Silent Intruder – A Delayed Diagnosis of a Retained Foreign Body in a Manual Worker: The Role of POCUS in Chronic Thumb Pain

Author: Dr Himanshu Gul Mirani, Ms Lorraine Keil

A 36-year-old builder presented with seven months of intermittent thumb pain following a penetrating injury with a wooden splinter. Despite multiple GP visits and antibiotic courses, there were no overt signs of infection, and plain radiographs were unremarkable. The persistent pain significantly affected his work. On ED review, examination remained non-specific, but point-of-

care ultrasound (POCUS) revealed a 5 mm retained foreign body. Formal imaging confirmed a granuloma, and the patient was referred for surgical removal. This case illustrates the diagnostic challenge of radiolucent foreign bodies in the absence of clear clinical signs and highlights a missed opportunity for early intervention. POCUS proved instrumental in identifying the pathology and expediting appropriate care. Retained foreign bodies can result in chronic pain, functional impairment, and prolonged healthcare use. Emergency clinicians should maintain a high index of suspicion and consider early ultrasound in patients with persistent symptoms following penetrating injuries, especially when routine imaging is inconclusive.