The patient was currently living with her 21-year-old daughter who was her main carer and helped her with washing, dressing, and household chores, as well as acting as a translator. The patient had given up work as a cleaner and there were no outstanding legal applications ongoing. She rated her mood as being low since her pain was becoming worse, and her sleep pattern was reasonable, but she was often woken at night if she rolled over and her arm pushed against a bedsheet.
On examination, there was significant guarding and the patient was not keen to expose her arm or let anyone touch it. With some gentle persuasion, she agreed to a limited examination. Her left hand was red and clawed, and her nails were growing long as she had been unable to cut them. She was unable to move her fingers, wrist or elbow without significant pain, and light touch evoked extreme pain. There was some swelling over the hand and wrist and possibly some more swelling in the proximal arm. Infrared (non-touch) thermometer registered a maximal 1.5 ℃ difference between respective limbs.
- What are your differential diagnoses?
- What criteria are available to help you?
