Year Woman Presents Explained for Students (Easy Guide)

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Original Question

A 52-year-old woman presents with a six-month history of progressive weakness and pain in both hands. She reports persistent stiffness lasting more than an hour each morning, followed by gradual improvement with activity. She describes increasing difficulty with fine motor tasks, such as buttoning clothes and holding small objects. The pain worsens with prolonged activity and improves with rest. Additionally, she notes intermittent swelling of the finger joints and occasional wrist discomfort. Physical Examination Findings: Inspection: Mild symmetrical swelling of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints Ulnar deviation of the fingers with mild joint deformities Visible nodes on some digits No skin lesions, rashes, or digital ulcers Palpation: Generalized tenderness over the MCP and PIP joints bilaterally Mild warmth over affected joints without erythema Subcutaneous nodules detected on the extensor surfaces of the forearm Range of Motion (ROM): Restricted flexion and extension of fingers due to pain and stiffness Wrist ROM mildly restricted, especially dorsiflexion Thumb opposition intact Weak grip strength bilaterally Reduced finger flexor strength compared to wrist flexion Difficulty sustaining power grip and pinch grip Phalen’s Test: Negative Tinel’s Sign: Negative

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