Hand infections: Kanavel signs: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Hand infections: Kanavel signs

Sample item

A carpenter has a swollen, flexed index finger after a puncture wound 3 days ago. Which Kanavel sign is considered the most important in diagnosing pyogenic flexor tenosynovitis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Severe pain on passive extension of the finger

The four Kanavel signs are flexed posture, fusiform swelling, tenderness along the flexor sheath and pain on passive extension. Pain on passive extension, because it stretches the inflamed sheath, is regarded as the most important and earliest sign. Treatment is urgent drainage with antibiotics.

Option by option

  • A. Tenderness over the dorsal metacarpal head

    Dorsal metacarpal tenderness is not a sign of sheath infection.

  • B. Severe pain on passive extension of the finger (correct)

    Correct. Pain on passive extension is the key Kanavel sign.

  • C. Numbness over the dorsal web space

    Web space numbness is not one of the four signs.

  • D. Pain on resisted abduction of the finger

    Resisted abduction pain does not form part of the Kanavel signs.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Severe pain on passive extension of the finger. The four Kanavel signs are flexed posture, fusiform swelling, tenderness along the flexor sheath and pain on passive extension.

Why is "Tenderness over the dorsal metacarpal head" not the answer?

Dorsal metacarpal tenderness is not a sign of sheath infection.

Why is "Numbness over the dorsal web space" not the answer?

Web space numbness is not one of the four signs.

Why is "Pain on resisted abduction of the finger" not the answer?

Resisted abduction pain does not form part of the Kanavel signs.

What concept does this question test?

It tests Hand infections: Kanavel signs in Orthopaedics. Pain on passive extension, because it stretches the inflamed sheath, is regarded as the most important and earliest sign. Treatment is urgent drainage with antibiotics.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hand infections: Kanavel signs?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.