Middle finger distal phalanx osteomyelitis

Case contributed by Bahman Rasuli
Diagnosis almost certain


Swelling, warmth and severe functional impairment of the right-hand third finger distal phalanx.

Patient Data

Age: 50 years
Gender: Female

Abnormal bone marrow signals are seen at the middle finger distal phalanx of the right hand, appearing low on T1 images and high on proton density images, as well as cortical erosion and destruction (best appreciated on T1 images). Together with a joint effusion of the distal interphalangeal joint, findings are suggestive of septic arthritis and osteomyelitis.

Destruction of the flexor tendon distal to proximal interphalangeal joint level also is seen.

Mild bone marrow edema is noted at the middle phalanx. Marked subcutaneous edematous changes and swelling are noted along the middle finger.

Case Discussion

Our patient had a history of trauma and penetrating injury to the middle finger three weeks ago. Progressive swelling, warmth, pain and limited finger mobility are important clinical findings suggestive of inflammatory disease and so the possibility of septic arthritis of the middle finger distal interphalangeal joint and osteomyelitis were considered.

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