what is your diagnosis ?

[passionate786]

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A 54-year-old man presents for evaluation of a painful hand of several weeks' duration. He has been employed as a painter for years. The hand has never been injured, according to the patient's account, and he states that he has no surgical history. In addition to pain, he is having difficulty extending his fourth and fifth fingers. He denies any paresthesias. Past medical history is significant for hyperlipidemia, for which he takes atorvastatin. He also reports a 29 pack-year history of cigarette smoking and an occasional drink after work, but denies any use of illicit drugs. On physical examination, you note a nodular lesion on the volar surface of the hand at the metacarpophalangeal joints of the fourth and fifth fingers.What's your diagnosis ?

 

[docB]

Sounds like that malady where you get fatty and or chlosterol deposits inside tendon sheaths. I can't for the life of me recall the name right now but it's often seen in the achilles.

 

[RxnMan]

Dupuytren's contracture?

Sounds like that malady where you get fatty and or chlosterol deposits inside tendon sheaths. I can't for the life of me recall the name right now but it's often seen in the achilles.

Tendinous xanthoma?

 

[alphaholic06]

Sounds like that malady where you get fatty and or chlosterol deposits inside tendon sheaths. I can't for the life of me recall the name right now but it's often seen in the achilles.

Tendious xanthoma secondary to hyperchlesterolemia.

 

[ThedarnmikeDO]

This kind of reminds me of a trauma case I read about where a painter injected paint into his hand with a high pressure airbrush. The incident was so quick he didn't even realize what had occurred. He later went on to develop compartment syndrome. It doesn't really fit the story (-parasthesias, -pain out of proportion) but other than this and the tendinous xanthoma I can't think of anything else.

 

[EdEmEr]

My 2c In order of likelihood:

Overuse injury/tendinitis
RA/OA
Tendinous xanthomas (but he should have arcus corneus or xanthalasmas as well?)

 

[hyperbaric]

Ganglion.

 

[docB]

Dupuytren's contracture?

Tendinous xanthoma?

That's what I was thinking of. Thanks. Med school's getting longer and longer ago.

 

[Painter1]

That's what I was thinking of. Thanks. Med school's getting longer and longer ago.

his he a drunk? Dupuytren's Contracture?