A 49-year-old right hand-dominant man with no significant medical history presented to the emergency department (ED) with severe right thumb pain. The patient sustained a laceration to the palmar surface of his right thumb 2 days prior to presentation; he did not seek care at that time because the laceration appeared superficial, bleeding was easily controlled and pain was minimal. The patient subsequently developed worsening pain and swelling of his thumb with pain radiating to his right forearm. His pain was exacerbated by any passive or active range of motion of the digit. He took naproxen at home with minimal pain relief, and at the time of presentation to the ED was unable to continue working due to pain. He endorsed subjective fevers and chills but denied any associated neurovascular symptoms, nausea or vomiting. On examination, the patient held the right thumb in slight flexion, with significant swelling of the entire digit extending to the right thenar eminence. There was minimal associated erythema and no proximal lymphangitic spread. There was a well-healed linear laceration on the medial aspect of the right thumb without any associated discharge, bleeding or dehiscence. There was no palpable crepitus. The range of motion was significantly limited by pain, and the patient had marked tenderness to palpation diffusely, including over his flexor tendon sheath. X-ray of the right hand showed mild soft tissue swelling around the right thumb but was otherwise unremarkable. Laboratory workup was notable for leucocytosis, with a white blood cell count of 14.4×109/L, and elevated inflammatory markers, with an erythrocyte sedimentation rate of 26 mm/hour (reference range, 0–10 mm/hour) and C reactive protein of 109.5 mg/L (reference range, <7.5 mg/L). ED point-of-care ultrasound (POCUS) performed by the ED resident and attending physicians showed oedema surrounding the flexor pollicis longus (FPL) tendon, demonstrated by a hypoechoic fluid …

中文翻译：

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床旁超声诊断化脓性屈肌腱鞘炎

一名 49 岁以右手为主的男性，没有明显的病史，因右手拇指严重疼痛到急诊科 (ED) 就诊。患者在就诊前 2 天右手拇指手掌表面出现撕裂伤；当时他没有寻求治疗，因为裂伤看起来很浅，出血很容易控制，疼痛很小。患者随后出现恶化的疼痛和拇指肿胀，疼痛放射至右前臂。手指的任何被动或主动活动范围都会加剧他的疼痛。他在家中服用萘普生，疼痛缓解很小，在就诊时因疼痛无法继续工作。他支持主观发烧和寒战，但否认有任何相关的神经血管症状、恶心或呕吐。考试时，患者握住右手拇指轻微屈曲，整个手指明显肿胀，延伸至右侧鱼际。有最小的相关红斑并且没有近端淋巴管扩散。右手拇指内侧有一个愈合良好的线性撕裂伤，没有任何相关的分泌物、出血或裂开。没有明显的捻发音。活动范围受到疼痛的显着限制，患者有明显的广泛触痛，包括在他的屈肌腱鞘上。右手X光片显示右手拇指周围有轻度软组织肿胀，其他方面无异常。实验室检查发现白细胞增多，白细胞计数为 14.4×109/L，炎症标志物升高，红细胞沉降率为 26 毫米/小时（参考范围，0–10 毫米/小时）和 109.5 毫克/升的 C 反应蛋白（参考范围，<7.5 毫克/升）。ED 住院医师和主治医师进行的 ED 床旁超声 (POCUS) 显示拇长屈肌 (FPL) 肌腱周围水肿，表现为低回声液体……