Question

26 year-old male presents with a swollen 4^th digit and pain during extension, what’s the diagnosis?

Answer

Answer: Infectious Flexor Tenosynovitis

Infectious Flexor Tenosynovitis

• Closed space infection of the flexor tendon sheath; an orthopedic emergency
• Typically an infection with skin flora secondary to penetrating trauma
• Remember Kanavel's cardinal signs via mnemonic B.E.S.T. (the "BEST" mnemonic):
  • B: Bend finger (i.e., finger held in slight flexion)
  • E: Extension pain (i.e., pain on passive extension)
  • S: Sausage-like digit (i.e., fusiform swelling
  • T: Tenderness along tendon sheath
• If early and not severe a course of IV antibiotics covering skin flora may be tried. Surgical intervention, however, is often necessary so early consultation with a hand surgeon is highly recommended

References

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