Flexor Tenosynovitis
Although the existence of PFT has been described in medical literature since at least 1912 when American surgeon Allen Kanavel described his three cardinal signs (now four), its diagnosis continues to elude practitioners - Sheema Samdani DO
HWN Suggests
Kanavel is Still Kicking
A high degree of suspicion helps to lead to the clinical diagnosis. PFT diagnosis is largely based off Kanavel’s cardinal signs: 1) tenderness along the tendon sheath, 2) fusiform swelling of the digit, 3) finger held at slight flexion at rest, and 4) pain on passive extension. While still a commonly used tool in clinical diagnosis, the sensitivity, specificity, and inter-observer reliability of this tetrad have not been established in the literature. Presence of Kanavel’s signs varies case by case and there is no agreement as to which signs are the most important in making the diagnosis of PFT.
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EM@3AM: Pyogenic Flexor Tenosynovitis
Typical history is a bite or puncture wound to the hand 2-5 days prior. Patients who have acute (<5 days) onset of painful extension and flexor sheath tenderness have a high likelihood of having PFT. The cornerstones of management are surgical consultation and early empiric antibiotics against MRSA and Streptococcus. Consider gonococcal tenosynovitis in sexually active patients with symptoms without antecedent hand injury.
Articles of Interest
EM@3AM – Flexor Tenosynovitis
If identified within the first 24 hours of onset, flexor tenosynovitis may respond to heat, rest, elevation, and antibiotics, however, during this time period the majority of cases are mistaken for cellulitis, a paronychia, or a felon.
