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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