Cold, painful hands prompts a referral to ED

Intense pain in the hands, aggravated by cooler temperatures prompts a GP to immediately refer this patient to the emergency department.

Clarrie is a 21-year-old working full-time as a receptionist.

She presents with pain in her hands and fingers bilaterally, which has been worsening over the past week.

The pain is now affecting all the fingers of both hands and has prevented her from sleeping the past two nights. It is aggravated by any fall in temperature.

She has undertaken no activity out of the ordinary in recent weeks and can recall no other associated symptoms. She takes a low-dose mini pill and no over-the-counter medications.