A 59 year-old left-hand dominant man with no previous hand symptoms reported a sudden spontaneous episode of pain over the dorsum of his right hand with associated loss of index finger extension. Examination revealed significant swellings over the dorsal aspects of both hands at the base of the index and middle metacarpals. These were mixed bony and soft tissue masses to palpation, with swelling on the right hand measuring approximately 20 mm in diameter. A 30deg index finger extensor lag was noted in the right hand, with full passive extension and normal flexion. X-rays revealed degenerative change and marked dorsal osteophyte formation of the middle and index carpometacarpal joints in both hands.
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