Glass foreign bodies - palm

Case contributed by Maulik S Patel

Presentation

Left palm glass injury a few months ago. Palmar pain, restricted 4th finger movement, loss of sensation along the ulnar side of the 3rd finger.

Patient Data

Age: 40 years
Gender: Male
ultrasound

Two echogenic linear foci in the subcutaneous plane of the palm with reverberation artifact represent the glass foreign bodies. Both foreign bodies are obliquely oriented lying superficial to the middle and ring flexor tendons. The proximal foreign body (16 mm) lies superficial to the palmar artery-nerve. The distal foreign body (16 mm) pierces the common palmar nerve of the middle and ring finger causing a short segment nerve thickening without loss of continuity. The accompanying palmar arterial branch lies superficial to the distal foreign body. The common palmar nerve of the ring and little fingers lie deep to the foreign body

4th flexor tendon is intact with thickening in the palm at the site of the foreign bodies without tenosynovitis.

Both ultrasound video loops are aligned to the short axis of the palm. 1st loop shows both foreign bodies. 2nd loop shows a foreign body stabbing the common digital nerve.

Annotated image

Distal foreign body pierces common palmar digital nerve of 3rd and 4th fingers. The nerve is marked by a circle.

Photo

Black ink marking - common palmar digital nerve to 3rd and 4th fingers. Blue ink markings - foreign bodies.

Photo

Two glass foreign bodies were retrieved.

Case Discussion

The case illustrates the sonographic appearances of glass foreign bodies in the palm with common palmar digital nerve injury. Foreign bodies were retrieved surgically. The injured nerve segment revealed fibrosis.

Intraoperative findings and glass foreign bodies photo: courtesy operating surgeon Dr Amar Vakhariya.

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