Questionnaire/history:

Penetrating injuries to the palmar surface of the hand or digits (eg thorns, cat bites)?

Examination:

Acute redness, pain and swelling on the palmar aspect of the hands or fingers?

Tenderness?

Kanavel signs (combined together are highly sensitive for flexor tendon sheath infection):

Exquisite pain on passive extension of the finger (earliest sign, absence of which should be documented if treating a palmar infection in the community)

Finger rests in a partially flexed position

Exquisite pain on palpation along the length of the flexor sheath

Fusiform swelling of the affected digit (late sign)

Management:

Referral to on-call orthopaedic team for prompt surgical wash-out to prevent long-term stiffness, pain and weakness

Resource(s):

BJGP 2019