Infectious Tenosynovitis

From WikEM
Jump to: navigation, search


  • 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!


  • 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)


  • 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)


  • Elevation of hand to help with swelling
    • Monitor clinically for hand compartment syndrome
  • Surgery/Ortho consult for wash-out vs. debridement


Treatment should cover S. aureus, Streptococcus, and MRSA

Animal Bites

Ampicillin/Sulbactam 3g (50mg/kg) IV four times daily