View Full Version : Suppurative Tenosynovitis (Anatomy - Aetiology - Clinical Picture - Complication- Treatment

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11-27-2009, 08:27 PM
Anatomy of Synovial Sheaths:

(1) Flexor tendons of middle 3 Fingers have sheaths only to front of the knuckle joint.
(2) Sheath of the little finger extend to joint with sheath
surrounding tendons of middle 3 fingers below the distal crease.
(3) Sheath of the thumb extends to the wrist radial bursa.
- Both radial and ulnar bursae communicate each other above the wrist "in 35% of cases".
Aetiology of infection: direct or extension from nearby spaces.
Cl. Picture:Hotness, reddess, tenderness, swelling along the sheath affected
1- In the middle 3 fingers Fusiform swelling of the finger with maximum point of tenderness over the line over the sheath affected (pencil point tenderness).
2- To differentiate infection of ulnar bursae from midpalmar space infection:
a- Affection of little finger with max. tenderness at Kanavel 's point opposite the base of the little finger.
b- The cup of the hand is preserved to some extent.
3- To differentiate between thenar space infection from radial tenosynovitis.
a- Affection of the thumb. b- Pencil point tenderness.
(1) Tenosynovitis of middle 3 Fingers:
Early: Transverse incision in the base of the finger from palmar aspect.
Advanced: Lat. incision at the sides of middle phalanx.
(2) Tenosynovitis of the ulnar bursa:
Incision along the lateral border of the hypothenar eminence.
(3) Tenosynovitis of the radial burasa:
Incision along the medial border of the thener eminence. It should stop at least 1/2 inch distal to flexor retinaculum to avoid injury of the lat branch of median nerve which supply the thenar muscles.

Commonly seen in the distal phalanx following pulp space infection

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