The Diagnostic Accuracy of Inflammatory Blood Markers for Purulent Flexor Tenosynovitis

Bishop, Gavin; Born, Trevor; Kakar, Sanjeev; Jawa, Andrew

doi:10.1016/j.jhsa.2013.08.094

Cited by 23 publications

(15 citation statements)

References 9 publications

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“…White blood cell count, erythrocyte sedimentation rate, and C-reactive protein level can aid in diagnosis. The laboratory tests, however, were limited owing to their low negative predictive value and specificity [ 7 ]. In this case, the gynecology surgery was performed at the rural hospital.…”

Section: Discussionmentioning

confidence: 99%

Progressive flexor tendon sheath infection on hand after needle puncture during surgery: a case report

2022

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Introduction Flexor tendon sheath infection may be due to trauma, laceration, or bites, commonly directly inoculating the sheath. Kanavel cardinal signs in flexor tendon sheath infection cases consist of symmetrical swelling of the entire digit, a digit with semi-flexed posture, exquisite tenderness along the course of the tendon sheath, and pain with attempted passive extension of the digit. Elevated levels of inflammation markers such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are often found in such cases. Flexor tendon sheath infections require immediate diagnosis and treatment to prevent poor clinical outcomes. This paper reports one case of severe flexor tendon sheath infection with poor outcomes that required ray amputation of the affected finger. Case presentation A 35-year-old Sundanese male presented to the emergency department with right middle finger pain accompanied with swelling, blister, and blackened color 24 hours after accidental puncture by suture needle during gynecologic surgery. The patient was a resident physician of the obstetrics/gynecology department. The finger was necrotic with blisters at the proximal phalanx of the palmar aspect. Both the palmar and the dorsal aspects of the hand were swollen and inflamed, with firmer swelling on the dorsal part. The necrotic area had extended to the middle phalanx. The patient has been diagnosed with flexor tendon sheath infection with compartment syndrome. Immediate surgical debridement and fasciotomy with shoelace technique at the distal interphalangeal joint were performed. On the initial presentation, erythrocyte sedimentation rate, white blood cell count, and C-reactive protein were elevated. Smear culture was negative. A clear boundary of necrosis at the level of the middle phalanx of the right middle finger was found; subsequently, disarticulation at the level of the distal phalanx was performed. A ray amputation was performed to preserve the hand’s function for performing surgeries in the future. Conclusion Prompt diagnosis and treatment of flexor tendon sheath infection are required to prevent complications. Progressive inflammation around infected soft tissue due to untreated tenosynovitis may lead to poor outcomes and may lead to the amputation of the affected finger. This condition may occur even in medical professionals; as such, awareness for proper protection during any medical procedure and prompt treatment-seeking are encouraged.

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Section: Discussionmentioning

confidence: 99%

Progressive flexor tendon sheath infection on hand after needle puncture during surgery: a case report

2022

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“…Additionally, whereas CRP and ESR were elevated in both the DM and no-DM groups, mean WBC was not in either group. Moreover, relative utility of CRP, ESR, and WBC is controversial for infections not involving the bone: Houshian et al 19 found CRP to have inferior sensitivity for upper extremity infections than ESR, whereas Bishop et al 37 reported CRP to detect hand infection with higher sensitivity than either WBC or ESR. CRP has been found to be nonspecific for bacterial infection, however, and higher levels have been reported in association with gram-negative compared with gram-positive bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Characterizing Hand Infections in an Underserved Population: The Role of Diabetic Status in Antibiotic Choice and Infection Location

Hayden

Shah

Stroud

et al. 2020

Journal of Hand and Microsurgery

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Introduction Patients with diabetes mellitus (DM) in underserved communities are at greater risk for hand infections. We aimed to describe the features of hand infections presenting to an urban hospital via laboratories, microbiology, and antibiotic choice with respect to diabetic status. Materials and Methods Patients presenting with any hand infection were reviewed and stratified by DM status and infection location. Labs, culture results, antibiotic regimens, and significant predictors of laboratories or infection location were analyzed. Results Fifty-three patients were included: DM (n = 24), no-DM (n = 24), and unknown status (n = 5). Culture rates were comparable between all groups. Mean erythrocyte sedimentation rate (ESR) was significantly higher in DM (76.19 vs. 51.33); mean white blood cell count (WBC) and C-reactive protein (CRP) were comparable. Diabetics had higher odds of increased ESR (odds ratio [OR] = 1.03). Diabetics received vancomycin/piperacillin/tazobactam (VAN/PTZ) significantly more often (52% vs. 8%). Providers treated DM with VAN/PTZ or any VAN-containing regimen more often than with any other regimen. Proximal infections had significantly higher mean CRP (136.9 vs. 50.5) and WBC (5.19 vs. 3.9) and higher CRP (OR = 1.02). Conclusion This study highlights the need for systematic criteria to better risk- stratify patients for appropriate antibiotic treatment. It may not be appropriate to treat both groups differently, as overly aggressive antibiotic selection may contribute to drug-resistance development.

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“…Die Diagnose der septischen Tenosynovialitis erfolgt in erster Linie klinisch [8]. Negative Laborwerte (Leukozytenzahl, CRP) schließen eine septische Tenosynovialitis nicht aus [30]. Eine Umfrage von Bolton und Bainbridge [31] zur Behandlungsstrategie ergab, dass 50 % der Behandler bereits im Frühstadium einer septischen Tenosynovialitis eine Dekompression und Spülung durchführen.…”

Section: Diskussionunclassified

Die Spül-Saug-Drainage zur Therapie der septischen Tenosynovialitis der Fingerbeugesehnen

Pillukat

Rahimli

Windolf

et al. 2021

Handchir Mikrochir Plast Chir

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Zusammenfassung Hintergrund/Ziel Die septische Tenosynovialitis der Beugesehnenscheiden erfordert eine dringliche Behandlung, um Sehnennekrosen und den Verlust von Fingern zu verhindern. Gegenstand des vorliegenden Artikels ist die Behandlung durch Revision und postoperativ kontinuierliche Spülung über eine geschlossene Spül-Saug-Drainage. Patienten und Methoden Vom 1.1.2007 bis zum 31.12.2016 wurden 54 Patienten mit septischer Tenosynovialitis einer Beugesehnenscheide mit einer Spül-Saug-Drainage behandelt. Zusätzlich zur Auswertung der Krankenakten (betroffener Finger, betroffene Hand, Dauer des stationären Aufenthaltes, notwendige Revisionsoperationen) konnten 33 Patienten (19 Männer und 14 Frauen) mit einem Durchschnittsalter von 51 (8–85) Jahren nach durchschnittlich 21 (4–38) Monaten nachuntersucht werden. Dabei wurden die Beweglichkeit des betroffenen Fingers/Daumens (Abstand der Fingerkuppe zur distalen Hohlhandbeugefurche beim Faustschluss, resp. der Kapandji-Index), die Grobkraft/Spitzgriffkraft prozentual zur unverletzten Gegenseite, die Schmerzen mittels numerischer Ratingskala (NRS) und der DASH-Score erfasst. Das Gesamtergebnis wurde mittels des Bewertungsschemas von Buck-Gramcko für Beugesehnenrekonstruktionen beurteilt. Ergebnisse Der Krankenhausaufenthalt dauerte im Durchschnitt 9 (3–26) Tage. Elfmal war eine Revision erforderlich, 3-mal davon eine Neuanlage der Spül-Saug-Drainage, 2-mal eine Strahlresektion und einmal eine Amputation in Höhe des Mittelgelenkes. Die nachuntersuchten Patienten wiesen im Mittel eine Grobkraft von 84 (23–163) % der nicht betroffenen Gegenseite auf. Der Ruheschmerz betrug durchschnittlich 0,2 (0–4), der Belastungsschmerz 1,2 (0–8) auf der NRS, der DASH-Score 16,8 (0–58) Punkte. Nach dem Bewertungssystem für Beugesehnenfunktionen war ein Ergebnis unbefriedigend, eines befriedigend, 5 gut und 26 sehr gut. Schlussfolgerungen Die kontinuierliche Spülung über eine Spül-Saug-Drainage bei der septischen Tenosynovialitis der Beugesehnenscheiden ist ein erfolgreiches Verfahren mit niedriger Amputationsrate. Die funktionellen Ergebnisse sind überwiegend gut und sehr gut.

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The Diagnostic Accuracy of Inflammatory Blood Markers for Purulent Flexor Tenosynovitis

Cited by 23 publications

References 9 publications

Progressive flexor tendon sheath infection on hand after needle puncture during surgery: a case report

Progressive flexor tendon sheath infection on hand after needle puncture during surgery: a case report

Characterizing Hand Infections in an Underserved Population: The Role of Diabetic Status in Antibiotic Choice and Infection Location

Die Spül-Saug-Drainage zur Therapie der septischen Tenosynovialitis der Fingerbeugesehnen

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