Linda Morris, Alan Stevens, Michael Doherty
Case report A 21 year old white medical student asked for informal advice while she was attached to the rheumatology module. She gave a 10 year history of chronic pain and stiffness affecting the index finger of her left hand, with swelling of the proximal volar aspect of the finger. Over the last year she had noticed increasingly frequent triggering and difficulty with precision movements of the left hand. She was otherwise fit and well.
Examination 3) and, like the semi-crystalloid blackthorn and date palm tips, may act as inflammatory extrinsic crystals or particles.'9 Alternatively the, protein epithelium may possess phlogistic potential.5
In Europe plant thorns, especially blackthorn and rose, are the more usual extrinsic agents to cause acute and chronic synovitis.' Nevertheless, with increased foreign travel radiograph. She was undertaking no unusual repetitive activity to cause chronic traumatic tenosynovitis, and had no -overlying callus or skin change. Imaging and biopsy were the key investigations; her symptoms and disability warranted total excision of abnormal tenosynovium. Histology was non-specific but consistent with urchin spine synovitis. 3 Penetrating foreign body injury is often overlooked as a cause of monosynovitis. 

{'paper_id': '11912551', 'title': 'Chronic flexor tenosynovitis: missed diagnosis for a decade.', 's2_url': 'https://api.semanticscholar.org/CorpusID:11912551', 'source': 'S2ORC'}