CHIEF COMPLAINT:
Right index finger pain.
HISTORY OF PRESENT ILLNESS:
A 24 year old female presents to the Emergency Department complaining of severe, sharp, and constant right index finger pain for two days. She has had a recurrent problem with the same type of discomfort and recently ran out of medication used for its treatment. She also has blisters at the painful site. She denies fever or trauma. She reports her problem originally began several years prior when, as a police officer, she frisked a prostitute who was not wearing underwear.
PHYSICAL EXAMINATION:
Our patient is an alert white female in moderate discomfort. Her vital signs are: temperature 99.8o F (oral), pulse 92 beats per minute, blood pressure 133/88 mmHG, and respirations 18 per minute. Her right index finger has a 0.8 cm area of irregularly shaped vesicles on an erythematous base with mild, localized, non-fusiform swelling. This area is extremely tender to palpation, although there is no worsening of her pain with active or passive flexion and extension. Flexor digitorum profundus, flexor digitorum superficialis, and extensor digitorum function is normal. No tenderness can be elicited along the course of the flexor tendon sheath and there is no evidence of lymphangitis. She has full range of motion, normal capillary refill, and her two point discrimination is less than five millimeters.
Her right upper extremity does not have antecubital or axillary adenopathy. The rest of her physical examination is normal.
LABORATORY:
Our patient's complete blood count and erythrocyte sedimentation rate is normal.
From Academic Emergency Medicine 1(3) 1994 May/June
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