Chronic Finger and Hand Pain in a Middle-Aged Woman
A 48-year-old woman complains of finger and knuckle pain in her right hand of 1 year's duration. She is right-handed. The pain is located over the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the index and middle fingers. The pain has recently become more intense and now makes it difficult to sleep and to grasp objects.
When she awakens in the morning, the index and middle fingers of her right hand are stiff and seem to be stuck in flexion at the PIP joint; she has to force them into extension. Once the fingers have been extended, however, there is no extension deficit. The stiffness, as well as the pain, hinders her ability to pick up a cup or to twist the cap off a bottle.
The knuckles of her right index and middle fingers are somewhat swollen. She denies numbness, tingling, and loss of sensation.
For the past 5 years, the patient has had type 2 diabetes that is not well controlled. She has noticed some "arthritis" in her left shoulder and right knee in the past, and adhesive capsulitis of the left shoulder was diagnosed 3 years earlier.
WHICH DIAGNOSIS IS MOST LIKELY?
A. Rheumatoid arthritis.
B. Dupuytren contracture.
C. Flexor tenosynovitis.
E. Carpal tunnel syndrome.
Whats Your Diagnosis?
1. Fauno P, Anderson HJ, Simonsen O. A long-term follow-up of the effect of repeated corticosteroid injections for stenosing tenovaginitis. J Hand Surg (Br). 1989;14:242-243.
FOR MORE INFORMATION:
- Hong E. Hand injuries in sports medicine. Prim Care. 2005;32:91-103.m Kale S. Trigger finger. Available at: www.emedicine.com/orthoped/topic570.htm. Accessed July 1, 2006.
- Mies RA, Francis ML. Diagnostic approach to polyarticular joint pain. Am Fam Physician. 2003;68:1151-1160.
- Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the wrist and hand region. Am Fam Physician. 2003;67:745-750.