Hello i am a medical assistant. I saw a patient today who was complaining about a small lump under the skin on the underside of his right forearm (aprox 0.5cm. There is no physical appearance to it or swelling you can only feel it when you palpate.
it is only painful/noticeable when pressure is applied when this is done it is hypersensitive. I only brushed my finger over the area and the patient gave a very reactive flinched (he is in the army and a big fella so this reaction took me by surprise!)He found it hard to describe the pain but said it is most like an intense burning sensation when your are scolded with an iron (not pin and needles)
He noticed it a few weeks ago but it was not as a result of and injury or illness. He is 46 years old in good physical and mental health and does like to lift weights. He has no PMH of neurological problems, back or neck.
I am at a loss as to what this could be please advise?
It sounds like it could be a neuroma. Causalgia is described as a burning pain, intensified by light touch. Usually deep pressure bothers the patient less than a light brushing of the lesion or even blowing air over it.
He could have developed a neuroma (ball of nerve endings, usually after cutting a peripheral nerve, but can develop denovo), in one of the small peripheral nerves supplying the skin.
If this is the case, usually an injection of a local anesthetic, such as Lidocaine, around the mass, should alleviate all of the symptoms. If this is the case, then the neuroma can be excised, preferably by a hand surgeon or plastic surgeon. The nerve ending then needs to be buried in muscle or bone, to prevent recurrence of the problem.
If the diagnostic injection a 1cc of Lidocaine does not work, then the mass needs to be evaluated by a hand surgeon or plastic surgeon, because, who knows what it could be. A phlebolith would not cause the type of symptoms described, neither would a foreign body granuloma. Such a small fat or muscle tumor does not cause that type of symptoms either. And it does not look like an infections. With the symptoms described, it has to be something with the nerves.