Commentary on an article by R.W. Draeger, MD, et al.: “Corticosteroids as an Adjunct to Antibiotics and Surgical Drainage for the Treatment of Pyogenic Flexor Tenosynovitis”

Abstract

Pyogenic flexor tenosynovitis, or suppurative flexor tenosynovitis, is a closed-space bacterial hand infection of the digital flexor tendon sheath that can cause considerable morbidity. The majority of these infections follow traumatic penetrating injuries; therefore, skin flora, including Staphylococcus aureus, are the most common infecting organisms1. Kanavel classified this condition among the grave infections of the hand, describing the classic cardinal signs of flexor sheath infections, including pain with passive extension of the digit, symmetric digital swelling (sausage digit), tenderness along the flexor sheath, and a semiflexed resting posture of the involved digit1. A high (38%) rate of complications, including stiffness, persistent infection, boutonniere deformity, and amputation, has been reported2. Several risk factors have been associated with poor outcomes following the treatment of pyogenic flexor tenosynovitis, including an age of more than forty-three years, the presence of diabetes mellitus, peripheral vascular disease, renal failure, the presence of subcutaneous purulence, digital ischemia, polymicrobial infection3, methicillin-resistant Staphylococcus aureus infection, and delay in diagnosis4. Nonoperative treatment with intravenous antibiotics may be possible if the infection is detected …