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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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