![]() Radiographs of the left hand revealed no acute osseous abnormalities, no retained foreign bodies, or evidence of osteomyelitis. His physical examination was significant for fusiform swelling, tenderness along the flexor tendon sheath, and limited extension of the left ring finger. The patient re-presented to his primary care physician 6 months after the initial envenomation injury, at which time he endorsed 3 months of insidious onset pain and swelling isolated to the left ring finger. ![]() ![]() His symptoms resolved over the course of 1 week. He was treated with a combination of oral prednisone, topical corticosteroid, topical antibiotic, and diphenhydramine. The patient experienced an acute localized inflammatory reaction to the envenomation injury. He sustained the injury while snorkeling. 4, 6 - 8Ī 30-year-old, healthy, immunocompetent, experienced male diver initially presented on the Pacific island of Guam with pain and swelling of his left ring finger immediately after a sting injury from a stonefish. 5 The dorsal spine's verrucotoxin acts on beta-adrenergic receptors and induces a cascade of histamine and catecholamines release. Stonefish are equipped with a venom apparatus that transmits venom originating in the paired glands lying in the two lateral grooves at the base of each spine when mechanical pressure is applied. Swimmers in shallow water may inadvertently step on or grab the fish, triggering an envenomation injury. The fish's vernacular name derives from its mottled brown-green pattern, giving it the ability to camouflage itself among stones and corals. 4 The stonefish, Synanceia verrucosa, is one of the more venomous fish to be found in the Pacific basin (Figure (Figure1). Stingrays, spine fish such as the stonefish and lionfish, sea urchins, sponges, and octopuses are common culprits for envenomation injuries. 2Įnvenomation from marine life is an injury risk for those participating in aquatic activities in the Pacific islands. 1 - 3 Whereas acute tenosynovitis commonly occurs via direct inoculation, IV drug use, or overuse, chronic tenosynovitis is less commonly caused by envenomation injuries. Tenosynovitis refers to a well-localized inflammation of a tendon and its synovial sheath, occurring commonly in the hand and wrist.
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