Horseshoe abscess: Hand

Abstract

Fig. Artist illustrations of the synovial sheaths and bursae of the wrist and hand, with the distribution of a horseshoe abscess extending along the radial and ulnar bursae.

Infections of Deep Hand and Wrist Compartments

“…No other clinical examination has proven to be superior to date (Figures 1 and 6). However, flexor tenosynovitis can be initially present without all four Kanavel's signs and caution should be applied when using the absence of one or more Kanavel's signs to exclude the diagnosis [27,28]. a partially flexed resting posture of the finger, and volar tenderness along the length of the finger and into the palm.…”

“…The synovial sheaths of both the flexor polices longus continues proximally as radial bursa, whereas the tendon sheaths of the ulnar digits or only the little fingers, continue proximally as the ulnar bursa, where both communicate with each other via the carpal tunnel to the space of Parona. This is a potential space at the level of the distal forearm, between the profundus tendons and the pronator quadratus [27,29,32] (Figure 7). Ulnar bursitis of the hand is characterized by the development of hand oedema, especially upon the dorsal aspect, and it is often difficult to be diagnosed due to its deep location.…”

“…There is exquisite tenderness and the wrist becomes fixed, whereas the little finger and sometimes ring finger show tenderness to palpation and pain on passive extension. Extension to the radial bursa is observed up to 85% of cases [27,28]. Radial bursitis is diagnosed by the swelling and tenderness in the thenar eminence and along the radial bursa [28].…”

“…Radial bursitis is diagnosed by the swelling and tenderness in the thenar eminence and along the radial bursa [28]. An infection that starts in the thumb might spread to the fifth digit via the wrist and vice-versa due to this connection, thus creating a horseshoe shaped abscess [27] (Figure 4). Special attention should be paid when tenderness is abruptly subsiding.…”

“…Deep space abscesses involving the thenar, the mid-palmar, the Parona's space, or the interdigital web spaces of the hand usually arise from direct inoculation or contiguous spread (Figure 7). Marked swelling, oedema, warmth, and pain are prominent, and the ultrasonography or magnetic resonance imaging may help in the differentiation from a superficial infection [27,29,32].…”