instruction: hello doctor I would like an opinion as to why the ring finger on my sons left hand is swollen the middle finger is a little swollen and possibly some fingers on his right hand are too but less so they are not painful this started about a year ago a rheumatologist saw him then and thought that it was not arthritis rays are taken last year were normal this is what the ray report says technique pa lateral and oblique views of the bilateral hands were obtained findings the alignment and joint spaces are normal there is no fracture osseous lesion or dislocation the soft tissues are normal impression no osseous or soft tissue lesion noted mri may be of value blood work taken a year ago was normal images attached
output: hello I have gone through the history and the pictures along with the reports I would like to ask you a few more questions to conclude the diagnosis and how to proceed further with it does he complain of early morning stiffness that he has to move his hands to open it anyone in the family has any degenerative arthritis like osteoarthritis any complaints of backache or neck pains as of the reports your rheumatologist are right it is not inflammatory arthritis we are looking at some metabolic causes of these swellings or some other genetic ones