Infectious tenosynovitis

Revision as of 06:36, 31 December 2013 by ManpreetS2006 (talk | contribs) (minor change)

Background

  • 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!

Etiology

  • Trauma with direct inoculation
  • Microbiology
  • "Clean trauma" - skin flora
  • DM, 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)

Diagnosis

  • Labs: CBC, ESR/CRP, pre-op labs (T+S, coags, Chem-10)
  • X-Ray
    • Usually normal but helpful to r/o bony involvement, FB
  • Blood culture (if possible, obtain from synovial fluid)

Treatment

  • Surgery consult for wash-out versus debridement
  • IV Abx (appropriate to the likely organism)
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