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50ish man w/ DM s/p renal tx p/w pneumonia & delirium. RN puts on mitts. Next day, his finger hurts. On physical exam, you note fusiform swelling, tenderness along palmar aspect of the finger, and pain with passive extension. What’s your ddx? #Physicalexamfriday #IDconsults 
The patient met 3 out of 4 Kanavel criteria for pyogenic flexor tenosynovitis (fusiform swelling, tenderness over the tendon, pain with passive extension, finger in slight flexion). MRI confirmed the diagnosis and orthopedic surgery took him to surgery for debridement...
Dr. Kanavel was a surgeon at Cook County who described the signs in 1912. They have been used ever since and were finally validated over a hundred years later in 2017 (Hand (N Y). 2017 Nov;12(6):585-590). I got my hands on a copy of his original book!
