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