Hand Disorder

A 42-year-old lady with a history of systemic lupus erythematosus presents to the clinic with a 5-day history of a painful purple lesion on her index finger. On examination, she has a tender red lesion on the index finger. What is the diagnosis?

A 62-year-old woman visits the orthopedic clinic with complaints of progressive stiffness and a non-tender lump over the joint of her index finger. She reports that the lump has been gradually developing over the past year and is accompanied by some difficulty when gripping objects. She mentions that the pain is minimal, and there is no history of recent trauma. On examination, she has a firm, non-tender swelling over the distal interphalangeal joint of her right index finger, with noticeable deviation at the tip of the finger. There is no redness, warmth, or signs of infection. Her past medical history is significant for osteoarthritis, and she takes occasional over-the-counter pain medication for joint discomfort. Radiographs confirm the presence of bony growth at the joint without signs of malignancy or infection. What is the most likely diagnosis?

A 43-year-old man presents to the emergency department after falling onto his left hand during a recreational activity. He complains of pain over the anatomical snuffbox, suggesting a potential scaphoid fracture. Despite this, x-rays performed both at the time of the injury and subsequently fail to show any signs of a scaphoid fracture. The patient has been immobilized in a futura splint for two weeks. After this period, he reports that the pain has completely subsided, and he is now asymptomatic. On examination, there is no tenderness or swelling in the wrist, and the patient has normal range of motion. Given the clinical picture, what is the most appropriate next step in management?

A 17-year-old boy is brought to the clinic by his mother, who is concerned about a lesion that has developed on the dorsal surface of his left hand. The lesion is soft and fluctuant, and it is most obvious when the patient makes a fist. The patient does not report significant pain or discomfort but has noticed that the swelling appears more prominent with hand movement. On examination, the swelling is easily palpated, and there are no signs of redness or warmth. What is the most likely diagnosis for this lesion?

A 62-year-old man presents to the clinic after his wife noticed an unusual shape of his fingers. On examination, the patient has a hard swelling adjacent to the distal interphalangeal joint of his right index finger. The swelling is non-tender and there is lateral deviation of the finger tip. There is no sensory disturbance noted. The patient denies pain or discomfort associated with the swelling. What is the most likely underlying pathological process?

A 52-year-old male, a retired mechanic, presents with discomfort in his left hand that has gradually worsened over the past six months. He reports difficulty fully extending his ring and little fingers, which have progressively become more flexed. He has noticed that these fingers feel stiff, particularly in the morning, and the flexion is most pronounced when he tries to stretch his fingers or hold objects. He also mentions that his hand has been “numb” at times but denies significant pain, redness, or swelling. On examination, the patient has a noticeable contracture in the ring and little fingers. Palpation of the medial half of the palm reveals firm, palpable nodules, and the skin over the fingers shows signs of contracture. The patient is unable to fully straighten his fingers, and when attempting to do so, there is noticeable tightness and resistance. The patient has no history of recent trauma or infection in the hand. He is otherwise healthy and has no known systemic diseases, such as diabetes or arthritis.
Given these findings, what is the most likely diagnosis?

A 42-year-old male skier presents to the clinic after falling and landing directly on his left hand while skiing. He reports immediate pain and tenderness localized to the anatomical snuffbox, which worsens with bimanual palpation. Despite this, he has no obvious deformity or swelling. An X-ray of the wrist with scaphoid views is performed, and no fracture is visible. However, the clinical suspicion for a scaphoid fracture remains high due to the mechanism of injury and the location of tenderness. The patient is not experiencing any significant neurological or vascular deficits in the hand. The treating physician must decide the next appropriate step in management.
What is the most appropriate course of action?

A 63-year-old woman presents with a three-month history of pins and needles in the fingers of her right hand, particularly at night. She notes that the symptoms tend to worsen while she is sleeping. On physical examination, there is a loss of sensation over the palmar aspect of the lateral three fingers (thumb, index, and middle fingers) and noticeable wasting of the thenar eminence. The patient has no other significant complaints or history of trauma. Based on her clinical symptoms and examination, a diagnosis is sought.
What is the underlying diagnosis?

A 13-year-old boy falls onto an outstretched hand and is brought to the emergency department. After a
thorough examination, a bony injury is ruled out clinically. A week later, the patient re-presents with persistent pain in his hand. The pain is localized, and there are no other significant findings on physical examination.
What is the most likely underlying injury?

A 25-year-old man is diagnosed with an undisplaced fracture of the proximal pole of the scaphoid following a fall. The fracture is confirmed via imaging, and the patient presents for management. Considering the location and type of fracture, what is the most appropriate course of action for this patient?

A 58-year-old male presents to the clinic with a 3-month history of pain and swelling in the first metacarpophalangeal joint of his right hand. He reports difficulty in gripping objects, and the pain worsens with movement. On examination, there is a hard swelling over the joint with limited range of motion and crepitus. His past medical history includes hyperuricemia. What is the most likely diagnosis?

A 40-year-old woman presents with a 2-week history of pain and swelling in the middle and ring fingers of her right hand, particularly after using the hand for repetitive tasks at work. On examination, she has palpable nodules over the flexor tendons at the level of the metacarpal heads. She has difficulty extending the fingers. What is the most likely diagnosis?

A 63-year-old woman presents with progressive pain and swelling in her left hand. She has a history of morning stiffness in the joints, which improves with activity. On examination, there is symmetrical swelling and tenderness in the metacarpophalangeal joints and proximal interphalangeal joints of both hands. What is the most likely diagnosis?

A 70-year-old male presents with pain and swelling in the first carpometacarpal joint of his right hand, which has worsened over the past 3 months. On examination, there is tenderness and a decreased range of motion in the joint. X-rays reveal joint space narrowing and osteophyte formation. What is the most likely diagnosis?

A 45-year-old male presents with pain and swelling over the dorsal aspect of his wrist after lifting heavy objects at work. On examination, he has tenderness over the extensor tendons, particularly at the radial styloid. Finkelstein’s test is positive. What is the most likely diagnosis?

A 33-year-old female presents with a gradual onset of pain and weakness in her right hand, particularly in the thumb and index finger. On examination, there is wasting of the thenar eminence. Tinel’s sign is positive over the carpal tunnel, and Phalen’s test causes discomfort in the distribution of the median nerve. What is the most likely diagnosis?

A 50-year-old male presents with chronic pain and stiffness in his left thumb, particularly with gripping or pinching movements. On examination, he has tenderness at the base of the thumb, and there is a noticeable enlargement of the first carpometacarpal joint. What is the most likely diagnosis?

A 28-year-old male presents with pain and swelling over the dorsal aspect of his wrist following a fall onto his outstretched hand. The pain is localized to the anatomical snuffbox, and tenderness is noted upon palpation. Initial X-rays show no fracture, but the pain persists. What is the most appropriate next step in management?

A 38-year-old woman presents with pain and swelling in the proximal interphalangeal joint of her right index finger, which she reports has worsened over the past week. On examination, there is a firm, non-tender nodule at the joint, and the range of motion is limited. X-rays show joint space narrowing and osteophyte formation. What is the most likely diagnosis?

A 60-year-old male with a history of diabetes and hypertension presents with a thickened, non-tender mass on the palm of his hand that has gradually increased in size over the past few months. There is no pain or limitation in function, but he reports difficulty placing his hand flat on the table. What is the most likely diagnosis?