Flexor tenosynovitis
Revisión del 02:35 10 mar 2015 de Rossdonaldson1 (discusión | contribs.)
Background
- Surgical emergency; flexor sheaths are contiguous w/ deep spaces of the hand
- Usually associated with penetrating trauma
Clinical Features
- Percussion tenderness
- Tenderness over entire length of flexor tendon sheath
- Uniform swelling
- Symmetric finger swelling along length of the tendon sheath
- Pain w/ passive extension
- Often the first sign seen
- 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
Workup
W/U should be an adjunct to a clinical diagnosis
- CBC
- ESR
- Ultrasound
- Xray
Management
- Antibiotics (start immediately)
- Vancomycin 1gm IV q12hr + (Ampicillin/Sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR Piperacillin/Tazobactam 3.375gm IV q6h)
- Consult hand surgery in the ED
Disposition
- Typically require I&D in the OR
See Also
External Links
Sources
- Tintinalli