Ulnar Deviation Secondary to Rheumatoid Arthritis
As can be seen in this picture, severe rheumatoid arthritis is characterized by, among other things, significant ulnar deviation and flexion of the non-thumb digits. The reason why this deviation occurs is that there is such articular swelling and inflammation, the phalangeal aspect of the joint is pushed off the metacarpal aspect, and so they slip off to the ulnar side of the hand. There is also a rheumatoid nodule, as many of you pointed out. The varied manifestations of RA are not worth repeating here, but since there are many inflammatory conditions that are associated with RA, it is important to recognize and take into account the preexisting disease when working someone up for another condition.
I'd also like to reflect on something we have briefly touched on before, but I was explaining to a friend that each one of my patient visits is, in many ways, like a mini-performance. I assume the role (as we discussed before) the patient expects me to conform to (father, brother, friend, etc.) and hit my mark and say my lines. It's a great way to hone my communication skills and ensure the patient gets the most out of the encounter. And, it keeps my energy up at the end of a busy, tough day. But hey, it's show business!!