- Definition: o Infection of the synovial sheath that surrounds the flexor tendon.
o It’s a surgical emergency!!
- Epidemiology
o Incidence 2-9% of all hand infections
- Risk factors
o diabetes
o IV drug use
o immunocompromised patients
- Mechanism
o Penetrating trauma
o direct spread from:
- Felon
- Septic joint
- Deep space infection
- Microbiology
o Staph Aureus (40-75%)
o MRSA (29%)
o Strep
- Presentation:
o pain and swelling
- typically presents in a delayed fashion (over last 24-48 hours)
- usually localized to palmar aspect of one digit
o Physical exam:
- Kanavel signs:
- digit held in flexion
- tenderness to palpation over the tendon sheath
- pain with passive extension of the digit
- fusiform swelling of the digit
- Imaging:
o X-ray:
- radiographs are not required, but may be useful to rule out a foreign object
o MRI
- cannot distinguish infectious flexor tenosynovitis from inflammatory but may help determine the extent of the ongoing process
- Management:
o Vancomycin + Cefepime
o Call ortho! low threshold to take the patient to the OR for I&D once suspected (orthopedic emergency)
o Nonoperative (rare)
- Hospital admission, IV Abx, and hand immobilization
- Indications:
o early presentation
o if signs of improvement within 24 hours, no surgery is required
Check out this 5 minute video from our amazing Dr. Anna Pickens!
https://emin5.com/2014/04/20/flexor-tenosynovitis/
Sources: Ortho bullets, EMin5, UpToDate
