What’s your Diagnosis?

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The images for this month’s challenge were submitted by Waldo Floyd III, MD, and Charles E. Hancock, MD, who provide the following information:

Despite increasing bilateral wrist swelling, a 43-year-old man continued to do significant manual labor. The right wrist swelling became massive, and he sought medical evaluation. His physical examination revealed very significant bilateral wrist swelling and limitation of motion, but without either erythema or significant pain. Joint symptoms were limited to his wrists.

Erythrocyte sedimentation rate, rheumatoid factor, anti-nuclear antibody, and C-reactive protein were normal. Anteroposterior (AP) and lateral radiographs of both wrists are shown. What’s your diagnosis?

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