Osipchuk Daria, Riddell Jeffrey
Keck School of Medicine of University of Southern California, Department of Emergency Medicine, Los Angeles, California.
Clin Pract Cases Emerg Med. 2023 May;7(2):73-76. doi: 10.5811/cpcem.1317.
Infectious extensor tenosynovitis is a rare infection spreading along the extensor tendons of the extremities. It presents a diagnostic challenge in the emergency department (ED) given the nonspecific signs and symptoms, as opposed to the more common flexor tenosynovitis that is diagnosed by the classic Kanavel signs on physical exam.
Here we present a case of bilateral extensor tenosynovitis in a 52-year-old female denying past medical history who presented to the ED with two days of bilateral dorsal hand swelling and pain. She denied any risk factors such as direct trauma to the hands or intravenous drug use. The rare diagnosis was suspected in the ED due to a very high complement reactive protein level and a concerning point-of-care ultrasound. Extensor tenosynovitis was ultimately confirmed on computed tomography and by operative irrigation and drainage of the tendon sheaths.
This case demonstrates the importance of keeping extensor tenosynovitis on the differential when seeing a patient with dorsal extremity edema and pain, even if the findings occur bilaterally.
感染性伸肌腱腱鞘炎是一种沿四肢伸肌腱蔓延的罕见感染。鉴于其体征和症状不具特异性，在急诊科诊断颇具挑战，与之相对的是更常见的屈肌腱腱鞘炎，后者可通过体格检查中的经典卡纳韦尔征来诊断。
我们在此呈现一例52岁女性双侧伸肌腱腱鞘炎病例，该患者否认既往病史，因双侧手背肿胀和疼痛两天就诊于急诊科。她否认任何危险因素，如手部直接外伤或静脉吸毒。由于补体反应蛋白水平极高且床旁超声检查结果令人担忧，急诊科怀疑这一罕见诊断。最终通过计算机断层扫描以及腱鞘的手术冲洗和引流确诊为伸肌腱腱鞘炎。
本病例表明，当见到有肢体背侧水肿和疼痛的患者时，即便症状为双侧出现，在鉴别诊断中考虑伸肌腱腱鞘炎也很重要。
