Flexor sheath infections Flashcards

1
Q

What is flexor sheath infections in the hand ?

A

Infection of the synovial sheath that surrounds the flexor tendon

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2
Q

What is the mechanism?

A

Penetrating trauma to tendons

direct spread from felon, septic joint and deep space infection

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3
Q

what are the organisms typically involved?

A

Staoh aureus

Gram negative and anerobic bacteria

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4
Q

What conditions are commonly associated ?

A

IV drug sbusers- significant risk of MRSA
diabetes
farmyard injuries
animal bites

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5
Q

What may the infection develop into?

A

A horse shoe abscess as conditions of radial flexor tendon sheath ( thumb) l and ulna flexor tendon sheaths ( little finer) at the wrist

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6
Q

Where do the flexor synovial sheaths extend from ?

A

DIPJ to midplam in index, middle and ring fingers
DIPJ to wrist in little finger
IPJ to wirst in thumb

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7
Q

What are the presentation ?

A

Pain which developed over the last 24-48 hours

usually located to palmar aspect of one digit

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8
Q

What clinical signs maybe present? How are they associated with?

A

KANAVEL signs 4 in total

FUSIFORM SWELLING OF DIGIT
FLEXED POSITION of involved digit
TENDERNESS on PALPATION over TENDON SHEATH
MARKED PAIN with PASSIVE EXTENSION

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9
Q

What is the tx ?

A

Non op- for early intervention 1-2 kanavel signs= splinting, elevation and iv antibiotics

Mainly surgical draininage

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10
Q

What is problem with pyogenic flexor sheath infections?

A

The incrase in pressure leads to obstruction of arterial blood flow to the flexor tendon thru vincula system-> necrosis and rupture

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11
Q

How do you preform surgery?

A

Aspirate sheath first to obtain sample between palmodigital crease and dipj - use 20 gauge needle under a1 pulley

2 incisions- one prox to a1 pullet at mcpj- transverse incision
2nd incision is proximal to DIPJ crease. tendon sheath exposed. NV bundles identifed, protected. a catheter ( no5 paed feeding tube) is places down the sheath and irrigated prox to distal to avoid infection into palm!!irrigate until fluid is clear.if required can do a continous drip of saline at 1 drop per second fr 24-48 hours. catheter is removed and exercise started. wick gauze into wounds to prevent closure

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12
Q

What is your post op tx?

A

iv antibiotics
analgesia
forst change dressing between 8-12hours
soaks in dilute povidone -idoine x3 per day
rpt in 48hours if Kanavel’s signs not resolving

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