Finger Tip Is Black and Blue and Getting Hard
Diagnosis
Why Did the Woman's Finger Turn Numb and Blue?
''What do you think of this?'' the 54-year-old woman asked her friend, who happened to be a doctor. They were at a popular bakery in downtown New Haven, Conn., on a Saturday afternoon making cupcakes with a church group they belonged to. All of a sudden, the woman noticed that the middle finger on her right hand had gone completely numb. She looked down and saw that the palm side of her finger looked bruised at the base. ''It doesn't hurt, it's just numb,'' she said. ''I don't think I banged it on anything.''
The doctor, a pediatrician, peered at her hand. ''Hmm,'' he mumbled thoughtfully. The skin beyond the bruising looked normal and pink. It wasn't swollen, though it was a little cooler than the other fingers. He pressed on the nail, and the skin underneath turned white. He let go, and it turned pink again. He wasn't sure what it was, he told her, but if it swelled up or got worse, he thought she should probably go to the E.R.
In the evening, as she shopped for Christmas presents, she took pictures of her finger to track the progress of whatever was going on. When she got home, she looked at her numb digit. It was still cool to the touch, still numb. The bruising now extended nearly the entire length of her finger. She could move it, and even when she pushed on the part that looked bruised, it didn't hurt at all. But it certainly looked as if it should hurt.
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The next morning, Sunday, her finger looked about the same, as if she'd whacked it hard against something. It still didn't hurt. But the whole thing was odd. She was generally healthy. She didn't drink or smoke. She exercised daily. She took a pill for her underperforming thyroid, and an occasional antacid. She saw her doctor maybe once a year for a physical; she hadn't even had a cold in ages.
When she went to church that day, she took a seat next to a friend — another doctor. After the whispered pleasantries, she showed him her finger. Like the pediatrician, he poked it and squeezed the nail. Had it gotten any worse? he asked. Nope. If it does, you should go to the E.R., he told her. But even if it doesn't, you should call your doctor tomorrow.
First thing Monday morning she called her doctor's office. The annoying phone tree routed her to a recorded message that instructed her to leave her name and number and someone would call her back. She still hadn't heard anything by lunchtime, so she called again. When she was automatically triaged to the same message, she gave up and called a nearby urgent-care center. When she explained that her finger was numb and discolored, they told her to go to the emergency room. So she drove to the UConn Health hospital, in Farmington, Conn.
Finally, a Doctor
The waiting room in the E.R. was surprisingly crowded for the middle of the day on a Monday. After a couple of hours, an emergency-medicine doctor, Rochelle Van Meter, prepared to meet her patient. Van Meter clicked on the patient's name on the computer screen, and glanced over the information that had been collected so far. Chief concern: a numb finger. Vital signs: normal. Then she went to see the patient.
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The woman explained her numb, bruised-looking finger. Strangely, that morning the discoloration had almost completely disappeared. But it had been dramatic, she told the doctor. She had never seen anything like it, so she'd taken pictures. She pulled out her phone and showed the doctor the first picture, taken on Saturday, of a dark blue bruise at the base of her third finger on the palm side. The next photo showed that the entire finger had turned bluish. Even the back of her hand had started to look dusky, especially when compared with her surrounding fingers. The next day it was no different. But that morning, on Day 3, the finger started to clear up. Yet it was still numb.
Any other symptoms? the doctor asked. Fever? Pain? Trauma? No, none of those. Just a numb, blue finger.
No Pain, but Strange
The doctor examined the patient's finger closely. The timeline seemed too fast, if the woman's finger had somehow been bruised and was now healing. Normally it takes days for the displaced blood to clear up. But the pictures showed that the finger started off with a blotch of dark blue and turned a kind of dusky purple as it spread and moved up the digit. And yet now that finger was the same color as her others. There was no swelling or tenderness. The pulses at her wrists were normal. When Van Meter pressed on the fingertip, the skin blanched — as expected. And as soon as she released the pressure, the normal pink color was quickly restored, indicating that her circulatory system there was intact.
A Memory Offers a Clue
Certainly the bruised appearance in the photographs suggested a vascular cause — a blockage, or even a leak, in one of the tiny arteries that bring blood to the fingertip — but it didn't look like that. Upon exam, the circulation seemed fine. The numbness suggested a nerve issue. But when she tested the strength and sensation of the finger, it, too, seemed normal. And it looked as if whatever it was was getting better.
Thinking about this patient, Van Meter remembered another she had seen maybe a year and a half before with a similar story. That patient, a woman in her 40s or 50s, also had a black-and-blue finger — but hers was painful. That woman had gone to her doctor, who was worried and sent her to the emergency room where Van Meter saw her. Like this woman, she had had no other symptoms, and she couldn't recall any trauma. Van Meter had been worried, and after examining that woman she hurried back to the ''doc box,'' as they called the clot of computers where the doctors worked when they weren't in a patient's room. She quickly looked through some online resources to help her figure it out.
In PubMed she found many reports of a single blue digit. In most reports it was called paroxysmal finger hematoma, or Achenbach's syndrome, named after the German physician who first described it, in 1958. The cause isn't clear. It seems to be most common in middle-aged women and most frequently affects the index or middle finger. The bruised appearance comes on rapidly and usually resolves within a few days. It hasn't been shown to be a sign of some hidden disease process. It's frequently described as benign. No treatment is needed. In most medical reports it's characterized as a rare disorder, but based on the number of pictures and stories that Van Meter saw on websites, she wondered if it was actually rare, or just rarely reported to doctors.
Still, one thing bothered Van Meter, and kept her from mentioning this diagnosis to the patient. In most cases, Achenbach's is described as painful, like a bruise. The patient she'd seen at the hospital more than a year before complained of tenderness. This woman just had numbness. Could it really be the same thing? Could Achenbach's cause numbness instead of pain?
Naming the Ailment
Van Meter walked back to the ''doc box.'' She asked a colleague there if she had heard of Achenbach's syndrome. She had, but her case hadn't presented with numbness. She went back to the literature. Yes. Pain was more common, but numbness had also been reported.
The doctor went back to the patient and quickly pulled up the pictures she had found in her search. The patient was amazed. They looked just like her finger. No further testing was needed, Van Meter told her. And no treatment. Her finger would get better on its own. The patient was relieved. Just having a name for it was somehow enough. She was grateful to learn it didn't indicate something terrible. The patient could hardly wait to see her two doctor friends in church the next Sunday to tell them what she had.
Finger Tip Is Black and Blue and Getting Hard
Source: https://www.nytimes.com/2020/01/15/magazine/why-did-the-womans-finger-turn-numb-and-blue.html