Flexor Tenosynovitis


The flexor tendons of the fingers are covered by a double layer of synovium to promote gliding of the tendon underneath. Infection of these flexor tendon sheaths presents a true surgical hand emergency. It is usually associated with penetrating trauma, although the patient may not recall the injury. Staphylococcus is the most common cause identified; however, the infection can be polymicrobic, including anaerobic organisms.

SYMPTOMS/EXAM (KANAVEL’S CARDINAL SIGNS)

DIFFERENTIAL

DIAGNOSIS

TREATMENT

Flexor tenosynovitis Ampicillin-sulbactam, 1.5 g IV every 6 h,
or
Cefoxitin, 2 g IV every 8 h,
or
Piperacillin/tazobactam, 3.375 g IV every 6 h.
S. aureus, streptococci, anaerobes, gram negatives Parenteral antibiotics are indicated; consider ceftriaxone for suspected Neisseria gonorrhoeae.
Plus:
vancomycin, 1 g IV every 12 h, if MRSA is prevalent in community.

 

COMPLICATIONS

Kanavel’s cardinal signs of flexor tenosynovitis:
1. Flexed posture of the involved digit
2. Fusiform swelling of the entire digit
3. Tenderness over the flexor tendon sheath
4. Pain with passive extension