Flexor tenosynovitis

Background

  • Surgical emergency - flexor sheaths are contiguous with deep spaces of the hand
  • Usually associated with a penetrating trauma

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)

Differential Diagnosis

Hand and finger infections

Evaluation

Workup

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)

Disposition

  • Admit

See Also

Video

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References

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