Intended for healthcare professionals

Endgames Spot Diagnosis

An endoscopist with a painful finger

BMJ 2019; 365 doi: (Published 29 May 2019) Cite this as: BMJ 2019;365:l1485
  1. Taj Tomouk, CT2 in plastic surgery1,
  2. Meg Birks, consultant orthopaedic surgeon2
  1. 1Royal Free Hospital, London, UK
  2. 2Northern General Hospital, Sheffield, UK
  1. Correspondence to T Tomouk t.tomouk{at}

A middle aged gastroenterologist presented with a two day history of sudden onset and exquisitely painful erythematous swelling around the distal interphalangeal joint of her left ring finger. She had no history of acute trauma but described repetitive hand use while performing four endoscopy sessions weekly for around 25 years: the left hand had been used to manoeuvre the endoscope and the left ring finger to press the control buttons. She was otherwise fit and well, right handed, and a non-smoker.

Flexor sheath …

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