Question of the Week

Over the past 10 months, a 55-year-old man has been having increasing difficulty taking care of his farm due to stiffness and pain in his right palm and third and fourth digits. He has tried multiple over-the-counter creams and warm compresses without significant relief. He denies trauma to the hand and does not recall an insect bite. He has not visited a healthcare provider in 20 years and reports no significant past medical history. His vitals are blood pressure 135/85 mm Hg, heart rate 90 bpm, and respiratory rate 16 breaths/min. Examination demonstrates decreased extension at the third and fourth left metacarpophalangeal joints, and the third and fourth digits are flexed on rest.