An Emergency from an Innocuous Bite

​BY GREGORY TAYLOR, DO, & ERIC MCDOWELL, DOA 47-year-old woman presented to the emergency department with a chief complaint of pain and swelling on her left index finger two days after she was bitten by her cat. Her vitals were within normal limits. Physical exam was notable for two puncture wounds to the left index finger along the radial aspect of the middle phalanx. Fusiform swelling was noted around the proximal phalanx to the level of the MCP joint, with erythema extending to the distal palmar crease. The index finger was held in slight flexion with pain during passive extension and pain with palpation of the tendon. She was neurovascularly intact.Plain radiographs did not show any evidence of a fracture or foreign body. Her tetanus was updated, and she was started on 3 gm IV ampicillin/sulbactam. Plastic surgery was consulted for flexor tenosynovitis. She was taken emergently to the operating room, and underwent an exploration of the left index finger and palm, decompression of the flexor tendon sheath, decompressive fasciectomy, tenosynovectomy, and decompressive arthrotomy.Infectious tenosynovitis, also known as pyogenic flexor tenosynovitis, is a purulent infection of the synovial sheath surrounding a flexor tendon. The incidence is up to 9.4 percent of all hand infections. (Orthobullets; http://bit.ly/2L1YsWH.) An orthopedic and plastic surgery emergency, infectious tenosynovitis must be recognized rapidly and treated accordingly to prevent severe deb...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research