Rheumatologists are full of pranks. First, we take a medical history and ask people where they are hurting. And then we always end up pushing or probing or testing those tender areas. After patient yelp in pain, we look at them with great sincerity and ask, "did that hurt?"
While examining the hands of an elderly lady, I asked the stupid question, "Does that hurt?" "It does when you mash on them like that!" she replied. Luckily for her she wasn’t a patient at the teaching clinic where I did my fellowship. We were required to fill out forms for the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS). For every patient, each knuckle had to be assigned separate scores for swelling and tenderness. I’m not sure which knucklehead designed this form, but it was the epitome of tedium for me and made clinic go very slowly. In retrospect, I don’t know how I ever made it through my fellowship with my sanity intact.
Many of the painful maneuvers we inflict on our patients in the course of an examination have eponyms associated with them. Finkelstein’s sign is used to detect de Quervain’s tenosynovitis. The unsuspecting patient is instructed to make a fist with his or her thumb on the inside. The examiner jerks the patient’s hand and wrist to the side so that tension is put on the abductor and extensor pollicis tendons at the base of the thumb in the area given the quaint name the anatomic snuff box.
Recently, one of my patients presented with pain and swelling in this area. He’s had a rough time the last few years. Because of diabetes and chronic kidney disease, he can’t take nonsteroidal anti-inflammatory drugs, leaving him with very limited treatment options. He also told me about multiple other painful problems, but as I pulled up my exam room stool in front of his chair, I decided that the biggest problem in his current litany of woes was de Quervain’s tenosynovitis. Now the reader might think that since he had already told me the area hurt, and he had swelling in the area, checking Finkelstein’s was adding insult to injury. But going through the physical exam on autopilot, I had him make a fist with his right hand with his thumb inside. I gave a light jerk on his wrist, and he let out a primordial yelp that sounded something like, "oooooooooyyyyyyyyyyyyyyy!" Luckily I didn’t fall off my stool, and we remained face to face. I looked him in the eye and said, "I didn’t know you speak Yiddish!" Luckily for me he thought that was funny.