Flexor tenosynovitis: Difference between revisions
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==Background== | ==Background== | ||
*Surgical emergency | *Surgical emergency - flexor sheaths are contiguous with deep spaces of the hand | ||
*Usually associated with penetrating trauma | *Usually associated with a penetrating trauma | ||
==Clinical Features== | ==Clinical Features== | ||
===Kanavel's Signs=== | |||
*Pain with passive extension (often the first sign seen) | |||
*Percussion tenderness (tenderness over entire length of flexor tendon sheath) | |||
*Uniform swelling (symmetric finger swelling along length of the tendon sheath) | |||
*Flexion posture (flexed posture of involved digit at rest to minimize pain) | |||
== | [[File:Flexor Tenosynovitis.JPG|thumb]] | ||
[[File:Flexor Tenosynovitis2.JPG|thumb]] | |||
==Differential Diagnosis== | |||
{{Template:Hand Infection DDX}} | {{Template:Hand Infection DDX}} | ||
== | ==Evaluation== | ||
[[File:FTS_Riscinti.gif|thumbnail|Waterbath POCUS demonstrating fluid collection between tendon and bone<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]] | |||
===Workup=== | |||
*CBC | |||
*ESR | |||
*[[Ultrasound (Main)|Ultrasound]]<ref>Ultrasound Probe: POCUS for Flexor Tenosynovitis from emDocs.net http://www.emdocs.net/ultrasound-probe-pocus-for-flexor-tenosynovitis/</ref> | |||
*Xray | |||
===Evaluation=== | |||
*Generally a clinical diagnosis, based on history and physical exam | |||
*Labs generally show elevated WBC and inflammatory markers | |||
*Xray is done to rule out radiopaque foreign body | |||
==Management== | |||
*Emergent hand surgery consult in ED | |||
*[[Antibiotics for most common skin pathogens Strep and Staph]] (start immediately if suspected but consider obtaining wound culture if any spontaneous drainage is present) | |||
**[[Vancomycin]] 1gm IV q12hr '''AND''' | |||
**[[Ampicillin/Sulbactam]] 1.5gm IV q6h '''OR''' [[cefoxitin]] 2gm IV q8h '''OR''' [[Piperacillin/Tazobactam]] 3.375gm IV q6h | |||
* [[Special Antibiotic Considerations]] | |||
** [[Diabetic Patients]] ensure you have Pseudomonal Coverage by using [[Piperacillin/Tazobactam]] rather than [[Ampicillin/Sulbactam]] or [[cefoxitin]] | |||
** [[Marine Exposure]] consider adding a [[Fluroquinolone]], [[Sulfamethoxazole/Trimethoprim]] or [[Doxycycline]] to cover common marine organisms | |||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Hand | *[[Hand infection]] | ||
==External Links== | |||
==Video== | |||
{{#widget:YouTube|id=4oCzzvTiwew}} | |||
== | ==References== | ||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 18:28, 28 July 2021
Background
- Surgical emergency - flexor sheaths are contiguous with deep spaces of the hand
- Usually associated with a penetrating trauma
Clinical Features
- Pain with passive extension (often the first sign seen)
- Percussion tenderness (tenderness over entire length of flexor tendon sheath)
- Uniform swelling (symmetric finger swelling along length of the tendon sheath)
- Flexion posture (flexed posture of involved digit at rest to minimize pain)
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Evaluation
Waterbath POCUS demonstrating fluid collection between tendon and bone[1]
Workup
- CBC
- ESR
- Ultrasound[2]
- Xray
Evaluation
- Generally a clinical diagnosis, based on history and physical exam
- Labs generally show elevated WBC and inflammatory markers
- Xray is done to rule out radiopaque foreign body
Management
- Emergent hand surgery consult in ED
- Antibiotics for most common skin pathogens Strep and Staph (start immediately if suspected but consider obtaining wound culture if any spontaneous drainage is present)
- Vancomycin 1gm IV q12hr AND
- Ampicillin/Sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR Piperacillin/Tazobactam 3.375gm IV q6h
- Special Antibiotic Considerations
- Diabetic Patients ensure you have Pseudomonal Coverage by using Piperacillin/Tazobactam rather than Ampicillin/Sulbactam or cefoxitin
- Marine Exposure consider adding a Fluroquinolone, Sulfamethoxazole/Trimethoprim or Doxycycline to cover common marine organisms
Disposition
- Admit
See Also
External Links
Video
{{#widget:YouTube|id=4oCzzvTiwew}}
References
- ↑ http://www.thepocusatlas.com/musculoskeletal/
- ↑ Ultrasound Probe: POCUS for Flexor Tenosynovitis from emDocs.net http://www.emdocs.net/ultrasound-probe-pocus-for-flexor-tenosynovitis/