Flexor Tenosynovitis (Kanavel’s Signs)

Suppurative (infectious) flexor tenosynovitis is a medical emergency because the tendon sheath is a closed space and too much swelling can lead to compartment syndrome and necrosis.

* You can’t really get these complications in extensor tendons as it is an open space (no tendon sheath)

There are 4 cardinal signs of flexor tenosynovitis (Kanavel’s Signs)

  1. Tenderness along the whole tendon sheath (late sign)
  2. Finger held in flexion
  3. Fusiform swelling (sausage finger)
  4. Pain with passive extension *this is the earliest finding

It is usually caused by some sort of inoculation, but this can be something very small and the patient may not be aware that he/she had ever been injured (can also be caused by local or hematogenous spread). It’s not unreasonable to get an x-ray to rule out other things and if there’s a fever or they seem very unwell, you can do blood cultures. You also probably want to start the patient on some broad spectrum antibiotics such as vancomycin + ciprofloxacin (or ceftriaxone).

Treatment is tendon sheath drainage and debridement as well as antibiotics.

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