High risk and low prevalence diseases: Flexor tenosynovitis

Flexor tenosynovitis (FTS) is a deep space infection of an upper extremity digit which carries a high rate of morbidity. This review highlights the pearls and pitfalls of FTS, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. FTS typically...

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Bibliographic Details
Published in:The American journal of emergency medicine 2024-03, Vol.77, p.132-138
Main Authors: Mehta, Prayag, Thoppil, Joby, Koyfman, Alex, Long, Brit
Format: Article
Language:English
Subjects:
Amputation
Animal bites
Anti-Bacterial Agents - therapeutic use
Antibiotics
Blood
Diabetes
Diagnosis
Disease
Emergency medical care
Erythema
Finger
Fingers
Flexor tenosynovitis
Hand
Humans
Infectious diseases
Ischemia
Medical diagnosis
Morbidity
Orthopedics
Patients
Prevalence
Risk factors
Staphylococcus infections
Tendons
Tenosynovitis
Tenosynovitis - diagnosis
Tenosynovitis - epidemiology
Tenosynovitis - etiology
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Summary:Flexor tenosynovitis (FTS) is a deep space infection of an upper extremity digit which carries a high rate of morbidity. This review highlights the pearls and pitfalls of FTS, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. FTS typically occurs after direct penetrating trauma to the volar aspect of an upper extremity digit. Development of a deep space infection that quickly propagates through the flexor tendon sheath of a digit can result in serious structural damage to the hand and place the patient at risk for significant morbidity such as finger amputation or even result in death. Signs of FTS include symmetrical swelling of the affected finger, the affected finger being held in a flexed position, pain on any attempt of passive finger extension, and tenderness along the course of flexor tendon sheath, known as the Kanavel signs. Systemic symptoms such as fevers and chills may occur. Recognition of these signs and symptoms is paramount in diagnosis of FTS, as laboratory and imaging assessment is not typically diagnostic. ED management involves intravenous antibiotics and emergent surgical specialist consultation. An understanding of the presentation and risk factors for development of FTS can assist emergency clinicians in diagnosing and managing this disease in an expedited fashion.
ISSN:0735-6757
1532-8171
1532-8171
DOI:10.1016/j.ajem.2023.12.023