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Seen in the ED Quiz: Severe Wrist and Knee Pain in an Older Man


The man in his early 70s complains of leg pain lasting a month and of arm pain that came on about 1 week ago. Does the x-ray offer a clue to a diagnosis?

History of present illness. A man in his early seventies presents to the hospital with 1 month of left leg pain and 1 week of left arm pain. He has a history of high cholesterol, hypertension, and diabetes. He states that the arm hurts from his shoulder all the way down to his hand and the entire left leg hurts as well, but not as bad as the arm. If he had to say which areas hurt the most it would be his left wrist followed by his left knee. He is unsure if there is weakness because the pain is so severe, but he denies any numbness, injury, fever, chest pain, shortness of breath, or other complaints.

Vital signs & physical examination. Vital signs are normal. The physical exam is otherwise normal except for swelling and redness to the left wrist and a possible small effusion of the left knee without any erythema. No induration is noted at either site.

Initial diagnostic testing

CBC: normal

Chem-7: normal

Imaging: X-ray, below

What is the most likely diagnosis?

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