Sound Bite 11 - Pyogenic Flexor Tenosynovitis

Author: Dr Gokul Sagar Bailur

Reviewer: Dr Nick Mani

A middle-aged farmer arrives at the Emergency Department with a painful, swollen, and red left index finger on the palmar side of his dominant hand. This issue began four days ago despite taking oral antibiotics prescribed in primary care facility, and there has been no improvement since.

Your clinical findings of the finger are as following: -

• Fusiform swelling

• Pain with passive extension of the digit

• Tenderness over the flexor sheath

• The digit held in slight flexion at rest

You decide to perform POCUS of the finger in a water-bath as an extension of your standard clinical assessment: -

Case Resolution

The enhanced clinical assessment by POCUS allowed timely diagnosis, management and urgent referral of pyogenic flexor tenosynovitis. Subsequently, the patient underwent exploration and washout by hand surgeons, resulting in a favourable outcome.

Take Home Message

POCUS of the digits can be rapidly performed in a water bath for various purposes such as detecting foreign bodies, assessing tendon damage, or identifying infections, among others. This would augment the standard clinical assessment, ultimately improving patient care and safety.