Title: Collar Button Abscess<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p>
47yo M chef presents to your ED with 2 days of worsening left hand pain after sustaining a puncture wound to hand at work. The hand is red and swollen and he complains of pain. Interestingly, his index and middle digits are in an ABducted position at rest.</p>
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<strong>Collar Button Abscess</strong></p>
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Web space infection of the palmer AND dorsal hand</p>
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The Palmer aponeurosis prevents volar extension (but promotes dorsal encroachment)</p>
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The pus spreads between the MC bones and erupts dorsally....creating a DORSAL abscess.</p>
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Loss of palmer concavity is seen.</p>
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ABduction of the adjacent digits, resulting in a "V" configuration with the apex pointing to the site of infection. This would not happen from simple pus in the dorsal space!</p>
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Can be missed if only focused on the dorsal hand. The palm will show the original injury (splinter, cut, foreign body)</p>
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Treatment is urgent surgical drainage.</p>
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http://www.eplasty.com/article_images/eplasty16ic06_fig1.gif</p>
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<span class="tl-document" font-size:="" font-weight:="" new="" style="display: block; font-family: " times="">Collar Button Abscess 2016</span></p>
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<span class="tl-document" font-size:="" font-weight:="" new="" style="display: block; font-family: " times="">www.eplasty.com</span></p>
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<span class="authors" font-size:="" font-style:="" font-weight:="" new="" style="font-family: " times="">Elle Kalbfell, BS<sup>a</sup>, Nicholas S. Adams, MD<sup>a,b</sup>, and William T. Cullen, MD, MA, FACS<sup>a,b,c</sup></span></td>
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