Extremely Late Presentation of Catfish Spine Injury to the Hand

To the Editor:

A 48-year-old male, right-hand-dominant, was evaluated for stiffness in his left index finger. He stated that this was related to an injury he had 10 years before, when he was fishing in Galveston, Texas and caught a hardheaded catfish. He stated that the catfish's dorsal fin spine had struck him in his left index finger, and the finger had swelled, turned purple, and looked “angry”; but he did not seek medical treatment at that time. He was convinced that no part of the spine had been left in the finger.

Although the finger had felt stiff occasionally through the years following the injury, at the time he presented, this was getting worse. When he first woke up in the morning, he noted he could barely flex the proximal interphalangeal (PIP) joint past 90°. He had not had any locking, but the finger would occasionally “catch.” He played guitar for a hobby, and felt that the stiffness was decreasing his ability to play.

An x-ray series of his left hand obtained during the first office visit was interpreted as normal, and did not show any obvious foreign body, erosions, or sign of bony injury.

Physical exam of his left index finger was also normal, and did not show any swelling, warmth, or palpable mass. Although flexion and extension was full, end-range of flexion was perceived by the patient as feeling tight. There was no tenderness at the A1 pulley, and the ligaments were stable.

The patient initially wished to try a cortisone injection and a course of hand therapy. For 6 months after the cortisone injection to the left index finger flexor tendon sheath, his symptoms were relieved, but they then returned to the prior level.

A repeat x-ray of the digit using soft-tissue technique showed an approximately 5 mm by 1.5 mm foreign body on the ulnar volar aspect of the proximal phalanx.

At surgery, a catfish spine fragment was removed after it was located in a mass of scar tissue between the digital nerve and artery on the ulnar aspect of the digit. Neither the nerve nor the artery had been damaged. Smooth flexor tendon gliding was inhibited by an enlargement of the flexor profundus tendon in the area of the PIP joint. The ulnar slip of the flexor superficialis tendon was excised, which markedly improved tendon gliding.

Gram stain and all cultures were negative, including for Mycobacterium marinum. Pathology tissue evaluation showed a foreign body measuring 0.6 cm in length and 0.2 cm in diameter and synovial fibromatosis with a foreign body type reaction.

The range of motion of his finger returned to normal postoperatively.