Infectious tenosynovitis: Difference between revisions

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==Background==
==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==
 
 
* Infection of extensor tendons rarely result in loculated infections
 
==Etiology ==








* Trauma with direct inoculation
*Trauma with direct inoculation
* Microbiology
*Microbiology
* "Clean trauma" - skin flora
*"Clean trauma" - skin flora
* DM, bites - Polymicrobial (gram -, anerobes)
*[[Diabetes mellitus]], bites - Polymicrobial (gram -, anerobes)
* Puncture from plants - Fungal (sporotrichosis)   
*Puncture from plants - Fungal (sporotrichosis)   
* Hematogenous spread  
*Hematogenous spread  
* Microbiology
*Microbiology
* Gonorrhea
*Gonorrhea
* Look for vesiculopustular skin lesion, polyarthralgia  
*Look for vesiculopustular skin lesion, polyarthralgia  
* Mycobacteria  
*Mycobacteria  
* Contiguous spread  
*Contiguous spread  
   
   


==Clinical Manifestations==
==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)


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


* Pain along the tendon with passive extension (early sign) 
==Management==
* Tenderness along the course of the flexor sheath (late sign)
*Elevation of hand to help with swelling
* Symmetric enlargement of the affected digit
**Monitor clinically for hand compartment syndrome
* Slightly flexed finger at rest
*Surgery/Ortho consult for wash-out vs. debridement
===[[Antibiotics]]===
 
{{Infectious Tenosynovitis Antibiotics}}
==Diagnosis==
[[Category:Orthopedics]]
 
 
 
 
* 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)
 
 
 
[[Category:Ortho]]

Latest revision as of 01:30, 10 May 2019

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
  • Diabetes mellitus, 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)

Evaluation

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

Management

  • Elevation of hand to help with swelling
    • Monitor clinically for hand compartment syndrome
  • Surgery/Ortho consult for wash-out vs. debridement

Antibiotics

Treatment should cover S. aureus, Streptococcus, and MRSA

Animal Bites

Ampicillin/Sulbactam 3g (50mg/kg) IV four times daily

Pediatrics

Mycobacteria related

Treatment should include usual therapy listed above in addition to:

AND consult infectious disease