Flexor Tenosynovitis

Surgical Emergency!

Author

Jesse Dashe MD
October 02, 2023

Greetings colleagues,

Welcome to the Hands-On The East Bay Newsletter, which summarizes key topics in hand surgery for providers on the front lines. I'm Dr. Jesse Dashe, an orthopedic hand surgeon at the East Bay Hand Medical Center.

Question:

What is pyogenic flexor tenosynovitis?

Answer: 

This is a surgical emergency involving an infection of the tendon sheath.

Pyogenic Flexor Tenosynovitis. Source: Orthobullets

Question:

What are the symptoms?

Answer: 

Kanavel’s signs:

  • Finger held in flexion

  • Pain over flexor tendon sheath

  • Fusiform edema of digit

  • Pain with extension of digit

Kanavel Signs. SourceL PinIMG.

Question:

Why is it an emergency?

Answer: 

Pyogenic flexor tenosynovitis can rapidly lead to necrosis, tendon rupture, and permanent stiffness if not treated urgently.

Question:

What is the treatment?

Answer: 

  • Broad spectrum IV antibiotics —> may be able to treat non-op within the first 24 hr

  • If worsening or no improvement —> surgical washout and debridement

Pyogenic Flexor Tenosynovitis. Source: orthobullets.

Please feel free to reach out if you have any questions or would like to refer any patients. You can refer patients at handreferral.com or by using this link:

If you need to reach me directly, please respond to this email or email me at [email protected].

Please contact me so I can come by your facility to meet face-to-face and/or give presentations, splinting sessions, etc.

Lastly, let me know if you have any other hand topics you would like covered in the future!

Sincerely,