A serious finger problem
- By: Declan McDonnell, James T H Paget, Oliver Harley
A 30 year old woman presents to the emergency department complaining of a painful left middle finger that she first noticed the previous night. She tells you that she had been bitten earlier in the week by her pet hamster. You establish that she is left hand dominant, a non-smoker, and she works as an artist. She is systemically well and has no evidence of pyrexia. You inspect the picture and record your findings (see figure). Palpating the digit along the volar (palm) side aspect elicits tenderness, which is made worse with passive extension (whereby the examiner moves the finger).
1. What are your findings on inspection?
2. What are your differential diagnoses?
3. What are Kanavel’s four cardinal signs1?
4. How should this condition be managed?
(1) On inspection, you notice her left middle finger is erythematous, swollen, and held in flexion in relation to the other fingers. There