Melbourne Hand Surgery 

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Latest news: Masks are and will remain mandatory when you attend our practice in person. Please check in via our Victorian Government QR code, by entering location code 3D7RE3 into the Services Victoria App or by writing your details on the physical register at our reception.

In accordance with the current COVID peak (black) status consultations are being conducted via videoconference, with in person consultations by exception. Hospital elective surgery has resumed at 50% capacity; cosmetic surgery is not able to be performed in hospital. All individuals undergoing elective surgery are required to obtain a negative COVID test within 72 hours of their scheduled surgery and must self-isolate from the time of their test until their hospital admission.

Our rooms will be closed for the festive season from 5pm Friday 17 December 2021 and will reopen at 9am on Wednesday 5 January 2022. Consulting and operating will resume on Monday 10 January 2022. 

Videoconsultations are conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. For in person consultations we have enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.      If you are eligible to get vaccinated, please do so. 

Flexor tenosynovitis

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.

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Cause

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.

Treatment

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.

handbehindpane 200x133If 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.

capsules 200x150After 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.

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FRACS

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