SUBJECTIVE: The patient presents today complaining of pain and symptoms in both hands for the last several weeks to months. The first complaint she has is multiple fingers in her hands will turn white with exposure to cold. It definitely occurs more in the winter, but it can occur if she goes to the grocery store and picks up ice cream. Her fingers go white and feel numb, and it takes about 20 minutes for them to warm up and be normal. There is no real associated pain with this, and it does not involve all fingers on her hands. Her feet never seem to be affected. There is no family history of lupus, rheumatoid arthritis or other autoimmune disorders.
Second issue for the patient is, on her right hand, her ring finger seems to get stuck in the flexed position. This definitely happens more at night, but during the day, she even has a bit of triggering. She does a lot of arts and crafts and uses her hands frequently throughout the day every day.
Finally, the patient reports pain at the base of both thumbs; again, using her hands often during the day. It is very painful. She has difficulty gripping things because of the pain.
OBJECTIVE: Blood pressure is 110/82. In general, this is a well-appearing woman in no acute distress. Hands bilaterally appear normal. There is no overt swelling, redness, etc. The hands appear symmetric. There is tenderness over each CMC joint bilaterally. Finkelstein is negative. There is pain with flexion of the thumb onto the fifth digit bilaterally. Right fourth ring finger with clear triggering appears to be at the PIP joint. No tenderness or overt swelling.
ASSESSMENT:
1. Raynaud phenomenon.
2. Right fourth digit trigger finger.
3. Bilateral carpometacarpal arthritis.
PLAN:
1. The patient is encouraged to keep her hands warm at all times. We spoke about calcium channel blockers as being a possible remedy; however, they would likely lower her blood pressure, and as it stands, her past three blood pressures have been between 106 and 110 systolic. She prefers to hold off for now.
2. The patient is referred to Dr. John Doe for consultation regarding her trigger finger and CMC arthritis. We also advised that she could try thumb spica splints until her appointment.
3. The patient will follow up here as needed.
