One of your patients calls you on the weekend; she is concerned with extreme pain

One of your patients calls you on the weekend; she is concerned with extreme pain in her right index finger. She helped someone move the previous Friday and Saturday, during which time she sustained a small puncture from a staple on a box. The puncture is at the base of her right index finger; it did not bleed. She considered it no big deal, and she put an adhesive bandage on it with some antibiotic cream. That was 24 hours ago, and now, the pain in her finger is excruciating. She says that the finger is red and swollen up twice its normal size. What factors about musculoskeletal trauma do you consider as you evaluate this situation? The rapid extensive swelling and erythema, along with the extent of the pain involved, indicate that this is compartment syndrome and requires immediate surgical intervention. Infection takes longer than 24 hours to develop. She can expect this to resolve within 1 or 2 weeks if she continues to keep the puncture wound clean and keeps using the antibiotic ointment as directed. Inflammation is expected after any musculoskeletal trauma. This is not worrisome unless she becomes febrile.

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