A 45-year-old alcoholic presents with finger swelling described as sausage-shaped with tendon sheath tenderness along the entire length and pain with passive motion. What is the most likely diagnosis?

A 45-year-old alcoholic presents with finger swelling described as sausage-shaped with tendon sheath tenderness along the entire length and pain with passive motion. What is the most likely diagnosis?

• A. Suppurative tenosynovitis due to Eikenella corrodens
• B. Paronychia
• C. Felon
• D. Extensor tendon rupture

Answer: (A)

This presentation is classic for septic flexor tenosynovitis. The sausage-shaped (fusiform) swelling of the finger, tenderness along the entire tendon sheath, and pain with passive extension are the Kanavel signs that point to infection within the flexor tendon sheath. This condition is a surgical emergency because the purulent process can rapidly track along the sheath and compromise the finger’s viability if not promptly drained and treated with antibiotics. The most likely organism in this scenario is Eikenella corrodens, which is a known cause of tenosynovitis in the setting of human bites or bite-related injuries involving the hand, as its flora is part of the oral cavity. In contrast, paronychia involves the nail fold, a felon is an infection of the fingertip pulp space, and an extensor tendon rupture would present with loss of extension rather than the described tendon-sheath–specific findings. Prompt surgical drainage and appropriate antibiotics are essential to prevent complications.

This presentation is classic for septic flexor tenosynovitis. The sausage-shaped (fusiform) swelling of the finger, tenderness along the entire tendon sheath, and pain with passive extension are the Kanavel signs that point to infection within the flexor tendon sheath. This condition is a surgical emergency because the purulent process can rapidly track along the sheath and compromise the finger’s viability if not promptly drained and treated with antibiotics.

The most likely organism in this scenario is Eikenella corrodens, which is a known cause of tenosynovitis in the setting of human bites or bite-related injuries involving the hand, as its flora is part of the oral cavity. In contrast, paronychia involves the nail fold, a felon is an infection of the fingertip pulp space, and an extensor tendon rupture would present with loss of extension rather than the described tendon-sheath–specific findings.

Prompt surgical drainage and appropriate antibiotics are essential to prevent complications.