Upper extremity disorders: The Daily PANCE Blueprint

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Upper extremity disorders: The Daily PANCE Blueprint

A 53-year-old man presents to the clinic due to difficulty using his left hand. Over the past two years, he has experienced increasing stiffness in the palm and third and fourth fingers, making it challenging to type and perform other manual tasks. He has tried using splints and warm compresses without relief. There is no history of trauma. On examination, he has decreased extension of the left third and fourth metacarpophalangeal joints, and thickened skin overlying the palmar fascia is noted. Which of the following conditions is most likely associated with the patient's current hand findings?

A. Acromegaly
B. Rheumatoid arthritis
C. Crohn disease
D. Diabetes mellitus
E. Psoriatic arthritis

Answer and topic summary

The answer is D. Diabetes mellitus

The patient’s presentation is consistent with Dupuytren contracture (DC), characterized by progressive fibrosis of the palmar fascia, leading to contractures and decreased finger extension, commonly involving the third and fourth digits. Risk factors for DC include age >50, male sex, family history, and diabetes mellitus. Up to 40% of patients with DC have a history of diabetes, and the condition tends to be more aggressive in these individuals. DC presents with painless thickening of the palmar fascia and nodules that can progress to form fibrous cords, restricting movement. Treatment includes conservative measures, such as modification of hand tools, but advanced disease may require collagenase injections or surgical intervention for contracture release.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Upper extremity disorders ⇒ Soft tissue injuries of the forearm, wrist and hand

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