J Korean Soc Surg Hand.  2015 Dec;20(4):186-192. 10.12790/jkssh.2015.20.4.186.

Acute Horseshoe Abscess of the Hand after Local Steroid Injection: A Case Report

• Kim YJ
• Kang CM
• Lee HH
• Chung DW

• KMID: 2150401
• DOI: http://doi.org/10.12790/jkssh.2015.20.4.186

Abstract

The differential diagnosis of hand infections is difficult because hand infections can manifest with variable clinical presentations due to the unique anatomic structures of the hand, and the significance of these infections is often overlooked. A horseshoe abscess is a rare type of deep space infection that can occur due to extension of infection through communications between the deep spaces of the hand. Although horseshoe abscesses are well known due to their anatomic characteristics, there are few clinical reports of such occurrences. Such a case has not been reported in the Korean literature. Here we report a case of horseshoe abscess of the hand after local steroid injection.

Keyword

Hand; Infection; Flexor tenosynovitis; Horseshoe abscess

MeSH Terms

Abscess*
Diagnosis, Differential
Hand*

Figure

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  Fig. 1. Preoperative photographs of the right hand. Note the diffuse swelling and erythema of the entire hand including the thenar and hypothenar areas. Swelling was obvious distal to the wrist crease.

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  Fig. 2. A contrast-enhanced magnetic resonance image demonstrating fluid collection with distension, and the common flexor tendon sheath, radial and ulnar bursae, and first and fifth flexor tendon sheaths showed diffuse inflammation around the tendon sheaths and adjacent lumbrical muscles.

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  Fig. 3. Intraoperative photograph showing a gush of turbid fluid from the abscess after carpal tunnel release (A). White foreign material after the skin incision and pulley release of the thumb (B). Two multiple nested catheters were inserted through both incisions (C).

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  Fig. 4. Photographs at 8 weeks after the operation. Of note, the patient had a pain-free active grip (A) and full extension with a cosmetically acceptable scar (B).

Reference

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