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J Hand Microsurg 2019; 11(03): 121-126
DOI: 10.1055/s-0039-1700370
Review Article
Society of Indian Hand & Microsurgeons

Pyogenic Flexor Tenosynovitis: Evaluation and Treatment Strategies

Talia Chapman
1   Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Asif M. Ilyas
1   Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

Received: 23 September 2018

Accepted after revision: 09 July 2019

Publication Date:
02 November 2019 (online)

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Abstract

Pyogenic flexor tenosynovitis (PFT) is a common closed-space infection of the flexor tendon sheaths of the hand, which remains one of the most challenging problems facing hand surgeons. PFT goes by several names including septic or suppurative flexor tenosynovitis. Adequate treatment requires timely diagnosis and often prompt surgical treatment. However, despite prompt treatment, and regardless of the protocol used, complication rates as high as 38% have been reported in the literature. Moreover, even with successful eradication of the infection, a significant proportion of patients will suffer from continuing pain, swelling, stiffness, loss of composite flexion, weakness, and recurrence potentially requiring amputation. This review will focus on current evidence-based antimicrobial and surgical treatment strategies to maximize treatment outcomes.

Keywords

pyogenic - suppurative - septic flexor tenosynovitis
 

  • References

  • 1 Pang HN, Teoh LC, Yam AK, Lee JY, Puhaindran ME, Tan AB. Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Am 2007; 89 (08) 1742-1748
    CrossrefPubMedGoogle Scholar
  • 2 Glass KD. Factors related to the resolution of treated hand infections. J Hand Surg Am 1982; 7 (04) 388-394
    CrossrefPubMedGoogle Scholar
  • 3 Boles SD, Schmidt CC. Pyogenic flexor tenosynovitis. Hand Clin 1998; 14 (04) 567-578
    CrossrefPubMedGoogle Scholar
  • 4 Neviaser RJ. Closed tendon sheath irrigation for pyogenic flexor tenosynovitis. J Hand Surg Am 1978; 3 (05) 462-466
    CrossrefPubMedGoogle Scholar
  • 5 Harris PA, Nanchahal J. Closed continuous irrigation in the treatment of hand infections. J Hand Surg [Br] 1999; 24 (03) 328-333
    CrossrefPubMedGoogle Scholar
  • 6 Giladi AM, Malay S, Chung KC. Management of acute pyogenic flexor tenosynovitis: literature review and current trends. J Hand Surg Eur Vol 2015; 40 (07) 720-728
    CrossrefPubMedGoogle Scholar
  • 7 Kanavel AB. The symptoms, signs, and diagnosis of tenosynovitis and major fascial space abscesses. In Infections of the Hand. 1st ed.. Philadelphia: PA: Lea & Febiger; 1912: 201-226
    Google Scholar
  • 8 Grinnell RS. Acute suppurative tenosynovitis of the flexor tendon sheaths of the hand: a review of one hundred and twenty-five cases. Ann Surg 1937; 105 (01) 97-119
    CrossrefPubMedGoogle Scholar
  • 9 Michon J. [Phlegmon of the tendon sheaths]. Ann Chir 1974; 28 (04) 277-280
    PubMedGoogle Scholar
  • 10 Lille S, Hayakawa T, Neumeister MW, Brown RE, Zook EG, Murray K. Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis. J Hand Surg [Br] 2000; 25 (03) 304-307
    CrossrefPubMedGoogle Scholar
  • 11 Nemoto K, Yanagida M, Nemoto T. Closed continuous irrigation as a treatment for infection in the hand. J Hand Surg [Br] 1993; 18 (06) 783-789
    CrossrefPubMedGoogle Scholar
  • 12 Fowler JR, Greenhill D, Schaffer AA, Thoder JJ, Ilyas AM. Evolving incidence of MRSA in urban hand infections. Orthopedics 2013; 36 (06) 796-800
    CrossrefPubMedGoogle Scholar
  • 13 Tosti R, Ilyas AM. Empiric antibiotics for acute infections of the hand. J Hand Surg Am 2010; 35 (01) 125-128
    CrossrefPubMedGoogle Scholar
  • 14 Abrams RA, Botte MJ. Hand infections: treatment recommendations for specific types. J Am Acad Orthop Surg 1996; 4 (04) 219-230
    CrossrefPubMedGoogle Scholar
  • 15 Small LN, Ross JJ. Suppurative tenosynovitis and septic bursitis. Infect Dis Clin North Am 2005; 19 (04) 991-1005
    CrossrefPubMedGoogle Scholar
  • 16 Kennedy CD, Huang JI, Hanel DP. In brief: Kanavel’s signs and pyogenic flexor tenosynovitis. Clin Orthop Relat Res 2016; 474 (01) 280-284
    CrossrefPubMedGoogle Scholar
  • 17 Chahal J, Dhotar HS, Anastakis DJ. Phaeohyphomycosis infection leading to flexor tendon rupture: a case report. Hand (N Y) 2009; 4 (03) 335-338
    CrossrefPubMedGoogle Scholar
  • 18 Juliano PJ, Eglseder WA. Limited open-tendon-sheath irrigation in the treatment of pyogenic flexor tenosynovitis. Orthop Rev 1991; 20 (12) 1065-1069
    PubMedGoogle Scholar
  • 19 Murray AR. The management of the infected hand: based on a clinical investigation of 513 cases. Med J Aust 1951; 1 (17) 619-622
    CrossrefPubMedGoogle Scholar
  • 20 Kennedy CD, Lauder AS, Pribaz JR, Kennedy SA. Differentiation between pyogenic flexor tenosynovitis and other finger infections. Hand (N Y) 2017; 12 (06) 585-590
    CrossrefPubMedGoogle Scholar
  • 21 Gutowski KA, Ochoa O, Adams WP Jr. Closed-catheter irrigation is as effective as open drainage for treatment of pyogenic flexor tenosynovitis. Ann Plast Surg 2002; 49 (04) 350-354
    CrossrefPubMedGoogle Scholar
  • 22 Draeger RW, Singh B, Bynum DK, Dahners LE. Corticosteroids as an adjunct to antibiotics and surgical drainage for the treatment of pyogenic flexor tenosynovitis. J Bone Joint Surg Am 2010; 92 (16) 2653-2662
    CrossrefPubMedGoogle Scholar
  • 23 Ketonis C, Hickock NJ, Ilyas AM. Rethinking pyogenic flexor tenosynovitis: biofilm formation treated in a cadaveric model. J Hand Microsurg 2017; 9 (03) 131-138
    Article in Thieme ConnectPubMedGoogle Scholar