Ultrasound for the diagnosis of pyogenic flexor tenosynovitis

Prunières, Guillaume; Igeta, Yuka; Díaz, J.J. Hidalgo; Gouzou, S.; Facca, S.; Xavier, Fred; Liverneaux, P.

doi:10.1016/j.hansur.2018.03.002

Cited by 9 publications

(11 citation statements)

References 11 publications

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“…The use of ultrasound to determine the presence or absence of fluid in the flexor sheath may help delineate a subset of patients with very early flexor tenosynovitis that may be better managed with IV antibiotics alone. 27 There are important limitations to this study to address. It was a retrospective case series with limited comparisons.…”

Section: Discussionmentioning

confidence: 98%

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis

Rao

Snapp

Crozier

et al. 2021

Hand (New York, N,Y.)

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Background Pyogenic flexor tenosynovitis (PFT) has been considered a surgical emergency. Varying operative approaches have been described, but there are limited data on the method, safety, and efficacy of nonoperative or bedside management. We present a case series where patients with early flexor tenosynovitis are managed using a limited flexor sheath incision and drainage (I&D) in the emergency department (ED) to both confirm purulence within the flexor sheath and as definitive treatment. Methods A retrospective study of all patients clinically diagnosed in the ED with flexor tenosynovitis at our institution from 2012 to 2019 was performed. Patients with frank purulence on examination were taken emergently to the operating room (OR). Patients with equivocal findings underwent limited flexor sheath I&D in the ED. Safety and efficacy were studied for patients with early flexor tenosynovitis managed with this treatment approach. Results Thirty-four patients met the inclusion criteria. Ten patients underwent direct OR I&D, and 24 patients underwent ED I&D. In the ED I&D group, 96% (24 of 25) of patients did not have frank purulence in the flexor sheath and were managed with bedside drainage alone. There were no procedural complications and no need for repeat operative intervention. Time to intervention (3.1 hours vs 8.4 hours) was significantly shorter for the ED I&D group compared with the OR I&D group. Within the ED I&D group, 86% of patients exhibited good/excellent functional scores. Conclusions Limited flexor sheath I&D in the ED provides a potential safe and effective way to manage patients with early flexor tenosynovitis.

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Section: Discussionmentioning

confidence: 98%

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis

Rao

Snapp

Crozier

et al. 2021

Hand (New York, N,Y.)

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“…Gram stain provides important information. While cultures are often false negative, recent advances in the detection and identification of bacterial pathogens by molecular methods greatly facilitate the diagnosis and expedite the initiation of treatment [18,23].…”

Section: Clinical Appearance and Diagnosismentioning

confidence: 99%

“…The bacterial growth causes increased pressure within the sheath, leading to impaired vascular flow, severe impairment of the tendon's gliding mechanism, tendon's ischemia, and subsequent necrosis leading to tendon rupture. In cases of crushing injuries, infection comes from the direct contamination of the tendon sheath [23,25]. Staphylococcus species, including methicillin-resistant Staphylococcus aureus, and Streptococcus species, are the commonly identified pathogens.…”

Section: Infections At the Deep Anatomical Compartmentsmentioning

confidence: 99%

“…Secondary infections are carried either through the lymphatics or through pus spreading from adjacent fascial spaces [ 6 ]. Tobacco use is an identified risk factor for more serious infections and delayed wound healing [ 23 , 25 ]. The diagnosis lacks laboratory or radiologic signs, except the ultrasound, and it is clinically based on the useful tool of the four Kanavel’s clinical signs, including: fusiform swelling of the finger, pain on passive extension, a partially flexed resting posture of the finger, and volar tenderness along the length of the finger and into the palm.…”

Section: Infections At the Deep Anatomical Compartmentsmentioning

confidence: 99%

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Infections of Deep Hand and Wrist Compartments

et al. 2020

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The human hand is the most exposed part of the body to highest risk for injuries, loss of the skin integrity, and to the inoculation of bacteria, most commonly Staphylococcus aureus, Streptococcus β-haemolytic, and gram-negative. In case of an infection, the mobile anatomical structures and the synovial membranes in close proximity to each other may spread the pus towards deep spaces and compartments. Mild early infections without an abscess formation may respond to antibiotics, but at more advanced stage, erythema, swelling, stiffness, and severe pain may ensue. Abscess formation will cause debilitating pain, fever, systemic symptoms, and even sepsis. Necrotizing infections may threaten not only the limb, but also patient’s life. Therefore, an initially “trivial” hand injury should never be neglected, as it might turn into a deep space infection, which must be treated immediately with drainage, wound debridement, and i.v. antibiotics. Delay in diagnosis and inadequate initial management might rapidly lead to abscess formation, destruction of the gliding surfaces and the normal anatomy, and irreparable functional deterioration.

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“…O uso sistemático de ultrassonografia na emergência, quando possível, tem se mostrado uma forte aliada no diagnóstico das infecções da mão. Prunieres et al 7 analisaram a ultrassonografia de 20 pacientes com tenossinovite piogênica e constataram um aumento de mais de 20% no diâmetro da bainha flexora perto da polia A2, achados esses que contribuíram para indicação do tratamento cirúrgico 7 .…”

Section: Introductionunclassified

Perfil das tenossinovites infecciosas em hospital terciário no Brasil

et al. 2021

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A tenossinovite piogênica é uma infecção da bainha do tendão flexor do dedo que pode resultar em necrose e aderência do tendão, perda de movimento, deformidade e, em último caso, acarretar perda do membro se o tratamento não for instituído rápido e adequadamente. O objetivo desse estudo é descrever o perfil epidemiológico e bacteriológico dos pacientes com o diagnóstico de tenossinovite infecciosa em um hospital terciário. Os dados foram coletados dos prontuários dos pacientes atendidos na instituição no período de janeiro de 2019 a junho de 2020 com o diagnóstico confirmado de tenossinovite infecciosa, e que tenham sido submetidos a tratamento clínico e cirúrgico. Os resultados encontrados foram: a prevalência de pacientes do sexo masculino, com média de 42 anos de idade, contaminados após ferimentos perfurocortantes. A bactéria mais encontrada foi Staphylococcus aureus e os resultados mais favoráveis foram nos pacientes que iniciaram o tratamento em menos de 72 horas do início dos sintomas. A suspeita clínica e o reconhecimento precoce do agente etiológico se mostraram fundamentais para minimizar as consequências potencialmente devastadoras do atraso no tratamento desta doença.

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Ultrasound for the diagnosis of pyogenic flexor tenosynovitis

Cited by 9 publications

References 11 publications

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis

Infections of Deep Hand and Wrist Compartments

Perfil das tenossinovites infecciosas em hospital terciário no Brasil

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