21. A patient that you are seeing for treatment of a distal radius fracture presents to clinic with a flexed posture of the middle finger, swelling, diffuse tenderness over the volar aspect of the entire digit, and severe pain with any attempt at passive extension.  The patient states she was trimming her rose bushes yesterday and woke up this morning with the symptoms.  Based on your exam what condition may be suspected?  A.  Trigger finger B.  Herpetic Whitlow C.  Infectious tenosynovitis  D.  Gout

Correct Answer: C. Infectious tenosynovitis  The patient is experiencing all four signs of Kanavel which indicate acute infectious/pyogenic flexor tenosynovitis.  Not all four signs need to be present for diagnosis. Infectious tenosynovitis can occur with penetrating trauma from an animal bite or foreign body (In this case a thorn from a rose bush).   The patient should be referred to her surgeon for urgent medical intervention.  Left untreated, infectious tenosynovitis can lead to tendon necrosis and rupture.   Stenosing tenosynovitis or trigger finger (Answer A.) is a non urgent medical condition that causes catching or locking of a digit with active flexion.  In this condition repetitive use or systemic illness such as diabetes causes swelling of the flexor tendon and prevents normal tendon glide under a flexor pulley (typically the A-1 pulley).  Herpetic Whitlow (Answer B.) is a finger tip infection caused by the Herpes viru...