FLEXOR TENOSYNOVITIS

Question 1

Mechanism

Answer 1

Most commonly penetrating trauma

Question 2

Etiology

Answer 2

Staphylococcus - most common
Anaerobes
Polymicrobial

Question 3

Suspected pathogen a/w recent suspected STI

Answer 3

Neisseria Gonorhoeae

Question 4

Clinical Features: Kanavel’s four cardinal signs

Answer 4

Percussion tenderness: over the length of the flexor tendon sheath

Uniform swelling: of the finger along the length of the tendon sheath

Intense pain with passive extension

Flexor posture of the involved digit at rest

Question 5

Management

Answer 5

Send spontaneous exudates for Gram stain and cuture with sensitivities

Immobilize and elevate the extremity

IV antibiotics:

Ancef
2 g IV q 8 hr

+-

Clindamycin
600 - 900 mg IV q 8 hr

OR

Ampicillin-sulbactam
1.5 g IV q 6 hrs

OR

Pip-tazo
3.375 g IV q 6 hrs

PLUS

Vancomycin
1 g IV q 12 hrs

Admission and consultation with plastics

Question 6

Addition medication if N. Gonorrhoeae is suspected

Answer 6

Ceftriaxine
1 g IV od