Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Question About a Bee Sting

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A reader writes: "I was stung by bee on the palm of my hand and forefinger 6 weeks ago. My palm remains inflamed and swollen, which worsens as the day progresses; all joints remain tender. I have a small pebble-like knot under the skin approx 1/4" to 1/2" from where I was stung. I have been to 6 different doctors without receiving much explanation. I recently saw a hand specialist who diagnosed "trigger finger" brought on by the bee sting. Anyone ever heard of this? Is it possible that the tip of the stinger remained inside and migrated a bit from the sting site? Could the hard place be tissue forming around the stinger that may have remained inside? An E.R. nurse practitioner says it is possible that the stinger remains inside, however, my treating doctor says no way possible."

There are a number of possibilities here, related to the pathophysiology of a bee sting. Depending on the species of bee, part or all of the stinger may have been present in the wound immediately after the sting. For instance, a honeybee often leaves the stinger and attached venom sac in the wound. Sometimes the stinger is easily visible, revealed as a tiny dark splinter or speck. Other times, it is impossible to see without magnification. So, unless the sting site was very carefully inspected under magnification and no stinger seen, something may have remained in the wound. This is not usually the case, but it happens.

Bee venom contains a number of components that cause pain, redness, and swelling, all of which can be part of the initial toxic envenomation and subsequent inflammatory response. Depending upon how close the sting was to a tendon (and its sheath, within which it slides), it could have caused tenosynovitis, which could cause persistent pain on motion, and ultimately lead to some contraction of the finger, which might be diagnosed as a “trigger finger.”

The formation of a knot might represent inflammatory tissue solidifying into a scar around the initial puncture wound, which would be more likely if there was a residual “foreign body.” The remaining material doesn’t need to be a huge piece – even a microscopic speck is enough to fuel the process. The material under the skin would not migrate to a different location, unless it was within an open tract, which is highly unlikely. So, is it possible that a fragment of the stinger is still within the tissue? The answer is yes. It might be visible using an enhanced ultrasound technique, so that might be worth a try.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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