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| Tendon & Ligament Injuries > Flexor Tendon Sheath Infections What are Flexor Tendon Sheath Infections? Tendons in the hand connect with muscles of the forearm, enabling you to bend and extend your fingers and lift your hand at the wrist. The flexor tendons are smooth, thick flexible strings, running through six lubricated tunnels or compartments known as flexor tendon sheaths. The tendons work like bicycle brake cables to bend your fingers, sliding smoothly within the fingers as they straighten and bend. Because this is a very precise mechanism, dependant upon the muscles of the forearm and many coordinated parts, injuries to a tendon or its sheath can cause major problems in the hand. The flexor tendons of the fingers and thumb are covered with a double layer of synovium, the lubricating fluid that allows them to slide freely within the tendon sheath. A flexor tendon sheath infection occurs in the space between these two layers. This condition is also known as infectious (or septic) tenosynovitis. Left untreated, flexor tendon sheath infections can lead to the loss of skin or even the entire finger. Infection may spread into the bone, resulting in a disease known as osteomyelitis, or it could develop into septic (infectious) arthritis. Causes of Flexor Tendon Sheath Infections? As in other infections of the hand or fingertips, infectious tenosynovitis is usually caused by bacterial agents entering the body by means of a penetrating injury such as a puncture wound. While staphylococcus aureus is the most common of these organisms, some infections are caused by streptococci. An example of penetrating trauma is a situation in which one person strikes another in the mouth, causing a fight bite to the hand. If the hand is clenched in a fist, laceration of the skin may injure a tendon sheath or tendon, as well as surrounding tissue and underlying bone. Infections caused by human bites may involve the bacteria eikenella corrodens. Pasteurella multocida and capnocyntophaga infections caused by cat and dog bites are extremely serious and can progress rapidly if untreated. Sometimes infection occurs by a process known as hematogenous spread, moving in the blood through the veins of the hand. N. gonorrhea is the offending agent in many cases of this kind. Infection usually follows the course of the tendon sheath, and may spread into the radial and ulnar bursae. Pressure within the sheath caused by infection impairs the flow of nutrients to the tendon, and, if untreated, is likely to result in impaired function of the hand or even tendon necrosis (death). Symptoms of Flexor Tendon Sheath Infections? Flexor tendon sheath infections are usually the result of a puncture wound or other traumatic injury to the hand. The entire finger swells, and attempts to flex, bend, or move it in any way is painful. The pain is typically throbbing in nature. Occasionally organisms from infectious tenosynovitis spread to the deep fascial space of the hand. If this happens, the hand will also appear swollen and any attempt to move the fingers produces pain. The patient may have an elevated temperature or a history of fever. Treatment of Flexor Tendon Sheath Infections? If you have injured your thumb, finger, or hand, seek medical treatment immediately. Many tissues quickly lose their elasticity, and treatment is necessary to prevent long-term damage. In the case of infections, it is crucial to update your tetanus booster status, if necessary, and to begin limiting the spread of infectious bacteria. Your doctor will examine your hand and ask about any contributing factors, such as a puncture wound or other traumatic injury. X-rays are typically used to rule out the possibility of a fracture, a foreign body within the injury, or damage to the bone indicating osteomyelitis. X-rays help identify any gas or air formation that may be present in the wound as well. Your doctor will have been trained to test the finger and hand according to the signs of hand infection identified and described in 1912 by Allen Kavanel, a pioneer in research concerning these conditions. Kavanel's cardinal signs for infectious tenosynovitis include: 1) swelling along the entire flexor surface; 2) tenderness over the course of the tendon sheath; 3) pain on passive extension of the finger; and 4) an inability to straighten the finger at rest. If some, but not all, of Kavanel's signs are present, your doctor may begin treatment with antibiotics and schedule a follow-up appointment for sometime within 12 to 24 hours. If the finger seems to be responding to treatment, this course may be continued for another 24 to 36 hours. Patients whose symptoms do not respond to antibiotics need to be evaluated for surgery. If you are diagnosed as having an infection of a flexor tendon sheath, you will be referred to an experienced hand surgeon for a consultation. Again, speed is of the essence. You will probably be given medication for pain relief, and antibiotic therapy will be initiated. It is important to take antibiotics for the entire course of the prescription. In addition to antibiotics, incision and drainage are necessary for the treatment of infectious tenosynovitis and related deep fascial space infections of the hand. This surgery should be performed by an experienced hand surgeon in an operating room. In some cases, transfer to another medical facility will be required. Anesthesia is used, and surgical risk increases with smoking and/or the use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids. Drink only water before surgery, following the instructions given to you by your doctor and other medical personnel. Your doctor will instruct you concerning surgical after-care. The finger is usually splinted, and you will be instructed to soak the wound periodically in warm water, changing the dressing each time. The use of ice massage and/or heat helps to alleviate discomfort as the wound heals, and specific exercises of the hand will help you regain strength in the injured area. Infectious tenosynovitis is a serious medical condition, one that must be treated promptly and thoroughly. Follow-up treatment is crucial to ensure that infection is no longer present, and to restore the hand as much as possible to its former condition. As in the case of any infection, watch the wound carefully, irrigate it well, and report any worsening condition to your doctor. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. ©2000 DynoMed.com, LLC, Indianapolis, IN |