Author response: Is fenestration really needed?

Drs. DeCastro, Stanton, and I thank Dr. Chee for presenting another approach to the treatment of subungual hematoma—a subject that has generated much debate.  We would point out, however, that fenestration of subungual hematoma is often required for pain relief, and that studies have found the overall complication rate to be low.^1,2

We would also like to take this opportunity to clarify our recommendation in Case 4, in which the patient had Jersey finger, caused by traumatic avulsion of the flexor digitorum profundus  from the distal phalanx.  In recommending ultrasound of the finger and palm, we were referring to musculoskeletal ultrasound (MSKUS)—a point-of-care scan typically done by primary care physicians and involving little or no cost. While MSKUS provides more information about the injury, it cannot replace clinical judgment and input from a hand surgeon, when warranted.

James M. Daniels, MD, MPH
Quincy, Ill

Drs. DeCastro, Stanton, and I thank Dr. Chee for presenting another approach to the treatment of subungual hematoma—a subject that has generated much debate.  We would point out, however, that fenestration of subungual hematoma is often required for pain relief, and that studies have found the overall complication rate to be low.^1,2

We would also like to take this opportunity to clarify our recommendation in Case 4, in which the patient had Jersey finger, caused by traumatic avulsion of the flexor digitorum profundus  from the distal phalanx.  In recommending ultrasound of the finger and palm, we were referring to musculoskeletal ultrasound (MSKUS)—a point-of-care scan typically done by primary care physicians and involving little or no cost. While MSKUS provides more information about the injury, it cannot replace clinical judgment and input from a hand surgeon, when warranted.

James M. Daniels, MD, MPH
Quincy, Ill

Drs. DeCastro, Stanton, and I thank Dr. Chee for presenting another approach to the treatment of subungual hematoma—a subject that has generated much debate.  We would point out, however, that fenestration of subungual hematoma is often required for pain relief, and that studies have found the overall complication rate to be low.^1,2

We would also like to take this opportunity to clarify our recommendation in Case 4, in which the patient had Jersey finger, caused by traumatic avulsion of the flexor digitorum profundus  from the distal phalanx.  In recommending ultrasound of the finger and palm, we were referring to musculoskeletal ultrasound (MSKUS)—a point-of-care scan typically done by primary care physicians and involving little or no cost. While MSKUS provides more information about the injury, it cannot replace clinical judgment and input from a hand surgeon, when warranted.

James M. Daniels, MD, MPH
Quincy, Ill