to frequent gaping of the wound. All this might have had initially created a hemotoma or blood collection, which would have got infected and resulted in a painful lesion. Other reason could be involvement of joint in the cut, causing healed joint capsule, which is also painful. If any tendons or nerves were cut at that time, the healed lesion will be a painful swelling usually. Firstly you must be evaluated by a plastic surgeon to check the healing of would and associated deformities around the joint due to delayed healing. Mostly you require removal or excision of the lump to regain normal movement and reduce pain. Consult a plastic surgeon for detailed management.

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