Infectious tenosynovitis

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Background

  • Infection of extensor tendons rarely result in loculated infections


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

  • Pain along the tendon with passive extension (early sign)
  • Tenderness along the course of the flexor sheath (late sign)
  • Symmetric enlargement of the affected digit
  • Slightly flexed finger at rest


Diagnosis

  • Xray
  • Usually normal but helpful to r/o bony involvement, FB
  • Blood culture


Treatment

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