Ver el código de «Flexor tenosynovitis»

==Background==
*Surgical emergency - flexor sheaths are contiguous with deep spaces of the hand
*Usually associated with a penetrating trauma

==Clinical Features==
===Kanavel's Signs===
*Pain with passive extension (often the first sign seen)
*Percussion tenderness (tenderness over entire length of flexor tendon sheath)
*Uniform swelling (symmetric finger swelling along length of the tendon sheath)
*Flexion posture (flexed posture of involved digit at rest to minimize pain)

[[File:Flexor Tenosynovitis.JPG|thumb]]

[[File:Flexor Tenosynovitis2.JPG|thumb]]

==Differential Diagnosis==
{{Template:Hand Infection DDX}}

==Evaluation==
[[File:FTS_Riscinti.gif|thumbnail|Waterbath POCUS demonstrating fluid collection between tendon and bone<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
===Workup===
*CBC
*ESR
*[[Ultrasound (Main)|Ultrasound]]<ref>Ultrasound Probe: POCUS for Flexor Tenosynovitis from emDocs.net http://www.emdocs.net/ultrasound-probe-pocus-for-flexor-tenosynovitis/</ref>
*Xray

===Evaluation===
*Generally a clinical diagnosis, based on history and physical exam
*Labs generally show elevated WBC and inflammatory markers
*Xray is done to rule out radiopaque foreign body

==Management==
*Emergent hand surgery consult in ED
*[[Antibiotics for most common skin pathogens Strep and Staph]] (start immediately if suspected but consider obtaining wound culture if any spontaneous drainage is present)
**[[Vancomycin]] 1gm IV q12hr '''AND'''
**[[Ampicillin/Sulbactam]] 1.5gm IV q6h '''OR''' [[cefoxitin]] 2gm IV q8h '''OR''' [[Piperacillin/Tazobactam]] 3.375gm IV q6h

* [[Special Antibiotic Considerations]]
** [[Diabetic Patients]] ensure you have Pseudomonal Coverage by using [[Piperacillin/Tazobactam]] rather than [[Ampicillin/Sulbactam]] or [[cefoxitin]]
** [[Marine Exposure]] consider adding a [[Fluroquinolone]], [[Sulfamethoxazole/Trimethoprim]] or [[Doxycycline]] to cover common marine organisms

==Disposition==
*Admit

==See Also==
*[[Hand infection]]

==External Links==

==Video==
{{#widget:YouTube|id=4oCzzvTiwew}}

==References==
<References/>

[[Category:ID]]
[[Category:Orthopedics]]