Orthopedic Tip of
the Month
KANAVEL’S FOUR CARDINAL SIGNS (to diagnose infectious tenosynovitis)
This test is a clinical sign found in patients with infection of the flexor tendon sheath in the hand, a serious condition which can cause rapid loss of function of the affected finger.
The sign consists of 4 components:
- Intense pain accompanies any attempt to actively or passively extend partly flexed finger:
- this is absent in local involvement;
- -pain will be noted along the course of tendon with extension;
- -this is the earliest and most important sign;
- Flexion posture – finger is held in flexion or slight flexion for comfort.
- Uniform / fusiform swelling over affected tendon – involving entire finger in contrast to localized swelling in local inflammation
- Percussion tenderness over affected tendon – along the course of the tendon sheath;
- tenderness is marked along the course of the inflamed sheath in contrast to its absence in a localized inflammation.
DIFFER. DX
- Beware that a mid palmar space abscess may elicit pain with attempted passive motion of the ring and long fingers;
- localized bleeding into the tendon sheath may occur in patients on Coumadin, and this will give the exact appearance of infectious tenosynovitis.
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