Kanavel signs of flexor sheath infection: a cautionary tale

摘要

Hand infections are a common problem among the population and carry significant morbidity.1,2 Deep hand infection such as flexor sheath infections are surgical emergencies and require prompt referral to prevent permanent disability. A misdiagnosis of flexor sheath infection can potentially lead to severe stiffness, deformity, or amputation of the digit.2This article presents an unusual case of a 22-year-old with a chronic intermittent history of swelling and pain to the right middle finger (RMF). Although the history was slightly atypical, examination findings identified the Kanavel cardinal signs of tendon sheath infection (Figure 1).Figure 1. Flexor sheath infection of the right middle finger from a patient with a drill puncture wound. A 22-year-old male left hand-dominant joiner presented to his GP with severe pain in the RMF. He was awoken the previous night by pain and swelling in his RMF. He was unable to attend work due to the severity of pain in his finger. The pain was constant, worse with movement, and relieved by analgesia (co-codamol and naproxen). He had no history of exacerbating factors, recent trauma, or systemic upset. He reported a glass injury to this finger 22 months previously.He complained of several similar episodes of pain and swelling to the RMF over the past few years. These episodes usually lasted for …