MANUAL MINORS
Pyogenic flexor tenosynovitis is an acute infection of the flexor tendon sheath in the hand, typically caused by bacteria such as Staphylococcus aureus or Streptococcus. This serious infection generally arises from puncture wounds, lacerations, or bites that introduce pathogens into the tendon sheath, leading to rapid inflammation. If not treated promptly, it can compromise tendon function and may even result in necrosis.
Diagnosis
The diagnosis is based on the classic signs known as Kanavel’s criteria:
Pain along the course of the flexor tendon.
Tenderness on palpation of the tendon sheath.
Involuntary finger held in a semi-flexed position.
Pain with passive extension of the finger.
The clinical presentation includes swelling, pain, and tenderness, which may progress to fever and general malaise. In severe cases, the affected finger appears tense and erythematous.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Cellulitis | Diffuse infection of the subcutaneous tissue without specific signs of tendon sheath involvement. |
Felon | Infection in the fingertip pad, with pus accumulation, without tendon involvement. |
Septic Arthritis | Pain and swelling in the affected joint, but without specific tenderness over the flexor tendon. |
Infected Ganglion | Presence of a mass or cyst in the hand that becomes infected, without direct involvement of the tendon. |
Emergency Management
Immobilisation of the affected finger in a functional position.
Urgent administration of broad-spectrum antibiotics, usually intravenously, such as cephalosporins or vancomycin if resistant organisms are suspected.
Elevation of the hand to reduce inflammation.
Pain control with analgesics and anti-inflammatory medications.
Imaging studies (ultrasound or MRI) may be requested if the diagnosis is uncertain, although it is primarily clinical.
Definitive Treatment
Definitive treatment involves urgent surgical drainage of the tendon sheath to remove pus and prevent the spread of infection. Continuous irrigation may be required to ensure complete cleaning of the area.
Systemic antibiotics should be continued for 1-2 weeks, depending on the severity and culture results. Rehabilitation with physiotherapy is crucial post-infection to restore mobility and prevent stiffness in the affected finger.
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