An epic stuntman known as Evel Knievel presents to the ER with intense finger pain. He noticed the pain start yesterday, a day after he nicked his index finger doing a flying motorcycle stunt. Although he’s broken 433 bones in his lifetime (true story- he’s in the Guinness book of World Records!) from stunts, it doesn’t appear that his finger is broken this time. He does have severe pain and says it’s so swollen and painful that he cannot move it. On exam, he has a mild fever and otherwise normal vitals. His left index finger is uniformly swollen like a sausage. It’s held in flexed position. When you try to examine it or touch it he cries in pain.
The finger looks like this:
What is your diagnosis?
What are Kanavel's Four Cardinal signs of this disease?
- Percussion tenderness – over the entire length of the tendon sheath
- Uniform / fusiform swelling of the digit, aka “sausage digit.” Yum!
- Intense pain with passive extension
- Flexed posture of the digit at rest
What is the treatment?
Evel Knieval ... 433 bone fractures?!?
References
Photo cred: https://drhem.wordpress.com/tag/tenosynovitis/
Tintinalli’s 7th ed., Ch 280.
https://en.wikipedia.org/wiki/Evel_Knievel
Kylie Birnbaum
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