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.
Collar Button Abscess
Web space infection of the palmer AND dorsal hand
The Palmer aponeurosis prevents volar extension (but promotes dorsal encroachment)
The pus spreads between the MC bones and erupts dorsally....creating a DORSAL abscess.
Loss of palmer concavity is seen.
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!
Can be missed if only focused on the dorsal hand. The palm will show the original injury (splinter, cut, foreign body)
