Soft Tissue Rheumatism, Fibromyalgia & MSK Manifestations of Systemic Disease
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Clinical VignetteQuestion 1 of 15
Locking Ring Finger
A 55-year-old man with type 2 diabetes mellitus (hemoglobin A1c 9.1%) presents to his primary care physician with a 6-week history of his right ring finger "getting stuck" when he tries to straighten it after making a fist. Each morning he must use his left hand to pull the finger into extension, after which it snaps back with a painful click. He works as a delivery driver and grips a steering wheel for most of the day. He has no swelling of the wrist, no numbness or tingling at night, and has not noticed any skin or tissue changes in his palm. On examination, there is no palmar thickening or cord palpable along the palm. Tenderness is elicited by pressing on the volar surface of the right hand directly over the knuckle of the ring finger, where a small, firm nodule is felt. The finger can be fully extended passively, though extension from a flexed position produces a painful snap. Laboratory results show ESR 11 mm/h and CRP 0.4 mg/dL.
Which of the following is the most appropriate initial treatment for this patient's condition?