History: A fit 80-year-old retired teacher woke up with a painful right wrist that prevented him from writing or holding a cup of coffee.

He thought it was due to 36 holes of golf and two hours of gardening the previous day.

Examination revealed no swelling, tenderness or other signs of inflammation. He had no family history and no previous attacks of gout.

I prescribed rest, immobilisation and paracetamol/ibuprofen tablets and arranged for a repeat visit in two days.