Overview
Suppurative tenosynovitis of flexor tendons involves infection within the tendon sheath, often complicating penetrating trauma or closed injuries, necessitating prompt surgical intervention and specialized care to prevent functional impairment 12.Diagnosis
Clinical suspicion based on history of trauma and signs of infection (redness, swelling, pain) 1.
Detailed physical examination focusing on range of motion deficits and local tenderness 1.
Imaging (e.g., ultrasound, MRI) to assess tendon integrity and extent of infection 1.
Laboratory tests (elevated inflammatory markers) to support diagnosis 1.Management
Surgical debridement: Early surgical intervention to remove necrotic tissue and infected material 12.
Antibiotic therapy: Systemic antibiotics tailored to suspected pathogens based on clinical context 1.
Tendon repair: Once infection is controlled, repair flexor tendons with strong suture constructs to minimize gap formation and preserve blood supply 13.
Postoperative care: Immobilization followed by gradual rehabilitation to prevent stiffness and promote healing 1.Special Populations
Pediatrics: Early recognition and specialized pediatric hand surgery are crucial due to growing bone and tendon dynamics 2.
Elderly: Increased risk of comorbidities; management tailored to overall health status and functional goals 1.Key Recommendations
Prompt surgical intervention for suspected flexor tendon injuries to prevent complications and ensure optimal functional outcomes (Evidence: Strong 12).
Early initiation of appropriate antibiotic therapy based on clinical suspicion to manage infection effectively (Evidence: Moderate 1).
Preservation of tendon blood supply and pulley structures during repair to enhance healing and functional recovery (Evidence: Expert opinion 1).References
1 Pearce O, Brown MT, Fraser K, Lancerotto L. Flexor tendon injuries: Repair & Rehabilitation. Injury 2021. link
2 Stenekes MW, Rüttermann M, Werker PM. Rare causes of closed rupture of the flexor tendon. Journal of plastic surgery and hand surgery 2014. link
3 Ho C, Schnall SB. Retrieving tendon ends in zone II flexor tendon injuries. Orthopedics 2006. link
4 Wehbé MA. Flexor tendon injury. Late solution. Hand clinics 1986. link