Acute blue finger syndrome: a rare benign cause of acute digit discolouration

Abstract

Acute blue finger syndrome is a rare benign condition that mimics digital ischaemia. We discuss the case of a 32-year-old woman who presented with a 6hour history of blue discolouration of the middle finger of the right hand, associated with pain and swelling. There was no history of trauma and this was the first time that the patient had experienced these symptoms. Examination found blue discolouration of the digit primarily on the volar aspect with associated swelling. All investigations, including blood tests, X-rays and Doppler scanning, were normal. The symptoms resolved spontaneously within 48 hours. There were no recurrent episodes or long-term sequelae. Patients presenting with an acutely blue finger need rapid assessment to exclude digit ischaemia. Knowledge of this rare benign condition may prevent unnecessary distress, invasive investigations and potentially harmful treatment of a healthy patient.

Achenbach’s hand and digital paroxysmal haematomas: a possible association with joint hypermobility syndrome in two sibling cases

“…3 The application of either a circulatory disease algorithm, 3 or a sieve, 7 duplex sonography and or peripheral angiography may be used to exclude ischaemic conditions. 2 However, given the characteristic presentations, the two-to four-day spontaneous regressions and the fact that Achenbach's syndrome has no association with serious bleeds into other organs, 2,3 the need for any invasive diagnostics is usually precluded, 2,[5][6][7] just simply the delivery of some simple reassurance. 2,3 Similar comorbidities that were present in the hygienist have been previously reported in other Achenbach patients, but no pathogenic connections have ever been established.…”

“…5 The syndrome is characterised by recurrent episodes and while a third of cases arise from simple, every-day manual activities, most develop spontaneously and without any abnormal coagulation variables. 3,6 In Britain, the female to male predilection is 6:1 7 with a median presentation age of 50 years, 3 but at present, there seem to be neither prevalence nor incidence data published for this condition, nor any aetiological explanations.…”

“…The condition of either a palm or a proximal/middle finger phalange experiencing a sudden sharp pain, followed by volar, sub-cutaneous bleeding and blueblack discolouration with swelling and numbness that develops over a few minutes, was first described by Achenbach in 1957. 1 Other cases have since been published, [2][3][4][5][6][7][8][9] involving restricted finger bending, 8 digital swelling in 60% of cases and paraesthesia and or itching in 25% of cases. 3 As the haematoma enlarges, it spreads into the adjacent phalanges and the palm of the hand with ensuing pain relief, 2 but characteristically never into the fingernail or fingertip.…”

“…Other cases have since been published, 2 – 9 involving restricted finger bending, 8 digital swelling in 60% of cases and paraesthesia and or itching in 25% of cases. 3 …”

“…The syndrome is characterised by recurrent episodes and while a third of cases arise from simple, every-day manual activities, most develop spontaneously and without any abnormal coagulation variables. 3 , 6 …”