Author Topic: Let's diagnose my finger  (Read 1234 times)

Let's diagnose my finger
« on: June 10, 2019, 10:33:14 am »
Yesterday, whilst down the allotment, I was clearing a path of the encroachment of an abandoned neighbour plot's goji berry bush. I'd taken the brushcutter to it and was clearing the resultant mess when I managed to - as I thought - get a thorn puncture the first joint of my third finger leaving some of the thorn behind in the wound.

Forward three hours and by the time I got home the pain was Not Good, there was substantial swelling and I'd lost movement in it.  I dug the rest of the thorn out with a pokey thing and tweezers, but it was clearly Not Right. After consulting 111 I took me to A&E where I discovered that there is something worse than sitting for hours in A&E on a Sunday night -  sitting in A&E on Sunday night with a littl'un watching peppa pig on their iPad at full volume.

I was the beneficiary of an x-ray which was meant to identify if anything was left in the wound (Really? sub mm particles, too?) and eventually sent away with broad spectrum antibiotics by a doctor who had no real idea what might have caused the reaction, which frankly is what I would like to know.

Today, there is a small improvement in that I now have almost 30 degrees of free movement from the joint  (it won't straighten and doesn't reach 90, still only about 5 degrees at the knuckle, still hot and swollen around that first joint. My plan is to visit the doctor tomorrow if there is no substantial improvement, although I don't hold out much hope of their knowing much more about the origin and likely remedy.

In the meantime, feel free to provide a diagnosis of the cause of the reaction. Can a normal infection really occur that quickly? Is there poison involved? Bitten by a critter? A subminiature alien ray gun?

ElyDave

  • Royal and Ancient Polar Bear Society member 263583
Re: Let's diagnose my finger
« Reply #1 on: June 10, 2019, 10:40:59 am »
Allergic reaction?

Olde unnoticed wound? I know from experience that there are some things like Robinia Pseudoacacia thorns that if not fully extracted casue painful swelling and mankiness 2-3 days later, but not to that extent in my experience.

Physical injury - i.e. gave it a whack or overextended it?
“Procrastination is the thief of time, collar him.” –Charles Dickens

Re: Let's diagnose my finger
« Reply #2 on: June 10, 2019, 10:46:27 am »
Allergic reaction?


I'm not allergic to anything I know of, although there clearly was clearly a violent reaction to something. I'm interested to know what it might be as, all things being equal, my life is complete without additional Peppa Pig.

Quote
Olde unnoticed wound? I know from experience that there are some things like Robinia Pseudoacacia thorns that if not fully extracted casue painful swelling and mankiness 2-3 days later, but not to that extent in my experience.
No. I'm well used to fossicking around with a pointy thing to remove old stuff. I felt this happen, and examined after, I could see there was something that I would need to attend to at some point.

Quote
Physical injury - i.e. gave it a whack or overextended it?

Again, no.

Re: Let's diagnose my finger
« Reply #3 on: June 10, 2019, 10:50:45 am »
Definitely take antibiotics in case it's an infection, and from experience I would go back to the doctor and/or A&E with an exponentially increasing sense of impending doom if you aren't getting taken seriously.
It is what it is. It's not what it's not, so it must be what it is.

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Let's diagnose my finger
« Reply #4 on: June 10, 2019, 10:53:40 am »
Sounds like a localized inflammatory reaction (it doesn't have to be an allergy per se). My wife got bit on the foot by a spider and the whole thing swelled up to proportions where I didn't know whether to laugh or hide. Once I did the first, it became rapidly prudent to do the second. Fortunately, by this time she wasn't very good at chasing me.

Similarly, I got bit on the hand by a geographically confused Blandford fly and within an hour the side of my hand had swollen to the size of a tennis ball. One that pulsated with each heartbeat. The doctor prescribed the usual horse pill antibiotics but I don't think it was infected.
!nataS pihsroW

Re: Let's diagnose my finger
« Reply #5 on: June 10, 2019, 11:04:41 am »
Well, yes. It's easier to understand a reaction like this from a critter than it is from a thorn of a not-that-poisonous plant (goji is apparently related to nightshade/potato things). I'm certain I would have seen a flying thing, and I was wearing fabric backed nitrile gloves, so a spider might have come up with a mouthful of fur. And, I pulled something out the wound which would preclude most sting-y things, except for a bee which it wasn't. Scorpion might fit the bill but we aren't too worried about those in this country. The area I was clearing might well have been the habitat of some critter, though.

T42

  • Tea tank
Re: Let's diagnose my finger
« Reply #6 on: June 10, 2019, 11:18:01 am »
Where's Gus McCrae when you need him?
I've dusted all those old bottles and set them up straight.

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Let's diagnose my finger
« Reply #7 on: June 10, 2019, 11:19:56 am »
I don't think the source matters so much – it can be plant or animal – anything the body perceives as being an unusual addition to its normal internal line-up can cause a reaction and once the cascade kicks in the result can be some epic swelling that takes several days to decline. They offered me oral steroids, which I decline and just settled for the antibiotics just in case.
!nataS pihsroW

hellymedic

  • Just do it!
Re: Let's diagnose my finger
« Reply #8 on: June 10, 2019, 12:11:38 pm »
Thoughts:

1) I also doubt a thorn would show up on X-ray but gas in the tissues would. Many (but not all) tiny glass splinters are radiopaque.
2) I am concerned you might have mischief within the flexor tendon sheath, which really needs the input of a hand specialist.
3) Can we have a picture or two?

Re: Let's diagnose my finger
« Reply #9 on: June 10, 2019, 12:20:25 pm »
2) I am concerned you might have mischief within the flexor tendon sheath, which really needs the input of a hand specialist.


Who may be along shortly.

I wondered whether some antihistamine early doors might have reduced the symptoms.
L'enfer, c'est les autos.

Kim

  • Timelord
Re: Let's diagnose my finger
« Reply #10 on: June 10, 2019, 12:25:05 pm »
I wondered whether some antihistamine early doors might have reduced the symptoms.

I generally reach for the chlorphenamine after any kind of triffid bite.  But I'm comprehensively allergic to green stuff (and some of the beasties who may be lurking amongst the green stuff).
To ride the Windcheetah, first, you must embrace the cantilever...

Re: Let's diagnose my finger
« Reply #11 on: June 10, 2019, 12:47:14 pm »
not enough info really.  was the thorn on the palmar aspect or the back of the hand. 
is first joint the one at the nail or the one in the palm.

Many thorns can produce a very severe reaction from direct irritation.  The classic is blackthorn but I have seen in with pyracantha, hawthorn and many others.

If it goes in to any depth and pentrates the tendon then bits can break off and cause longer problems.

If on the palmar aspect then a flexor sheath infection is possible but they are unusual.

the x-ray was done to cover themselves against being sued.  many patients lie about the cause of injury but splinters do not show up on x-ray and need a very good ultrasonographer.  Even then I have found bits of thorn when the ultrasonographer had said there was nothing.


Re: Let's diagnose my finger
« Reply #12 on: June 10, 2019, 12:49:22 pm »
Thoughts:

1) I also doubt a thorn would show up on X-ray but gas in the tissues would. Many (but not all) tiny glass splinters are radiopaque.
I think (?) I can be reasonably certain that no glass is involved
Quote
2) I am concerned you might have mischief within the flexor tendon sheath, which really needs the input of a hand specialist.

I would have thought (again, ?) that mechanical damage would have been felt close to immediately

Quote
3) Can we have a picture or two?

Wot? even though the pics probably make it look pathetic and not worthy of concern? OK

Here's an image I took before the diggage out of object.



Here's the now




hellymedic

  • Just do it!
Re: Let's diagnose my finger
« Reply #13 on: June 10, 2019, 12:50:33 pm »
2) I am concerned you might have mischief within the flexor tendon sheath, which really needs the input of a hand specialist.


Who may be along shortly.

I wondered whether some antihistamine early doors might have reduced the symptoms.

I was thinking of Ham actually getting seen by a hand bod.

Flexor tendon sheath trouble needs prompt personal attention. I am not in a position to assess Ham's hand from here. Somebody Who Knows should SEE him IMHO.

Re: Let's diagnose my finger
« Reply #14 on: June 10, 2019, 12:53:11 pm »
not enough info really.  was the thorn on the palmar aspect or the back of the hand. 
is first joint the one at the nail or the one in the palm.

Many thorns can produce a very severe reaction from direct irritation.  The classic is blackthorn but I have seen in with pyracantha, hawthorn and many others.

That sound like it, really. goji has wicked thorns. Was about 4mm I removed.




ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Let's diagnose my finger
« Reply #15 on: June 10, 2019, 12:54:17 pm »
Amputate, you know it makes sense. You have ten fingers so unless you're really into counting, you can spare a few.
!nataS pihsroW

Re: Let's diagnose my finger
« Reply #16 on: June 10, 2019, 12:54:54 pm »
Thank you for the photos.  they show a dorsal penetrating injury at the level of the PIP joint.  Assuming a typical tropicalish thorn this had a high risk of pentrating the PIPjoint.

Antihistamines are not indicated but antibiotics are.

If the antibiotics have not reduced pain and swelling in 24 hours or the pain is getting worse then head back to A&E and ask how they are ruling out a septic arthritis secondary to a pentrating wound.

Kim

  • Timelord
Re: Let's diagnose my finger
« Reply #17 on: June 10, 2019, 12:55:28 pm »
Amputate, you know it makes sense. You have ten fingers so unless you're really into counting, you can spare a few.

And do all your gardening with glyphosate in future.  Much safer.
To ride the Windcheetah, first, you must embrace the cantilever...

Re: Let's diagnose my finger
« Reply #18 on: June 10, 2019, 12:57:01 pm »
4mm length at right angles to the skin at that level is definately in the joint.  Either direct reaction or sptic arthritis real possibilities.

Where do you live?

Re: Let's diagnose my finger
« Reply #19 on: June 10, 2019, 12:58:56 pm »
Thanks for that, I was planning on evaluating tomorrow and heading to a doctor as a means to finding a hand bod, as opposed to A&E, but your suggestion seems sound to me. Again if at any time it appeared to be worsening I'd be doing something about it, too. East London is where I am

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Let's diagnose my finger
« Reply #20 on: June 10, 2019, 01:04:07 pm »
Amputate, you know it makes sense. You have ten fingers so unless you're really into counting, you can spare a few.

And do all your gardening with glyphosate in future.  Much safer.

Agent Orange. From a helicopter. It's the only way.
!nataS pihsroW

Re: Let's diagnose my finger
« Reply #21 on: June 10, 2019, 01:06:25 pm »
Amputate, you know it makes sense. You have ten fingers so unless you're really into counting, you can spare a few.

And do all your gardening with glyphosate in future.  Much safer.

Agent Orange. From a helicopter. It's the only way.

You see, Ian, that's where your plan re amputation falls down. If agent orange visits this country again, I'm really going to need EXACTLY that finger.

hellymedic

  • Just do it!
Re: Let's diagnose my finger
« Reply #22 on: June 10, 2019, 01:52:11 pm »
Are you left-handed then?

Re: Let's diagnose my finger
« Reply #23 on: June 10, 2019, 01:54:10 pm »
Are you left-handed then?

As any fule kno you need BOTH hands simultaneously for someone like that

Re: Let's diagnose my finger
« Reply #24 on: June 11, 2019, 10:49:29 pm »
There's some very nasty thorns out there. Back in the day we had a village Bobby. A mad gardener he wrote an article in the neighbourhood watch newsletter about plants to put in your garden for security. One plant was euphorbia which has nasty thorns which introduce a chemical into the wound that causes painful red wealds where it scratches. Those wealds last for weeks and at the very least if you are burgled there is a good chance those thorns have marked the miscreant. Since police often know who is most active they can simply spot the one showing signs of painful scratches.

That copper was very inventive and more than a little sadistic with his plant choice and advice on their location.

My point is simple plant thorns are often more to them than just the scratch or penetration. You could simply have a reaction to the thorn.