View source for Infectious tenosynovitis

==Background==
*Infection of extensor tendons rarely results in loculated infections, but disruption of normal flexor tendon function can be dangerous as it may spread proximally involving the wrist/forearm (Parona space). It is an surgical/orthopedic emergency!

==Etiology==




*Trauma with direct inoculation
*Microbiology
*"Clean trauma" - skin flora
*[[Diabetes mellitus]], bites - Polymicrobial (gram -, anerobes)
*Puncture from plants - Fungal (sporotrichosis)  
*Hematogenous spread 
*Microbiology
*Gonorrhea
*Look for vesiculopustular skin lesion, polyarthralgia 
*Mycobacteria 
*Contiguous spread 
 

==Clinical Manifestations==
*4 Kanavel signs:
**(1) Finger held in slight flexion
**(2) Fusiform swelling
**(3) Tenderness along the flexor tendon sheath (late sign)
**(4) Pain with passive extension of the digit (early sign)

==Evaluation==
*Labs: CBC, ESR/CRP, pre-op labs (T+S, coags, Chem-10)
*X-Ray
**Usually normal but helpful to rule out bony involvement, FB
*Blood culture (if possible, obtain from synovial fluid)

==Management==
*Elevation of hand to help with swelling
**Monitor clinically for hand compartment syndrome
*Surgery/Ortho consult for wash-out vs. debridement
===[[Antibiotics]]===
{{Infectious Tenosynovitis Antibiotics}}
[[Category:Orthopedics]]