September 1, 2016 ◆ Volume 94, Number 5 www.aafp.org/afp American Family Physician 375
Nontender Elbow Nodules
SCOTT CORDTS, MD, Deaconess Family Medicine Residency, Evansville, Indiana
A 77-year-old woman presented with a long-standing history of daily pain and stiffness in
multiple joints. She reported morning stiffness in her shoulders, knees, dorsal feet, and
metacarpophalangeal joints that improved
with hot showers. She did not have acute
attacks of pain or constitutional symptoms
such as fever, chills, or weight changes.
On physical examination, she had sym-
metric swelling, warmth, and tenderness
of the second, third, and fourth metacar-
pophalangeal joints. She also had bilateral
irregularly shaped, nontender, firm, fixed
nodules over the extensor surfaces of her
elbows (Figure 1).
Based on the patient’s history and physical
examination findings, which one of the following is the most likely diagnosis?
❏ A. Epidermoid cysts.
❏ B. Olecranon bursitis.
❏ C. Rheumatoid nodules.
❏ D. Tophaceous gout.
See the following page for discussion.
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