A 42-year-old woman came to our clinic to have lumps on her right elbow removed. She said the lumps did not bother her, but on further questioning, admitted that her fingers turned white when they were exposed to the cold. She had frequent heartburn, but denied fatigue, weight loss, dysphagia, diarrhea, dyspnea, chest pain, palpitations, muscle weakness, or digital pain.
On physical exam, there were multiple small, firm subcutaneous nodules—some with a white surface protruding through the skin of her right elbow (FIGURE 1A). The nodules were slightly tender to palpation. On further examination we noted tight, smooth skin on her fingers (FIGURE 1B). Her right thumb was fixed in an extended position (FIGURE 2). There were also small blood vessels on her hands and pitted scars on her fingertips.
FIGURE 1
Elbow nodules and clubbing of the fingers
The 42-year-old patient sought care at the clinic to have slightly tender nodules removed from her right elbow. The patient also had tight skin and clubbing of the fingers.
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FIGURE 2
Thumb fixed in an extended position
The patient had tight skin on her fingers and a pitted scar on her thumb, which was fixed in an extended position.