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Flexor tenosynovitis
From WikEM
Contents
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
- Bedbugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Evaluation
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
See Also
External Links
Video
