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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Kanavel's Four Cardinal Signs



- Discussion:
    - for diagnosing infectious tenosynovitis;
    - intense pain accompanies any attempt to extend partly flexed finger;
          - this is absent in local involvement;
          - pain will be noted along the course of tendon with extension;
          - this is the earliest and most important sign;
          - in case of a local furuncle, in contrast, the finger can be held straight without much pain;
    - flexion posture: finger is held in flexion for comfort;
    - uniform swelling involving entire finger in contrast to localized swelling in local inflammation;
    - percussion tenderness along the course of the tendon sheath;
          - tenderness is marked along the course of inflammed sheath in contrast to its absence in a localized inflammation;

- Diff Dx:
    - beware that a mid palmar space abscess may elicit pain w/ attempted passive motion of the ring and long fingers;
    - localized bleeding into the tendon sheath may occur in patients on coumadin, and this will give the exact appearance of infectious tenosynovitis



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 15, 2012 3:49 pm