Diferencia entre revisiones de «Flexor tenosynovitis»
| Línea 23: | Línea 23: | ||
===Evaluation=== | ===Evaluation=== | ||
*Generally a clinical diagnosis, based on history and physical exam | *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== | ==Management== | ||
*Emergent hand surgery consult in ED | *Emergent hand surgery consult in ED | ||
*[[Antibiotics]] (start immediately if suspected) | *[[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''' | **[[Vancomycin]] 1gm IV q12hr '''AND''' | ||
**[[Ampicillin/Sulbactam]] 1.5gm IV q6h '''OR''' [[cefoxitin]] 2gm IV q8h '''OR''' [[Piperacillin/Tazobactam]] 3.375gm IV q6h | **[[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== | ==Disposition== | ||
Revisión del 21:05 9 abr 2020
Background
- Surgical emergency - flexor sheaths are contiguous with deep spaces of the hand
- Usually associated with a penetrating trauma
Clinical Features
- 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)
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Evaluation
Waterbath POCUS demonstrating fluid collection between tendon and bone[1]
Workup
- CBC
- ESR
- Ultrasound
- 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
External Links
Video
{{#widget:YouTube|id=4oCzzvTiwew}}