In pyogenic flexor tenosynovitis a bacterial infection proliferates in the tendon sheath of the finger. It is a painful condition that requires urgent treatment if future hand function is to be maintained.
Commonly the infection can be traced to a penetrating injury that the individual considered quite minor at the time, such as a rose thorn in the garden, or a cat bite. Sometimes the injury was so minor that it isn't remembered.
Symptoms and signs
The symptoms of flexor tenosynovitis are of increasing pain, usually in a single finger (or the thumb), with swelling, increased warmth and redness of the whole finger. The affected finger is held slightly flexed and it is extremely painful (or impossible) for the patient to completely straighten the finger. It is also painful to press on the front of the affected finger (on the palmar side).
Patients may not have systemic symptoms in the early stages, but as the condition progresses they commonly develop a fever and feel generally unwell.
Early treatment of this condition reduces the likelihood of surgery or of needing repeated surgeries. In the very early stages of pyogenic flexor tenosynovitis complete resolution of the infection may be possible with hospital admission, intravenous antibiotics, strict elevation and complete immobilisation of the hand and forearm.
If there is a visible wound on the finger it is necessary to perform surgery to wash out this infected wound. If the condition has passed the very early stages then surgery will be performed, with incisions made on the front of the finger and hand to provide access to wash the tendon sheath. In moderate and severe cases more than one surgery is usually required. During this time the patient remains in hospital, receiving intravenous antibiotic therapy and keeping their hand still and immobilised. Operations are continued every 24-48 hours until the infection is controlled.
Severe pyogenic flexor tenosynovitis is more likely in older patients, patients with diabetes, peripheral vascular disease or renal failure, patients with compromised blood flow to the fingers and when multiple different types of bacteria are involved in the infection. Smoking reduces blood flow to the hands and fingers, which increases the risks of infection and compromises healing.
In extremely severe cases the infection may result in an extremely stiff finger, or in a dead finger that requires amputation.
After the infection has resolved to the point that intravenous antibiotics are no longer considered necessary you will be discharged home from hospital with oral antibiotics. It is important to complete the entire course, and to contact your surgeon if you are having increasing pain in the hand or fingers. You will be discharged home with dressings on the surgical wounds and with your hand in a splint to keep it still. You should still keep your hand elevated at all times.
Post operative therapy
After the infection has resolved sufficiently you will be instructed to begin moving the hand and finger joints to regain the range of movement. In severe cases of tenosynovitis it can take some weeks before the swelling completely resolves. The input of a hand therapist in instructing you how to reduce this swelling and regain hand movement and function is invaluable.