Flexor tenosynovitis

Background

• Surgical emergency; flexor sheaths are contiguous w/ deep spaces of the hand
• Usually associated with penetrating trauma

Clinical Features

• Kanavel's Signs:

1. Percussion tenderness
   • Tenderness over entire length of flexor tendon sheath
2. Uniform swelling
   • Symmetric finger swelling along length of the tendon sheath
3. Pain w/ passive extension
   • Often the first sign seen
4. 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

• Digital mixoid cyst

Workup

W/U should be an adjunct to a clinical diagnosis

• CBC
• ESR
• Ultrasound
• Xray

Management

1. Antibiotics
   1. Start immediately
   2. Vancomycin 1gm IV q12hr + (Ampicillin/Sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR Piperacillin/Tazobactam 3.375gm IV q6h)
2. Consult hand surgery in the ED

Disposition

• Typically require I&D in the OR

See Also

• Hand Infection

Sources

• Tintinalli