Construction Worker with Painful Swelling on the Hand

Abstract

A 27-year-old right-handed construction worker presented to the emergency department with a 1-week history of an enlarging, rounded, and painful swelling at the base of the right thumb (Figure 1). A history of trauma was denied. On clinical examination, there was no numbness or paresthesia. However, the Tinel sign of the palmar thumb nerve was positive. Capillary refill was normal. Leucocyte count and C-reactive protein level were within the normal range. Point-of-care sonography showed a subcutaneous, hypoechogenic lesion of 3 × 2 × 1 cm over the thenar muscles with substantial vascularization (Figure 2).