Correspondence

The Stethoscope as a Diagnostic Aid in Tenosynovitis

N Engl J Med 1999; 340:156January 14, 1999

Article

To the Editor:

On September 30, one of us experienced pain at the arch of the right foot. The pain increased, and pressure from the shoe became annoying. In the evening, crepitation was detected on palpation, and a distinct friction rub could be detected by auscultation on movement of the big toe. On the next day, the friction rub was verified by a phonogram (Figure 1Figure 1Phonograms of the Right and Left Arches at Rest and during Alternate Dorsal and Ventral Flexion of the Big Toes.). By October 2, the pain had diminished, and two residents were not able to detect crepitation on palpation. On auscultation, however, when the big toe was flexed dorsally and ventrally, a sound similar to a bronchial breath sound could be heard at the right arch, and a sound similar to a vesicular breath sound at the left arch. During the period from October 3 to October 6, a blindfolded resident could not detect crepitation but did notice the bronchial-breath–like sound at the still slightly painful arch and the vesicular-breath–like sound at the left arch.

Rolf H. Adler, M.D.
Marc Gertsch, M.D.
University of Bern Medical School, 3010 Bern, Switzerland