Medical Imaging Analysis Report

I. Imaging Findings

Based on the ultrasound images, there is a small nodule in the distal pulp area or beneath the nail of the right thumb. It presents as a hypoechoic lesion (or hypoechoic area) with a significant blood flow signal on color Doppler. The lesion’s boundary is relatively clear, and the local structure appears intact. There is no obvious sign of bone destruction.

II. Differential Diagnosis

1. Hemangioma or Vascular-Related Lesions: Because of the abundant blood flow within the lesion, vascular-origin lesions such as a cavernous hemangioma should be considered.
2. Neurilemmoma (Schwannoma), Neurofibroma: A fingertip lesion with neurogenic pain may suggest a benign lesion originating from the nerve sheath, however, it usually exhibits less blood supply compared to this case.
3. Giant Cell Tumor (Tenosynovial Giant Cell Tumor): Commonly seen in fingers, presenting as a localized nodule, but typically displaying less color Doppler flow than observed in this case.
4. Highly Suggestive of a Vascular-Active Tumor: Based on the painful nature of the tumor (especially tenderness and pain exacerbated by cold exposure) and the abundant blood supply on ultrasound, a painful vascular lesion in the subungual or fingertip area must be highly considered.

III. Final Diagnosis

Taking into account the patient’s clinical symptoms (fingertip pain, cold sensitivity), highly localized tenderness, and the ultrasound findings of rich blood supply, the most likely diagnosis is a glomus tumor of the fingertip (thumb). This benign tumor originates from specialized arteriovenous anastomoses (glomus bodies) in the fingertip, most commonly found under the nail or in the pulp, with characteristic clinical manifestations including stabbing pain, localized sensitivity, and cold-induced pain.

If uncertainty remains or if further clarification is required, an MRI examination may be considered to better delineate the lesion; if necessary, a surgical excision followed by pathological examination can confirm the diagnosis.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategies:
   • Because glomus tumors are usually solitary and cause significant pain, surgical excision is typically the first-line treatment. It effectively relieves pain and reduces the risk of recurrence.
   • A thorough preoperative evaluation of the imaging characteristics (lesion size, location, and blood supply) helps with precise surgical targeting.
   • If there is no severe pain or if symptoms are mild and the patient refuses surgery, regular follow-up may be an option. However, due to the typically pronounced pain, surgery is generally preferred.
2. Postoperative Rehabilitation and Exercise Prescription:
   • Early postoperative care focuses on protecting the surgical site for proper healing. It is advised to keep the fingertip clean and dry, and to avoid high-intensity use of the affected limb in the short term.
   • Within 1-2 weeks post-surgery, simple range of motion exercises (like gentle flexion and extension) may be initiated to prevent joint stiffness.
   • From 2-4 weeks, gradually increase finger grasping and pinching exercises, starting with light intensity 2-3 times per day, 5-10 minutes per session.
   • After 4 weeks, based on medical advice, slowly resume daily finger function and light resistance exercises (e.g., elastic band or grip strength exercises). Follow a progressive intensity principle (FITT-VP):
     • Frequency (F): 3-4 times per week;
     • Intensity (I): start with low resistance, increasing gradually;
     • Time (T): 10-15 minutes per session, gradually extending to 20;
     • Type (T): isotonic or isometric training targeting hand and forearm muscles;
     • Volume (V) & Progression (P): progressively increase total volume or difficulty as tolerance and pain improve.
3. Precautions:
   • If redness, swelling, increased pain, or reduced range of motion appear in the surgical area, a follow-up examination is recommended.
   • If the patient has other systemic conditions (e.g., diabetes, osteoporosis), recovery exercises should be done under specialized medical guidance to avoid unnecessary complications.

Disclaimer

This report is based solely on the provided imaging and clinical history, serving as a reference analysis. It is not a substitute for in-person diagnosis or professional medical advice. Patients should follow the treatment and rehabilitation recommendations of their specialized physicians.