A 63 year-old healthy secretary presents complaining of hand and wrist pain. While the pain is bilateral, it is more problematic in her dominant hand. It was initially intermittent but she now notices it on a daily basis. She relates that she has stiffness in her hands in the morning lasting for about 15 minutes. The pain is in her finger joints but spares the MCPs. In the wrist, she points to pain at the base of her thumb rather than the wrist itself. This area is particularly painful when she grips things with her thumb such as turning her key in her car ignition or picking up a stack of files. She denies any joint swelling but admits that her fingers are getting "knobbier". She relates her mother also had very crooked fingers and complained of arthritis. She denies any other joint complaints.

On examination of the hands, she has bony enlargement with tenderness in multiple distal interphalangeal joints (DIP) and proximal interphalangeal joints (PIP). There is also increased pain at both the carpometacarpal joint and metacarpophalangeal joint (MCP) of the thumb. The other metacarpophalangeal joints and the wrist are normal. There is no synovitis. The appearance is similar to that in the attached picture.

Findings on radiograph are attached.

This patient has osteoarthritis (OA) of her hands.