Infectious tenosynovitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Labs: CBC, ESR/CRP, pre-op labs (T+S, coags, Chem-10) | |||
*X-Ray | |||
**Usually normal but helpful to r/o bony involvement, FB | |||
*Blood culture (if possible, obtain from synovial fluid) | |||
* | |||
* Usually normal but helpful to r/o bony involvement, FB | |||
* Blood culture | |||
==Treatment== | ==Treatment== | ||
Revision as of 06:35, 31 December 2013
Background
- Infection of extensor tendons rarely result in loculated infections, but disruption of normal flexor tendon function can be dangerous as it may spread proximally involving the wrist/forearm (Parona space).
Etiology
- Trauma with direct inoculation
- Microbiology
- "Clean trauma" - skin flora
- DM, 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)
Diagnosis
- Labs: CBC, ESR/CRP, pre-op labs (T+S, coags, Chem-10)
- X-Ray
- Usually normal but helpful to r/o bony involvement, FB
- Blood culture (if possible, obtain from synovial fluid)
Treatment
- Surgery consult for wash-out versus debridement
- IV Abx (appropriate to the likely organism)