ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT

FACULTY OF MEDICINE HASANUDDIN UNIVERSITY

Flexor tenosinovitis
Widya wahab
C014212188

RESIDENTS ::
dr. Yoga Kusmawan
SUPERVISOR :
dr. Muh. Rahmat Ridha
dr. Zulfan Oktosatria Siregar, Sp. OT
dr. Muh. Zulkifli
 IDENTITY
Initial : P F

Age : 64 years old

Gender : Male

Regostration : 1040543

Admission : August 31th, , 2023 at 18:00 WITA

 autoanamnesis
● Chief Complaint : Pain at right hand
● A 64 years old men presented to the emergency
department with pain at right hand has been felt 1 months
ago before entering the hospital, the pain provocated by
movement and reduced by rest. Complaints felt only on the
right hand,Numbness is absent. Previous patients fell and
the right hand was hit by a stones. Patients also
complaining of swollen right hand and pus discharge about
3 weeks ago.
 autoanamnesis
● History of fever is absent
● History of old cough and treatment TB is
missing
● History of diabetes mellitus exists, insulin
Levemir 0-0-10iu, Novorapid 6-6-6iu
 GENERAL STATUS
•Conscious / well nourished
•Vital Signs :
•Blood pressure : 112/70 mmHg
•Pulse rate : 85x/min
•Respiratory rate : 20 x/ min
•Temperature : 36,6
•NRS : 3/10
CLINICAL FINDING
 CLINICAL FINDING
RIGHT HAND REGION

● Look : Deformity (-), Hematoma (-). Swelling (+), Hipeeremi (+).

Wound dehiscence at extensor zone V
● Feel : Tenderness : (+)
● Move : Active and passive movement of MCP and IP joint digiti II, III,
IV, V cannot be evaluated due to pain
● NVD : Sensibility cannot be evaluated, Capillary refill time < 2
seconds
● Special Test : OK Sign (+), Thumb Up, (+), Finger abduction and
adduction (+)
RADIOLOGY FINDING
 LABORATORY FINDING
WBC 10,3 SGOT 25

HGB 11,5 SGPT 24

HCT 33 UREUM 22

PLT 243 CREATININE 1.14

PT 10,7 NATRIUM 134

APTT 24,1 CALIUM 3.9

HbsAg Non reactive CLORIDA 100

GDS 341 SENSITIVITES Aspergillus Sp.

 DIAGNOSIS
● Flexor Tenosynovitis
● Destruction head of 4th Metacarpal right hand
● Diabetes Mellitus Type 2
 MANAGEMENT
● IVFD
● Analgesic
● Maintain elastic bandage
● ROM exercise
discussion
 DEFINITION

Tenosynovitis is an inflammatory condition affecting the tendon sheath has a wide

variety of causes and treatment considerations. Infectious forms of tenosynovitis can be
rapid and progressive, resulting in damage to the tendon and surrounding structures,
and in addition to antibiotics, may require surgical debridement and washout and
sometimes necessitate amputation.

Ray G, Sandean DP, Tall MA. Tenosynovitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544324/
ANATOMY
 EPIDEMIOLOGY

Tenosynovitis remains a common condition, with its incidence, prevalence, and distribution remaining
variable depending on the etiology. For the general population taken as a whole, the incidence is
between 1.7 to 2.6% for the stenosing form of tenosynovitis.This number is much higher for persons
with diabetes mellitus, ranging from 10 to 20%. Of those who develop infections of the hand, only 2.5
to 9.4% of patients will go on to develop infectious tenosynovitis.Individuals with rheumatoid arthritis
are significantly at risk of tenosynovitis, with 55% of patients reporting symptoms averaging 3.1
tendons.

Ray G, Sandean DP, Tall MA. Tenosynovitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544324/
 ETIOLOGY
● Autoimmune
● Overuse
● Idiopathic
● Infective

Ray G, Sandean DP, Tall MA. Tenosynovitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www-ncbi-nlm-nih-gov.translate.goog/books/NBK544324/?_x_tr_sl=en&_x_tr_tl=id&_x_tr_hl=id&_x_tr_pto=tc
 PATHOPHISIOLOGY
Entry of bacteria in puncture wounds /
incisions -> edema, hypertrophy of the
synovial sheath and increased production
of synovial fluid -> The inflammatory
synovial sheath will be stretched due to
the pressure of the below it with the
semiflexion position of the fingers
(semifleksion can make increased of
voulme fluid) -> decreased tendon blood
flow leads to necrosis
Pyogenic Flexor Tenosynovitis - Hand - Orthobullets
 DIAGNOSIS
● Anamnesis :
● pain and swelling
● typically present in delayed fashion (over last 24-48 hours)
● usually localized to palmar aspect of one digit

● Examination Physical :
● Kanavel Sign, there is 4 :
1. flexed posturing of the involved digit
2. tenderness to palpation over the tendon sheath
3. marked pain with passive extension of the digit
4. fusiform swelling of the digit

Pyogenic Flexor Tenosynovitis - Hand - Orthobullets

 DIAGNOSIS
● Imaging :
- Radiographs
- MRI = cannot distinguish infectious flexor tenosynovitis from inflammatory but
may help determine the extent of the ongoing process

Pyogenic Flexor Tenosynovitis - Hand - Orthobullets

 TREATMENT
● Non Operative :
● Antibiotics like a vancomyicin at 15 - 20 mg/kg/dose every 8 - 12 hours with third
generation, cephalosporin at 1 - 2 mg/kg/dose IV every 24 hours

● Operative :
- I&D followed by culture-specific IV antibiotics
- Indications :
- low threshold to operative once suspected (orthopaedic emergency)
late presentation
no improvement after 24 hours of non-operative treatment

Pyogenic Flexor Tenosynovitis - Hand - Orthobullets

 PROGNOSIS
● In cases of infectious tenosynovitis, the best outcomes
are related to early empiric antimicrobial therapy and
early irrigation or debridement when necessary
● Poor prognostic factors of infectious tenosynovitis
include infection by Streptococcus pyogenes or
multiple agents, delayed antibiotics and surgical
intervention, purulence of the tissue, diabetes mellitus,
renal failure, and peripheral vascular disease

Ray G, Sandean DP, Tall MA. Tenosynovitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544324/
 COMPLICATION
The rate of complications for infectious/pyogenic tenosynovitis is high at 38% and includes
long-term finger stiffness, boney/tendinous deformation, further infection into the deep
spaces of the hand, necrosis of the tendon, adhesions, and eventual need for amputation.

Ray G, Sandean DP, Tall MA. Tenosynovitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.
ncbi.nlm.nih.gov/books/NBK544324/
thankyou