infectious Flexor Tenosynovitis Flexor Sheath Infection

Last Updated on by FRCEM Intermediate

Overview

  • Infection within the flexor tendon sheath

Clinical features

  • symmetrical swelling of the affected finger“sausage digit”
  • tender along flexor tendon sheath
  • finger held in slight flexion
  • pain with passive extension

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
    • 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
  • refer urgently for tendon sheath exploration,irrigation,drainage +/-debridement

Complications

  • speared  of infections
  • soft tissue necrosis
  • osteomylitis
  • stiffness and loss of Range of movements-adhesions

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