Jesus, Mary and Joseph, and all the angels and saints of the most high God in heaven above, save us and preserve us.

Major distress. This is flexor tenosynovitis. Go ahead. Google it. Now you understand why I am very, very distressed to see this.

PTZ can serve a useful purpose. Zitpopping is a normal, human/simian behavior. There are place you don’t do this. You don’t pop a zit in the triangle formed by the corners of your mouth and the bridge of your nose; and you don’t pop zits when you have a medical emergency. Which flexor tenorsynovitis certainly is. This is not fun. This is loss of function, with sequelae that…..

Look, I had a pt come in once who had had this. And it healed up, “got all better.”

No, it did not. The deep spaces of the hand (palmar and thenar) contain an astonishingly-great capacity to hide, store and incubate purulent material. You take this pt to the ER stat, open the palm and debride like you’re some kind of barbarian horde. One fellow I worked with would spend a few hours pulling the junk out of the hand, and then irrigate with FULL STRENGTH betadine. This new patient had a hand that was not all better. The infection had fulminated in the deep spaces for months, doing irreparable damage to tendons and sheaths, as well as nerve and vascular bundles. He transferred to a public hospital for course of IV vancomycin, so I don’t know the outcome, but the statistics are bad, more than half of “untreated” cases lose the hand or much of it, and mortality is quite high as well.

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