PDA

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



Medical Videos
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.
Treatment:
(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.


Osteomyelitis
Commonly seen in the distal phalanx following pulp space infection

SOURCE: Prof. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (Vascular Society of Egypt (http://www.vsegypt.org/)) &Medical Educational web (Medical Educational web (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt