ORTHOPEDICSCOMPLICATIONS
Osteomyelitis, bacteremia
Flexor Tenosynovitis
The flexor tendons of the fingers are covered by a double layer of synovium to
promote gliding of the tendon underneath. Infection of these flexor tendon
sheaths presents a true surgical hand emergency. It is usually associated with
penetrating trauma, although the patient may not recall the injury. Staphylo-
coccusis the most common cause identified; however, the infection can be
polymicrobic, including anaerobic organisms.
SYMPTOMS/EXAM(KANAVEL’SCARDINALSIGNS)
■ Flexed posture of the involved digit
■ Fusiform swelling of the finger
■ Tenderness over the flexor tendon sheath
■ Pain with passive extension
DIFFERENTIAL
Cellulitis, subcutaneous abscess
DIAGNOSIS
■ Clinical diagnosis
■ X-ray may reveal air or a foreign body.
TREATMENT
■ Hand should be immobilized and elevated.
■ IV antibiotics with ampicillin/sulbactam, first-generation cephalosporin or
vancomycin
■ Hand surgeon consultation for possible surgical drainage
COMPLICATIONS
■ Osteomyelitis
■ Septic arthritis
■ Loss of digit
■ Chronic stiffness
Kanavel’s cardinal signs of
flexor tenosynovitis:- Flexed posture of the
involved digit - Fusiform swelling of the
entire digit - Tenderness over the flexor
tendon sheath - Pain with passive extension