Unusual ultrasound diagnosis of hair implantation osteomyelitis of the thumb.

Osteomyelitis is a challenging condition to diagnose and successfully treat. A clinician diagnosing osteomyelitis is reliant on relevant aspects of clinical history, inflammatory markers and radiological imaging such as X-rays, CT and contrast MRI. The confirmation of the presurgical diagnosis is made from microbiological analysis of the bone biopsy and/or histological analysis for features of inflammatory changes. An ultrasound scan is generally thought to have less value in osteomyelitis diagnosis due to its inability to interrogate bone. However, this investigation can be helpful in detecting the site and size of soft tissue collections secondary to osteomyelitis and the presence of any associated foreign bodies. We present a case where an ultrasound scan played a key role in supporting the diagnosis of osteomyelitis of the thumb in a dog groomer. This is the first reported case of hair implantation osteomyelitis presenting without a cutaneous sinus.