UMEM Educational Pearls


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


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


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