Stenosing flexor tenosynovitis following a rattlesnake bite

Snakebite victims have been described previously in orthopedic literature in regard to complications such as compartment syndrome and carpal tunnel syndrome. We introduce a previously unreported complication of stenosing flexor tenosynovitis in a patient bitten by a rattlesnake. After being bitten in her right forearm, the patient experienced mild systemic symptoms of fever and nausea and was assessed at an outside hospital, where it was determined that she did not suffer from envenomation and therefore did not require antivenin therapy. She presented to our institution 1 week later with signs and symptoms of acute, new-onset right thumb flexor tenosynovitis, with pain and tenderness at the level of the A1 pulley of the thumb, with intermittent triggering. She also presented the following week with ipsilateral carpal tunnel syndrome. The patient reported no such symptoms prior to the snakebite. Given the recent development of these conditions after her snakebite, in addition to her history of endocrine disorders, we believe that our patient suffered from envenomation that led to these complications. Nonoperative measures including splinting and steroid injections were taken, with mixed results, and surgical intervention was necessary. While the proper management of snakebites is controversial, especially in regard to the administration of antivenin, we believe our patient would have benefitted from immediate evaluation and consideration for antivenin.