http://www.boneschool.com/ en http://www.boneschool.com/upper-limb/hand/hand-infection/flexor-tendon-sheath-infections <span class="field field--name-title field--type-string field--label-hidden">Flexor Tendon Sheath Infections</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h3 style="margin: 0px; padding: 0px; font-weight: bold; font-family: Helvetica,Arial,sans-serif; font-size: 14px; color: rgb(92, 158, 209);">Aetiology</h3> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">S. aureus / Strept</p> <p style="margin: 0em 0px; padding: 0px;">- usually a history of trauma</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <h3 style="margin: 0px; padding: 0px; font-weight: bold; font-family: Helvetica,Arial,sans-serif; font-size: 14px; color: rgb(92, 158, 209);">Anatomy</h3> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">IF / MF / RF</p> <p style="margin: 0em 0px; padding: 0px;">- extend from DP to distal crease</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">LF</p> <p style="margin: 0em 0px; padding: 0px;">- extends to mid palm</p> <p style="margin: 0em 0px; padding: 0px;">- communicates with ulna bursa</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">Thumb&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">- distal phalanx to volar wrist crease</p> <p style="margin: 0em 0px; padding: 0px;">- communicates with radial bursa</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <h3 style="margin: 0px; padding: 0px; font-weight: bold; font-family: Helvetica,Arial,sans-serif; font-size: 14px; color: rgb(92, 158, 209);">Examination</h3> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;"><strong>Kanavel's 4 signs</strong></p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">1. &nbsp;Tenderness along course of flexor tendon</p> <p style="margin: 0em 0px; padding: 0px;">2. &nbsp;Fusiform swelling</p> <p style="margin: 0em 0px; padding: 0px;">3. &nbsp;Flexed attitude to finger</p> <p style="margin: 0em 0px; padding: 0px;">4. &nbsp;Pain on passive extension of finger</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <h4 style="margin: 0px; padding: 0px; font-weight: bold; font-family: Helvetica, Arial, sans-serif; font-size: 14px; color: rgb(34, 139, 34);">Management</h4> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <h3 style="margin: 0px; padding: 0px; font-weight: bold; font-family: Helvetica,Arial,sans-serif; font-size: 14px; color: rgb(92, 158, 209);">Nonoperative</h3> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">May settle with antibiotics if get early</p> <p style="margin: 0em 0px; padding: 0px;">- want improvement in 12 - 24 hours</p> <p style="margin: 0em 0px; padding: 0px;">- risk adhesions / tendon necrosis</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <h3 style="margin: 0px; padding: 0px; font-weight: bold; font-family: Helvetica,Arial,sans-serif; font-size: 14px; color: rgb(92, 158, 209);">Operative</h3> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">Distal incision</p> <p style="margin: 0em 0px; padding: 0px;">- distal finger crease</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">Proximal incision</p> <p style="margin: 0em 0px; padding: 0px;">- distal palmar crease</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">Will see pus</p> <p style="margin: 0em 0px; padding: 0px;">- take swab for MCS</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">Pass infant feeding catheter</p> <p style="margin: 0em 0px; padding: 0px;">- into flexor sheath</p> <p style="margin: 0em 0px; padding: 0px;">- irrigate +++</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">IV ABx 48 hours</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">Occupational / hand therapy to prevent adhesions</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> <p style="margin: 0em 0px; padding: 0px;">&nbsp;</p> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>andrewbirchley</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 12/22/2009 - 18:15</span> <div class="field field--name-field-tags field--type-entity-reference field--label-hidden clearfix"> <ul class="links field__items"> <li><a href="/category/tags/flexor-tendon-sheath-infections" hreflang="en">flexor tendon sheath infections</a></li> <li><a href="/category/tags/aetiology" hreflang="en">aetiology</a></li> <li><a href="/category/tags/kavanels-signs" hreflang="en">kavanels signs</a></li> <li><a href="/category/tags/management" hreflang="en">management</a></li> <li><a href="/category/tags/surgical-technique" hreflang="en">surgical technique</a></li> </ul> </div> Tue, 22 Dec 2009 07:15:40 +0000 andrewbirchley 810 at http://www.boneschool.com