This can’t be good!

The clinical scenerio goes something like this:  35yo male comes in with a swollen finger.  Several days ago he sustained a minor cut to the volar surface of his 2nd digit.  He  noticed over the next few days  increased swelling and redness.  He has a fever on exam.  What is the diagnosis?

This is a great picture of flexor tenosynovitis.  The goal of this entry is to review the diagnostic criteria for this condition.  There are 4 physical exam findings collectively known as Kanavel’s sign’s  that help diagnose the condition:

  1. The finger is diffusely swollen (“sausage finger”)
  2. The finger is held in slight flexion
  3. There is tenderness to palpation over the flexor tendon
  4. There is pain on passive extension of the finger

I’m referencing two papers in case you’d like to read more about this condition.  The paper entitled Factors Affecting the Prognosis of Pyogenic Flexor Tenosynovitis provides not only a great review of the condition but also provides you with information about what happens after the patient leaves the ED.  I’m a great believer in knowing what you need to know AS WELL AS one step beyond.  Which patients do well with treatment and which ones are at greater risk for amputation? This paper helps risk stratify.

References

  1. Torralba, K and Quismorio, F;  Rheum Dis Clin N Am: 35 (2009) 45-62
  2. Pang, H, Teoh, A, Yam, KT et al; J Bone Joint Surg Am. 2007;89:1742-1748
Advertisements