An Update on Suppurative Tenosynovitis

Suppurative tenosynovitis is a serious infection mostly affecting the flexor tendons of the hand and is considered a medico-surgical emergency.

Infectious tenosynovitis is mostly caused by Staphylococci, Streptococci, Gram negatives, and following bite injury, Eikenella and Pasteurella species. Atypical organisms especially in immunocompromised patients are increasingly being reported like fungi and slowly or rapidly growing mycobacteria. Management can be conservative with intravenous antibiotics and close monitoring especially in mild cases. Minimally invasive catheter irrigation of the tendon sheath can be used with improved functional outcomes.

Suppurative tenosynovitis is an infection of the tendon sheath. Inoculation usually occurs following injury, puncture wounds, bites, recent surgery, or via hematogenous or contiguous spread of infection. Kanavel signs are helpful when evaluating patients. Hand surgeons should be promptly consulted for decision about need for surgical exploration. Uncomplicated cases can be treated with 7 to 14 days of an oral antibiotic. Smoking, diabetes, vascular disease, and advanced Michon stage infection are associated with higher risk of amputation or decreased mobility. Infectious diseases specialists should be consulted in the management of atypical presentations like fungal and mycobacterial tenosynovitis.