A true pilonidal sinus in the hand of a sheep shearer

Occupationally acquired inter-digital pilonidal sinuses are seldom seen and typically found on the hands of hair dressers. Sheep shearing has traditionally been believed to be a cause of inter-digital pilonidal sinuses; although in reality it is infrequently so with only two previously reported cases in 1951 and 1966. We present a rare case of a shearer who worked with a variety of sheep and presented with a chronic pilonidal sinus in the 3(rd) web space of his hand. This work demonstrates for the first time a histological confirmation of the presence of wool, and in this case different varieties and coloured fibres within the sinus. The report presents our investigations into the aetiology and the mechanical theories supporting it. The clinical presentation and surgical management of this condition are discussed alongside occupational realities and expectations.