Subscribe to RSS
DOI: 10.1055/s-0039-1700370
Pyogenic Flexor Tenosynovitis: Evaluation and Treatment Strategies
Publication History
Received: 23 September 2018
Accepted after revision: 09 July 2019
Publication Date:
02 November 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00031417/201903/lookinside/thumbnails/10-1055-s-0039-1700370_00075-1.jpg)
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.
-
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
- 2 Glass KD. Factors related to the resolution of treated hand infections. J Hand Surg Am 1982; 7 (04) 388-394
- 3 Boles SD, Schmidt CC. Pyogenic flexor tenosynovitis. Hand Clin 1998; 14 (04) 567-578
- 4 Neviaser RJ. Closed tendon sheath irrigation for pyogenic flexor tenosynovitis. J Hand Surg Am 1978; 3 (05) 462-466
- 5 Harris PA, Nanchahal J. Closed continuous irrigation in the treatment of hand infections. J Hand Surg [Br] 1999; 24 (03) 328-333
- 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
- 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
- 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
- 9 Michon J. [Phlegmon of the tendon sheaths]. Ann Chir 1974; 28 (04) 277-280
- 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
- 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
- 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
- 13 Tosti R, Ilyas AM. Empiric antibiotics for acute infections of the hand. J Hand Surg Am 2010; 35 (01) 125-128
- 14 Abrams RA, Botte MJ. Hand infections: treatment recommendations for specific types. J Am Acad Orthop Surg 1996; 4 (04) 219-230
- 15 Small LN, Ross JJ. Suppurative tenosynovitis and septic bursitis. Infect Dis Clin North Am 2005; 19 (04) 991-1005
- 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
- 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
- 18 Juliano PJ, Eglseder WA. Limited open-tendon-sheath irrigation in the treatment of pyogenic flexor tenosynovitis. Orthop Rev 1991; 20 (12) 1065-1069
- 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
- 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
- 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
- 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
- 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