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Case of the Month

A monthly selection of intersting cases relating to orthopaedic hand surgery.

Thorns
A middle age gent fell onto a thorn bush. He immediately extracted a long thorn from his palm but did not notice other problems as he was pretty scratched up.

A month later he had pain when bending his thumb and a very sensitive wrist area. An ultrasound performed confirmed the suspicion of a retained foreign body. In theatre we found a thorn (circled in yellow) had gone right through his median nerve and into the thumb tendon.

COVID-19 Complication
Miss Anonymous is a 40+ year old female who crushed her thumb in a door. After a few days the pain subsided but thereafter increased again. Because of the lockdown and fear of traveling she delayed her self-referral by 3 weeks. She now presents with a severely infected thumb and unfortunately the infection has got into her bone – a complication called osteomyelitis. Treatment now involves at least 6 weeks of antibiotics and a very real risk of losing part of her thumb.

Lessons:
Hand infections are very serious and should be managed urgently
Even in this COVID-19 period, urgent cases must be seen and managed.

Beware palm trees
Note area of swelling, gentleman was working in garden pruning a palm tree.

Note: palm thorn and surrounding granulation tissue (bodies response to the foreign body).

Also called palm thorn synovitis

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