Flexor Tendon Sheath Infections

Aetiology

 

S. aureus / Strept

- usually a history of trauma

 

Anatomy

 

IF / MF / RF

- extend from DP to distal crease

 

LF

- extends to mid palm

- communicates with ulna bursa

 

Thumb 

- distal phalanx to volar wrist crease

- communicates with radial bursa

 

Examination

 

Kanavel's 4 signs

 

1.  Tenderness along course of flexor tendon

2.  Fusiform swelling

3.  Flexed attitude to finger

4.  Pain on passive extension of finger

 

Management

 

Nonoperative

 

May settle with antibiotics if get early

- want improvement in 12 - 24 hours

- risk adhesions / tendon necrosis

 

Operative

 

Distal incision

- distal finger crease

 

Proximal incision

- distal palmar crease

 

Will see pus

- take swab for MCS

 

Pass infant feeding catheter

- into flexor sheath

- irrigate +++

 

IV ABx 48 hours

 

Occupational / hand therapy to prevent adhesions