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Internal Medicine

Pyogenic flexor tenosynovitis

Tenosynovitis is the inflammation of the synovium surrounding tendons, typically leading to joint pain, swelling, and stiffness.

Tenosynovitis is the inflammation of the synovium surrounding tendons, typically leading to joint pain, swelling, and stiffness.

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Pyogenic flexor tenosynovitis. Appreciable pain along the tendon sheath with passive extension of the digit often is the first clinical sign of this hand infection. | Clark, D. C. (2003) ‘Common acute hand infections.’, American family physician. United States, 68(11), pp. 2167–2176.

Clinical features

Four cardinal signs:

  1. Uniform, symmetric digit swelling
  2. Digit is held in partial flexion at rest
  3. Excessive tenderness along the entire course of the flexor tendon sheath
  4. Pain along the tendon sheath with passive digit extension (M/clinically reproducible)
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Pyogenic flexor tenosynovitis of the index finger of the right hand. | Lamb DW, Hooper G. Colour guide hand conditions. New York: Churchill Livingstone, 1994:58.

Complications

  • Tendon necrosis
  • Adhesion formation
  • Spread of infection to the deep fascial spaces

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