Intended for healthcare professionals

Endgames Spot Diagnosis

A painful swollen hand

BMJ 2020; 368 doi: (Published 05 March 2020) Cite this as: BMJ 2020;368:m614
  1. Henry O’Brien, core surgical trainee year one1,
  2. Jayanth Paniker, consultant orthopaedic hand surgeon2
  1. 1Scunthorpe General Hospital, North Lincolnshire, UK
  2. 2Rotherham Hospital, Rotherham, UK
  1. Correspondence to H O’Brien henry.o%E2%80%99brien1{at}

A 25 year old man presented with a painful, swollen right hand after a night socialising with friends. He had consumed enough alcohol for him to be unable to recall the mechanism of injury. He had no medical history.

On examination there was swelling extending from the wrist to the metacarpophalangeal joints, which was greater on the ulnar side of his hand and palpation was tender in this region.

He was able to make a fist and extend his fingers and wrist. No rotational deformity or neurovascular deficit was seen.

No fractures were visible …

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