Musculoskeletal Injuries 331318.A 43-year-old man presents to the ED complaining of right hand
pain. The individual states that 3 days ago he accidentally punctured his
index finger with a thumb tac. Subsequently, the finger became red and
began to swell, and he had pain with movement of the finger. His tetanus
status is up to date. You suspect the patient’s diagnosis is tenosynovitis.
Which of the following statements regarding Kanavel four cardinal signs of
flexor tenosynovitis is correct?
a. The infected finger is held in slight flexion at rest
b. Asymmetric swelling of the finger
c. Tenderness along the extensor tendon sheath
d. Painless with passive range of motion
e. Purplish hue at the distal tip
319.A 29-year-old figure skater lands incorrectly after a jump and injures
her right ankle. She stands up on her own but has difficulty bearing weight
so she calls EMS. She presents to the ED with swelling and tenderness of her
lateral malleolus. You palpate a dorsalis pedis and posterior tibialis pulse.
She is able to plantar and dorsiflex without difficulty. You are unsure if the
patient requires an ankle radiograph because you think she only sustained a
sprain. In addition to pain near the malleoli, which of the following is an
indication for a radiograph according to the Ottawa ankle and foot rules?
a. Boney tenderness is present at the anterior edge of the distal 12 cm or at the tip
of either malleolus.
b. The patient is able to bear weight for at least four steps immediately after the
injury but not at the time of evaluation.
c. Boney tenderness is present at the navicular or at the base of the fifth metatarsal.
d. The Achilles reflex is diminished on the side of the injury.
e. An effusion is present on clinical examination.