Second, men in their 60s do not commonly have urinary tract infections.13 The patient was questioned frequently by several providers about sexual behaviors, medical problems, and urinary symptoms. Repeatedly, he denied all of these issues. While a urinalysis may be omitted in the evaluation of an otherwise healthy, asymptomatic patient, its results in this case were a key piece of data.
It should be noted that the patient thought it inappropriate to be asked for urine samples. He repeatedly said, “It’s my hand!”
Conclusion
Even in patients presenting with the most routine complaint, a careful evaluation can reveal unexpected, serious problems. This patient complained of pain in his hand some time after a fall and ultimately was treated for an occult urosepsis and hand abscess—pyomyositis, which rarely occurs in small muscles, such as those of the hand. Either condition, left untreated, could have led to serious morbidity or even mortality.