Case Report: 30 y/o Man with Swollen Hands

History of Present Illness:

A man in his 30’s presents to the ED for an ankle injury. He recently moved to the United States and has never seen a doctor before. He admits to years of gradually worsening joint pain. He states his hands have always looked “fatter” than everyone else he knows, and continue to look more and more that way.

Vital Signs & Physical Exam:

Vital signs are normal. A physical exam is otherwise normal except for ankle tenderness and thick, hairy hands (my hand is pictured on the left).

Initial Diagnostic Testing:

Imaging: Ankle x-ray shows no fracture.