Ortho Case of the Week – Hand Soft Tissue

Link to quiz

Okay time to give you guys a “break” from bones (said no ortho bro ever). SOFT tissue, HARD core.

Case 1: 30-year-old female presents with right middle finger pain and swelling after getting bit by her cat 4 days ago, but she did not seek medical care at that time.

  1. What is the feared diagnosis?
  2. What are the four Kanavel Signs?
  3. What is the treatment?

Case 2: A 37-year-old male presents with right thumb pain after a skiing accident where he fell backwards with his right hand landing awkwardly on his pole. Plain films are pending. On exam he is unable to maintain a “pincer” grasp (thumb and index finger opposition) and has laxity at the MCP compared to the other side.

  1. What is your working diagnosis?
  2. How would you treat it?

Case 3: 26-year old-male presents after a rugby game with the exam below, unable to bend at the ring finger DIP.

  1. What is the diagnosis?
  2. How would you treat it?
  3. How do you test the tendon functions of the individual digits on exam?
  4. Should you as an ED Doc attempt to repair flexor or extensor tendons of individual digits?