A 30-year-old female presents with left second finger pain with overlying erythema, warmth, and swelling the day after her cat bit her finger. She cannot fully extend the finger, it is tender and she has pain when it is passively extended. Her hand appears as shown above (Figure 1. Case courtesy of Kristina Kyle, MD).
The flexor tendon sheaths are contiguous with other deep spaces of the hand. These anatomic pathways facilitate rapid spread of the infection as it follows the path of least resistance .
Pearl: Delay in diagnosis or presentation is associated with increased complications such as stiffness, tendon necrosis and rupture, osteomyelitis, deformity, and even amputation, so have a low threshold to consult early [9,10].
Ultrasound. This is particularly useful early in the course when differentiation can be difficult .
Figure 4: Transverse views of palm, MCP, PIP, and DIP moving top left to right bottom respectively. Demonstrates diffuse synovial thickening with mild effusion involving flexor digitorum tendons. Case courtesy of Dr. Maulik S Patel, Radiopaedia.org, rID: 48661.
Figure 5: Longitudinal view of the same finger in image 4 again demonstrating diffuse synovial thickening with mild effusion involving flexor digitorum tendons. Case courtesy of Dr. Maulik S Patel, Radiopaedia.org, rID: 48661.
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