This patient in their 50s had been referred to the radiology department by a hand surgeon, for an ultrasound of the finger with suspicion of flexor tenosynovitis.

Initial images ultrasound images show thickening of common flexor tendon of the finger associated with hyperaemia on power Doppler suggestive of tenosynovitis.

I was concluding the scan, and the patient suddenly recalled that she did some work in her garden a few weeks earlier and  since then she had  noticed symptoms. She also reported the sensation that something was inside. Following a further careful examination under ultrasound there was indeed a focal hyperechogenic lesion noted underlying the flexor tendon over the middle phalanx associated with minimal granulation tissue. Appearances are consistent with a foreign body, potentially a wood splinter. The patient was referred back to the Orthopaedic team who surgically removed a wood splinter.

Ultrasound report

There  is  a  focal  hyper echogenic  lesion  measuring  4mm  in length  noted  underneath  the  flexor  tendons  near  to  the  PIP  joint  of the  right  middle  finger  associated  with  a  moderate  degree  of thickening  of  common  flexor  tendon  sheath  and  neovascularity  on  power  doppler. Appearances  are  consistent  with  a  foreign  body  possible  splinter within  the  common  flexor  tendon  sheath  associated  with  tenosynovitis.

Subsequent xray reports ‘No  radiopaque  foreign  body  /  periosteal  reaction  is  seen’ , the images can be seen below.

The lack of posterior shadowing is suggestive of a less dense structure compared to a needle or metal. This can also be seen in another case study of a foreign body at the ankle.

Some articles on foreign bodies and their sonographic appearance.

Mohammadi, A., Ghasemi-Rad, M and Khodabakhsh, M (2011) Non-opaque soft tissue foreign body:sonographic findings, BMC Medical Imaging, 11:9.

Peterson, J., Bancroft, L., Kransdorf, M (2002) Wooden Foreign Bodies: Imaging Appearance, American Journal of Roentgenology, 178(3).

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