Suppurative Tenosynovitis Research Articles

Septic Tenosynovitis of the Lower Extremity: A Case Report

Category: Other Introduction/Purpose: Tibialis anterior rupture is an exceptionally rare complication of septic tenosynovitis. One case of septic tenosynovitis of TA has been previously documented by Lowell et al. 2020 It is worth noting in this case, that TA was unruptured. In this abstract, we present a case of TA rupture secondary to septic tenosynovitis. Methods: A 46-year-old female with a past medical history of depression, HIV, HCV, Diabetes Mellitus, medication noncompliance and current heroin abuse presented with 2 days of right ankle pain. She also reported fever, chills, diaphoresis, nausea and vomiting. She was diagnosed with right foot cellulitis based on clinical findings of erythema, induration and tenderness. She underwent computed tomography (CT) with contrast of her right lower extremity which showed a peripherally enhancing fluid collection surrounding the tibialis anterior tendon consistent with tenosynovitis. There appeared to be medial extension beyond the tendon sheath (Figure 1). A sagittal view is provided in Figure 2, which further demonstrates the fluid collection. Results: She had an I&D of the fluid collection and started on IV vancomycin. After admission to the medical floor, blood cultures were drawn. The patient failed to improve after 2 days of vancomycin therapy. The blood cultures were negative. She subsequently had MRI of her right lower extremity that showed a persistent peripherally enhancing fluid collection anterior to the tibialis anterior tendon and high-grade partial tear of the tibialis anterior tendon (Figure 3). She was then taken to the operating room for a repeat incision and drainage where the tendon sheath of the tibialis anterior was incised and the tendon was exposed with washout. Wound cultures were drawn, and afterward, her antibiotic regimen was broadened with Piperacillin-Tazobactam. She was taken back to the operating room a third time for primary closure of the wound. Wound cultures grew methicillin- sensitive Staphylococcus Aureus resistant to clindamycin and she was discharged on Bactrim. Conclusion: Septic or suppurative tenosynovitis is the infection and inflammation of the closed synovial sheath of a tendon. These infections typically involve the tendons and tendon sheaths of the flexor muscles in the hand. The potential spaces of tendon sheaths create a walled-off environment ideal for pathogens to grow in isolation from host defenses. he pathogenesis of septic tenosynovitis typically involves trauma from a laceration, puncture or bite but other cases of disseminated hematogenous spread have been reported (Newman et al., 1989). Both medical and surgical management is recommended for the best possible outcome.

Collar-button abscess as a complication of infected hematoma in the setting of uncontrolled type 2 diabetes.

IntroductionCollar-button abscesses are deep space infections of the hand.Case presentationWe present a case of a 66-year-old man who developed an acute collar-button abscess of the hand after a concrete bench fell onto the dorsal aspect of his hand. The hand abscess was managed successfully with intravenous antibiotics and operative intervention.DiscussionWhile such infections comprise a small percentage of hand infections, insufficient or delayed treatment results in permanent hand disfiguration and dysfunction. This case highlights an uncommon dorsal-to-volar pattern of hand abscess extension.ConclusionKnowledge of the anatomy of the hand is essential to diagnosis and appropriate surgical management.

Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients

De Quervain described tenosynovitis of first dorsal compartment more than 120years ago. Women, particularly of 4th-5th decades, are at more risk of developing disease. Steroid injection has been described as first line of management over many decades, but it is associated with some significant complications like depigmentation of skin, atrophy of subcutaneous tissue, suppurative tenosynovitis and even tendon rupture. Animal studies have also reported increased risk of peritendinous adhesions with steroid injection. We prospectively managed 46 cases of De Quervain's tenosynovitis with longitudinal incision at tertiary care hospital from 2014 to 2016. There were totally 40 patients with 9 males and 31 females between age group of 28 and 62years. All patients were evaluated using DASH and VAS scores preoperatively and post-operatively. The mean preoperative DASH score was 42.26 which reduced to 5.37 post-operatively. The mean preoperative VAS score was 7.30 which reduced to 2.33 post-operatively. Intraoperatively, we found peritendinous adhesions in 8 patients and ganglion arising from first dorsal compartment in one patient. Post-operatively, we found hypertrophic scar in 3 patients and persistent numbness to first dorsal web space due to injury to superficial radial nerve in 2 patients. Six patients had recurrent symptoms and required revision surgery. Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons.

Case Commentary: a Reflection on Ethical Dilemma in End-of-Life Care

This case report illustrates the complexity of managing a young patient with complications of diabetes mellitus (DM) and the ethical considerations in decision-making to withhold treatment. Mr. T suffered from poorly controlled type 1 diabetes mellitus with microvascular and macrovascular complications including nephropathy requiring long-term haemodialysis. He was admitted for necrotising suppurative tenosynovitis, which is a type of infection of tendon and synovium, of the right upper limb that led to sepsis and multi-organ dysfunction despite antibiotics and multiple debridements or surgeries. As his condition deteriorated, Mr. T became increasingly confused and uncertain about his goals of care leaving his medical team with difficulty in planning his further treatment. In thinking through the ethical dilemma that arose from this case on end-of-life care, the four-quadrant approach was applied.

Effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand

Objective: To investigate the effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand. Methods: A total of 9 cases acute and chronic suppurative tenosynovitis patients from January 2013 to April 2015 in Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. There were 6 males and 3 females, aging from 27 to 65 years, the average age was 55 years. There were 3 cases of index finger, 3 cases of middle finger, 2 cases of ring finger, 1 case include three fingers. The infection causes included stabbing with fishbone in 3 cases, stabbing with animal bone fragments in 3 cases, wound by sawdust in 3 cases, meat grinder injury in 1 case, multiple fingers crush injury postoperative infection of garbage truck in 1 case. Bacterial infection included 2 cases with Staphylococcus aureus, 2 cases with Staphylococcus epidermidis, 1 case with normal Escherichia coli, 1 case with mixed infection of Enterobacter aerogenes, Klebsiella oxytoca and Staphylococcus, 1 case with Bauman Acinetobacter bacillus, 1 case with Proteus mirabilis and 1 case of no growth of pathogenic bacteria culture. After thorough debridement, vacuum sealing drainage was used to observe the characteristics of irrigation fluid, the formation of cavity inflammation, the prognosis of infection and the recovery of finger function. Results: Seven patients with suppurative tenosynovitis were treated for 7 to 14 days, replaced the vacuum sealing drainage dressing once; 1 patient was an illustration of the finger tip defect flap infected patients after 21 days of treatment, replaced the vacuum sealing drainage dressing twice, 1 patient was an illustration of the central refers to trauma, postoperative infection patients 28 d, replaced three times in the VSD. The follow-up time was 3 to 12 months (mean 8.2 months), 7 patients without tendon necrosis, secondary suture with no infection, 2 cases of traumatic surgery of patients with infection, tendon necrosis was removed, the infection has been effectively controlled, secondary suture with no infection. There were 6 cases were good and 3 cases were poor in the evaluation of postoperative finger function. Conclusion: Thoroughly debridement after vacuum sealing drainage in the treatment of suppurative tenosynovitis of hand has satisfactory curative effect.

EXTENSIVE OPEN DRAINAGE FOR SUPPURATIVE FLEXOR TENOSYNOVITIS INVOLVING FIVE DIGITS: A CASE REPORT

An unusual case of suppurative tenosynovitis involving all five digits up to distal forearm in a 20-year-old male with no known risk factors is reported. We highlight the strategy of extensile skin incisions from the wrist to all five digits that allowed flexor sheath debridement, synovectomy, and infection resolution without causing skin flap ischemia. At three months, total active motion of 70% of contralateral hand was achieved.

Modified Tenoscopic Method for Carpal Flexor Retinaculum Release in a Horse

To report the use of a proximolateral endoscopic portal with a distolateral instrument portal for carpal retinaculum release in a horse clinically affected with carpal canal syndrome. Clinical report. A 4-year-old Thoroughbred female. Carpal canal syndrome secondary to traumatic suppurative tenosynovitis was treated by accessory carpal bone debridement and carpal retinaculum release using a tenoscopic approach to the carpal flexor synovial sheath through a proximolateral endoscope portal and a distolateral instrument portal. Resolution of carpal sheath effusion and lameness occurred allowing racing 14 months later. Use of a distolateral instrument portal was not associated with complications or iatrogenic damage to neurovascular structures and reduced endoscope and instrument interference and offered easier access to the distal aspect of the carpal sheath. Carpal retinaculum release may be safely accomplished with a distolateral instrument portal when access to the distal aspect of the carpal sheath is needed. The distolateral instrument portal described may be a useful alternative to a proximolateral portal when distal carpal sheath instrument access is necessary or advantageous.

Hazards of steroid injection: Suppurative extensor tendon rupture

Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain's tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.

Simultaneous Infected Pseudoaneurysm and Suppurative Tenosynovitis Resulting from Radial Artery Cannulation

Simultaneous Infected Pseudoaneurysm and Suppurative Tenosynovitis Resulting from Radial Artery Cannulation

Sesamoiditis of the index finger presenting as acute suppurative flexor tenosynovitis

Sesamoiditis involving the hand is uncommon, usually reported in the thumb, and has not been reported in the index finger. As rare as this clinical entity remains, its presentation simulating an acute suppurative flexor tenosynovitis is even more rare. We report a patient who presented with Kanavel's 4 cardinal signs of acute suppurative tenosynovitis who was subsequently found to have an acute sesamoiditis of the index finger. This finding was supplemented by a cadaveric and radiographic study to better delineate the anatomy of the index sesamoid and further explain the clinical presentation.

Three-Phase Bone Scintigraphy in Suppurative Tenosynovitis

A 50-year-old man had swelling, stiffness, and pain 2 days after the removal of a foreign body from the palmar aspect of the distal phalanx of the right ring finger. A three-phase bone scan was performed to exclude underlying bony infection. Distinctive changes on bone images and subsequent ultrasound suggested a diagnosis of suppurative tenosynovitis. This was confirmed at follow-up surgery.

Remote Acute Suppurative Tenosynovitis Secondary to Carpal Tunnel Release Under Local Anaesthesia

LA Hughes, GH Knutson. Remote acute suppurative tenosynovitis secondary to carpal tunnel release under local anaesthesia. Can J Plast Surg 1993; 1(2):95-97. A case of acute suppurative tenosynovitis following carpal tunnel release under local anaesthesia is presented. This complication is believed to have resulted from injection contamination of the flexer tendon sheath during the administration of local anaesthesia. This is supported by the fact that the incisional wound remained healthy and healed uneventfully.

SOFT TISSUE INFECTIONS

Several infectious processes ranging in severity from mild to overwhelming that affect the soft tissues are reviewed. Superficial infections such as impetigo, erysipelas, cellulitis, and subcutaneous bursitis are common and, for the most part, can be easily treated. Because suppurative tenosynovitis has the potential to destroy tendons, consultation with a hand surgeon should be obtained immediately. Mycobacterial and fungal tenosynovitis is usually chronic and patients present with a mass which, when excised and examined with appropriate stain and culture, reveals the unexpected diagnosis. Tropical myositis (muscle abscesses) is seen in temperate climates, primarily as a complication of AIDS. Necrotizing fasciitis and gas gangrene represent the hyperacute end of the spectrum of soft tissue restrictions. Although in most cases a history of trauma is present, spontaneous gas gangrene may arise from occult and colonic cancer. Patients do poorly unless immediate and extensive surgery is performed and appropriate antibiotics are given.

Remote acute suppurative tenosynovitis secondary to carpal tunnel release under local anaethesia

Remote acute suppurative tenosynovitis secondary to carpal tunnel release under local anaethesia

Community outbreak of invasive group A streptococcal infection

In a two-month period, three cases of septicaemia and one of suppurative tenosynovitis caused by a single strain of Lancefield group A streptococcus, serotype T/M/R 3/3/3, occurred in the district of Nairn (population: 10,239). A primary portal of entry for the organism could not be identified in any of the cases. Laboratory isolates from all four patients were highly susceptible to beta-lactam antibiotics, but prompt treatment failed to prevent the deaths of two previously healthy adults. Group A streptococci of M-type 3 have not previously been associated with outbreaks of invasive infection.

Suppurative extensor tenosynovitis caused by Staphylococcus aureus

Suppurative tenosynovitis is a rare infection, occurring almost exclusively in the flexor tendon sheath as a posttraumatic event. We report the case of a systemically ill woman with suppurative tenosynovitis of the extensor tendons caused by Staphylococcus aureus. Early recognition of this unusual infection may prevent unnecessary morbidity.

Use of sonography in the early detection of suppurative flexor tensosynovitis

Eighteen patients with swollen fingers suggesting acute suppurative tenosynovitis were studied by ultrasonography. All patients received intravenous antibiotics. Twelve patients required surgical drainage. Eleven of 12 patients had sonographic evidence of both a swollen tendon and fluid in the flexor sheath. Eleven of the 12 patients operated on had purulent fluid in the flexor sheath. Four of the operative cases were culture positive and four were culture negative. All six patients treated only with antibiotics had swollen tendons, but five of the six had no sonographic evidence of fluid in the flexor sheath. All patients had a full recovery. Sonographic evidence of fluid in the flexor sheath is a useful sign in the early diagnosis of acute suppurative flexor tenosynovitis.

Acute suppurative tenosynovitis of the hand: diagnosis with US.

The sonographic findings in seven patients with surgically proved acute tenosynovitis of the hand (bacterial in six cases, of presumed viral origin in one) were reviewed. In the six patients with bacterial tenosynovitis the affected flexor tendon was larger than that of the contralateral normal digit. In five patients hypoechoic areas were identified surrounding the flexor tendon that proved to be pus at surgery. Sonography failed to depict a small amount of pus in the tendon sheath in one patient. The affected tendon of the single patient with tenosynovitis thought to be of viral origin was normal in size, but a focal tendon sheath fluid collection was detected that proved to be sterile at surgery. Sonography appears to be a useful imaging technique in the early diagnosis of acute suppurative tenosynovitis of the hand.

Modern considerations of major hand infections.

LYMPHANGITIS, deep-fascial-space abscess and acute suppurative tenosynovitis are the major infections of the hand. Usually, one of these conditions exists in a single patient. However, on rare occasions, more than one may occur simultaneously. A knowledge of the anatomy involved is basic for a proper understanding of the clinical aspects and treatment of each of these entities. Lymphangitis Lymphangitis may be defined as an acute inflammatory process of the lymphatic vessels. There are two types of lymphangitis of the upper extremity, superficial and deep. The former involves the superficial vessels that arise in the skin. The collecting trunks of superficial . . .

Acute suppurative tenosynovitis of the hand.

SUPPURATIVE inflammation of the flexor tendons of the hand presents a controversial problem, and one that has not been solved surgically.The incidence and complications of acute suppurative tenosynovitis have decreased since the advent of antibiotics. However, this serious infection is still encountered too frequently.Analysis of StudyThe material studied consisted of 100 cases of acute pyogenic infection of the flexor tendon sheaths of the hand, previous to antibiotics, and 50 cases since the advent of antibiotics, in which patients were treated at the Boston City Hospital.The origin of the infection has not changed since the advent of . . .