Pyogenic Flexor Tenosynovitis – Infection of the Flexor Tendon Sheath

Pyogenic Flexor Tenosynovitis

What is it?
This is an infection of the tendon sheath that surrounds the flexor tendons (the tendons responsible for closing the hand into a fist) on the palmar surface of the hand.

What are the symptoms?
This presents with tenderness over the finger, swelling and pain on straightening the finger. Patients tend to keep their finger in a bent position as it is more comfortable.

What is the natural history?
Unfortunately, this type of infection usually fails to settle on its own despite antibiotics. Infection can track down the sheath as it difficult to eradicate without “cleaning out” the tendon sheath.

What is the treatment?
Often this infection requires surgical intervention in addition to intravenous antibiotics as the infection can damage the gliding mechanism of the finger. Sometimes the infection can track further into the palm of the hand. A more extensive operation to try to eliminate the infection may be necessary.

What is the outcome of surgery?
Surgery aims to prevent further damage to tendon. If caught early enough then the aim is to achieve a normal finger. Unfortunately, this is not always the case and infection can damage the tendon as well at the gliding mechanism. This can cause problems with bending or flexing the finger as well as stiffness.

© Fife Virtual Hand Clinic 2021

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