Infectious flexor tenosynovitis

Flexor sheath infection



background

Tenosynovitis
  • Infection within the flexor tendon sheath
  • Penetrating injury may not be recalled
  • Finger in slight fixed flexion (position of rest)
  • Tender along tendon sheath with pain on passive extension
  • Systemic signs / fever are rare

Pathogens

  • Skin commensals (Staph aureus and group A Strep)
  • Pasteurella multocida if cat bite
  • Eikenella corrodens infection in human bite wounds
  • ? N gonorrhoeae if no trauma and Hx immunocompromised or HIV/AIDS

Beware

Tenosynovitic Irrigation under GA
  • Check blood glucose - DM mixed gram negatives
  • Consider rheumatoid factor - Gram negatives
  • ? possible IVDU - Gram positive bugs
  • Fish spines - (mycobacterium!)

Treatment

  • Analgesia, rings off, elevate
  • IV antibiotics (and ATT as required)
  • FBC, Renal Fxn, culture pus or blood samples
  • Admit plasitcs for washout under GA

Content by Dr √ćomhar O' Sullivan 22/09/2011. Last review Dr ÍOS 19/01/15.