Diferencia entre revisiones de «Flexor tenosynovitis»
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==Background== | ==Background== | ||
*Surgical emergency | *Surgical emergency - flexor sheaths are contiguous w/ deep spaces of the hand | ||
*Usually associated with penetrating trauma | *Usually associated with a penetrating trauma | ||
==Clinical Features== | ==Clinical Features== | ||
===Kanavel's Signs=== | ===Kanavel's Signs=== | ||
#Pain w/ passive extension | |||
#*Often the first sign seen | |||
#Percussion tenderness | #Percussion tenderness | ||
#*Tenderness over entire length of flexor tendon sheath | #*Tenderness over entire length of flexor tendon sheath | ||
#Uniform swelling | #Uniform swelling | ||
#*Symmetric finger swelling along length of the tendon sheath | #*Symmetric finger swelling along length of the tendon sheath | ||
#Flexion posture | #Flexion posture | ||
#*Flexed posture of involved digit at rest to minimize pain | #*Flexed posture of involved digit at rest to minimize pain | ||
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{{Template:Hand Infection DDX}} | {{Template:Hand Infection DDX}} | ||
==Workup== | ==Diagnosis== | ||
===Workup=== | |||
*CBC | *CBC | ||
*ESR | *ESR | ||
*[[Ultrasound (Main)|Ultrasound]] | *[[Ultrasound (Main)|Ultrasound]] | ||
*Xray | *Xray | ||
===Evaluation=== | |||
*Generally a clinical evaluation, based on history and physical exam | |||
==Management== | ==Management== | ||
*Emergent ortho (hand) consult in ED | |||
*[[Antibiotics]] (start immediately if suspected) | |||
**[[Vancomycin]] 1gm IV q12hr '''PLUS''' | |||
**[[Ampicillin/Sulbactam]] 1.5gm IV q6h '''OR''' [[cefoxitin]] 2gm IV q8h '''OR''' [[Piperacillin/Tazobactam]] 3.375gm IV q6h | |||
==Disposition== | ==Disposition== | ||
* | *Admit | ||
==See Also== | ==See Also== | ||
*[[Hand | *[[Hand infection]] | ||
==External Links== | ==External Links== | ||
== | ==References== | ||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revisión del 06:50 19 ago 2015
Background
- Surgical emergency - flexor sheaths are contiguous w/ deep spaces of the hand
- Usually associated with a penetrating trauma
Clinical Features
- Pain w/ 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
Diagnosis
Workup
- CBC
- ESR
- Ultrasound
- Xray
Evaluation
- Generally a clinical evaluation, based on history and physical exam
Management
- Emergent ortho (hand) consult in ED
- Antibiotics (start immediately if suspected)
- Vancomycin 1gm IV q12hr PLUS
- Ampicillin/Sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR Piperacillin/Tazobactam 3.375gm IV q6h
Disposition
- Admit