Flexor Tendon Sheath Infection

Infection within tendon sheath, tracking up palm + arm

Aetiology

  • Can occur from direct penetrating trauma e.g. knife wound
  • Haematogenous spread e.g. from dental infection

Clinical presentation

  • Extremely painful
  • Limited extension (including passive) due to pain

Investigations

  • Kanavel's cardinal signs:
    • Affected finger held in fixed flexion
    • Fusiform swelling over finger
    • Painful to percuss over sheath
    • Painful on passive extension
  • X-rays
  • Culture of drainage/surgical sample

Management

  • Elevation and high dose antibiotics
  • Emergency surgery - washout tendon sheath, opening up A1 and A5 pulleys