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Inpektadong Flexor Sheath (Pyogenic Flexor Tenosynovitis)

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Updated Oct 2026
Illustration: Inpektadong Flexor Sheath (Pyogenic Flexor Tenosynovitis)

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang iyong nararamdaman

Ang infected flexor sheath ay isang impeksyon sa tunnel na dinadaanan ng bending tendon ng daliri. Madalas na pantay na namamaga ang buong daliri, sa buong haba nito, sa halip na sa iisang masakit na bahagi lamang. Maaaring nakaposisyong bahagyang nakabaluktot ang daliri at mahirap itong ituwid. Ang pagtuwid dito, o ang dahan-dahang pagtuwid dito ng ibang tao para sa iyo, ang karaniwang pinakamasakit, lalo na malapit sa base ng daliri kung saan maaaring makita ang pamamaga.

Ang sakit ay nasa kahabaan ng linya ng tendon, mula sa base ng daliri pababa patungo sa palad, sa halip na sa ibabaw ng iisang joint. Karaniwan itong naroroon sa lahat ng oras at lumalala kapag itinutuwid ang daliri. Ang bahagyang pagbaluktot ng daliri ay madalas na nagpapagaan dito, kaya naman kumukulot ang daliri. Ang pamamaga at sakit ay maaaring magpahirap sa mga pang-araw-araw na gawain: paghawak ng takure, pagpihit ng susi, pagbubutones, paghawak ng panulat o paghawak sa handrail.

Maaaring mabilis lumala ang impeksyong ito, at hindi ito dapat ipagpaliban. Kung ang iyong daliri o kamay ay nagiging mainit, namumula, namamaga at masakit, lalo na kung may lagnat, pumunta sa emergency department sa parehong araw. Hindi mo kailangang kumuha muna ng referral mula sa GP. Ganoon din kung ang iyong daliri ay nagiging maputla, malamig, puti o asul, o kung bigla kang nawalan ng pakiramdam o paggalaw dito.

Ano ang aktwal na nangyayari

Sa ilalim na bahagi ng bawat daliri ay may bending tendon, isang matibay na cord na humihila sa dulo ng daliri patungo sa palad. Dumudulas ang tendon na iyon sa loob ng isang saradong tunnel na tinatawag na flexor sheath. Ang tunnel ay may madulas na lining na nagpapakain, nagpapadulas at nagpapanatiling malayang nakakadulas ang tendon, medyo tulad ng isang cable na dumadaan sa isang manggas na may grasa.

Kapag nakapasok ang mga bacteria sa loob ng manggas na iyon, kadalasan sa pamamagitan ng hiwa, tusok o kagat, napupuno ng nana ang saradong espasyo. Dahil selyado ang manggas, nakadiin nang may pressure ang nana sa mismong surface na kailangan ng tendon upang makadulas. Iniipit ng pressure ang supply ng dugo ng tendon at nagsisimula ng pagpepeklat sa pagitan ng tendon at ng lining nito. Iyan ang dahilan kung bakit pantay na namamaga ang buong daliri, kung bakit ito kumukulot, at kung bakit napakasakit ng pagtuwid dito: sabay-sabay na namamaga ang bawat bahagi ng tunnel.

Maaaring kumalat ang impeksyon. Ang tunnel ng hinlalaki ay nakakonekta sa isang espasyong may likido sa palad na tinatawag na radial bursa, at ang sa kalingkingan ay nakakonekta sa isang tinatawag na ulnar bursa. Sa maraming tao, umaabot ang mga espasyong ito hanggang sa pulso, kaya ang impeksyon sa isang daliri ay maaaring kumalat patungo sa palad o maging patawid sa hinlalaki o kalingkingan, na bumubuo ng tinatawag na horseshoe abscess.

Ang nakataya ay nakadepende sa timing. Umaasa ang tendon sa pagdulas, at habang tumatagal ang nanang nakakulong sa tabi nito, lalong lumalaki ang pangmatagalang pinsalang idinudulot nito. Kapag nagamot nang maaga, karamihan sa mga daliri ay gumagaling nang maayos. Kapag pinabayaan nang masyadong matagal, maaaring mamatay ang mismong tendon, maaaring tumigas ang daliri dahil sa peklat, at sa mga malalang kaso ay maaaring mawala ang daliri. Kahit may agarang antibiotic at operasyon, karaniwan ang ilang paninigas ng daliri pagkatapos, dahil ang gumagaling na tissue ay may tendensiyang kumapit sa halip na dumulas.

Susuriin ng iyong surgeon kung gaano na kalayo ang inabot ng impeksyon bago magpasya kung gaano kaagaran ito dapat i-drain.

Ano ang maaari naming gawin tungkol dito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay itinuturing na emergency ang infected flexor sheath at agad na sinisimulan ang paggamot. Hindi naghihintay ang impeksyong ito, at hindi ka rin dapat maghintay. Ang layunin ay alisin ang impeksyon bago nito mapinsala ang tendon na nagpapahintulot sa iyong daliri na bumaluktot.

Ang unang hakbang ay mga antibiotic na ibinibigay sa pamamagitan ng drip sa iyong braso. Gumagana ang mga antibiotic kasabay ng drainage, hindi bilang kapalit nito. Dahil ang sheath ay isang selyadong tunnel, madalas na hindi kayang alisin ng mga antibiotic lamang ang impeksyon. Ang pag-drain ng nana ay nag-aalis ng pressure sa tendon at nagpapahintulot sa mga antibiotic na maabot ang buong bahagi.

Karamihan sa mga kaso ay nangangailangan ng operasyon upang i-drain ang sheath. Gumagawa kami ng maliliit na incision, maliliit na hiwa sa balat, upang mabuksan namin ang tunnel at mahugasan palabas ang nana. Ang agarang paghuhugas sa sheath ay nagpoprotekta sa dumudulas na surface na kailangan ng iyong tendon. Ang eksaktong timing at uri ng operasyon ay nakadepende sa kung gaano na kalayo ang inabot ng impeksyon at kung gaano ka kaagang dumating.

Pagkatapos ng operasyon, maaaring kailanganin ng iyong daliri ng splint upang ipahinga ito. Ang iyong hand therapy pagkatapos ng operasyon ay kasama si Ruby Doolan sa Extend Rehabilitation. Si Ruby ay isang hand therapist: ginagabayan niya ang iyong mga ehersisyo at gumagawa siya ng anumang splint na kailangan mo. Nakatuon siya sa muling pagpapadulas ng tendon, dahil ang pagpepeklat sa pagitan ng tendon at ng lining nito ang naglilimita sa paggalaw sa kalaunan.

Ang ilang impeksyon ay nagmumula sa mga di-pangkaraniwang mikrobyo, tulad ng mycobacteria o fungi, na nangangailangan ng partikular na antibiotic o antifungal na paggamot sa mas mahabang kurso. Kung malubhang napinsala ng impeksyon ang tendon, ang muling pagbuo nito ay isang hiwalay na operasyon na maaaring gawin kapag tuluyan nang humupa ang impeksyon.

Ang prognosis ay nakadepende nang malaki sa timing. Ang maagang pagpunta ang iisang bagay na pinakanagpoprotekta sa iyong daliri, kaya kung ang iyong daliri ay mainit, namumula, namamaga at masakit, lalo na kung may lagnat, pumunta sa emergency department sa parehong araw.

Ano ang dapat asahan

Ang prognosis para sa isang infected flexor sheath ay higit na nakadepende sa kung gaano kabilis itong nagamot. Ang maagang pagpunta ay nagbibigay sa iyong daliri ng pinakamagandang pagkakataon na muling bumaluktot nang normal. Ang paghihintay ay nagpapahintulot sa nana na manatiling nakadiin nang may pressure sa tendon, at ang pressure na iyon ay nagdudulot ng pinsalang hindi na maaaring maibalik sa kalaunan.

Sa agarang paggamot, karamihan sa mga daliri ay humuhupa at nagsisimulang gumalaw muli sa mga sumusunod na linggo at buwan. Gayunpaman, karaniwan ang ilang paninigas pagkatapos, kahit sa mga taong malusog naman na mabilis na nabigyan ng antibiotic at operasyon. Ang gumagaling na tissue ay may tendensiyang kumapit sa halip na dumulas, kaya maaaring hindi na bumaluktot o tumuwid ang daliri nang kasing-luwag ng dati. Tinutugunan ito ng hand therapy, ngunit nangangailangan ito ng panahon at tuloy-tuloy na pagsisikap.

Kung malala ang impeksyon o pinabayaan nang masyadong matagal, mas mahirap ang prognosis. Maaaring masira ang tunnel sa paligid ng tendon, at maaaring mag-iwan ang pagpepeklat ng permanenteng paninigas sa daliri. Sa ilang kaso, nagiging napakalala ng pamamaga kaya naiipit nito ang supply ng dugo sa mismong daliri, isang problemang tinatawag na compartment syndrome. Sa mga pinakamalalang impeksyon, maaaring mamatay ang daliri at mangailangan ng amputasyon, kahit napapanahon at masusi ang paggamot.

Ilang hindi gaanong karaniwang bagay ang maaari ring mangyari. Minsan ay hindi tuluyang nawawala ang impeksyon at nangangailangan ng pangalawang washout. Bihira, maaaring lumitaw ang isang di-pangkaraniwang mikrobyo sa daliri ilang linggo pagkatapos ng paggamot at mangailangan ng karagdagang pangangalaga.

Ang iisang bagay na kaya mong kontrolin ay ang timing. Kung ang iyong daliri o kamay ay nagiging mainit, namumula, namamaga at masakit, lalo na kung may lagnat, pumunta sa emergency department sa parehong araw. Hindi mo kailangang kumuha muna ng referral mula sa GP. Ganoon din kung ang iyong daliri ay nagiging maputla, malamig, puti o asul, o kung bigla kang nawalan ng pakiramdam o paggalaw dito.

Kailan dapat magpatingin

Ang impeksyong ito ay isang emergency, at mabilis itong lumala. Pumunta sa emergency department sa parehong araw kung ang iyong daliri o kamay ay nagiging mainit, namumula, namamaga at masakit, lalo na kung may lagnat. Ganoon din kung ang iyong daliri ay nagiging maputla, malamig, puti o asul, o kung bigla kang nawalan ng pakiramdam o paggalaw dito. Hindi mo kailangang kumuha muna ng referral mula sa GP. Kung hindi mo makontak ang klinika, halimbawa sa labas ng oras ng opisina o sa katapusan ng linggo, pumunta sa pinakamalapit na emergency department.

Sinusundan ng mga babalang senyales ang hugis ng impeksyon: pantay na namamaga ang buong daliri, nakaposisyon itong nakabaluktot, masakit ito sa kahabaan ng linya ng tendon, at napakasakit ng pagtuwid dito. Hindi mo kailangang magkaroon ng lahat ng senyales na ito bago magpasuri. Ang daliri na nagpapakita lamang ng ilan sa mga ito ay maaari pa ring may ganitong impeksyon.

Magpatingin sa iyong GP o humingi ng specialist review kung hindi humuhupa ang mga sintomas, lumalala sa loob ng ilang linggo, o pumipigil sa iyong paggamit ng kamay.

Higit pang detalye

Advanced reading: the deeper science (optional)

Ang seksyong ito ay mas malalim kaysa sa kailangan mo para sa iyong sariling mga desisyon sa paggamot. Ang isang infected flexor sheath ay karapat-dapat sa karagdagang pagbabasa dahil ito ang kaisa-isang impeksyon sa kamay na isang tunay na emergency, at dahil ang dalawa sa mga bagay na pinaka-nagtatakda kung paano ito magtatapos ay napagdesisyunan na bago ka pa makarating sa ospital — ang isa sa mga ito ay maraming taon na ang nakalipas.

Ang diagnosis ay nakabatay sa apat na signs mula noong 1930s na hindi kailanman wastong nasuri

Inilarawan ni Allen Kanavel ang apat na signs ng isang infected flexor sheath: isang daliring namamagang buo ang haba sa halip na sa isang bahagi lamang, nakaposisyong bahagyang nakabaluktot, masakit sa buong haba ng tendon sheath sa halip na sa isang joint lamang, at, ang pinaka-kapaki-pakinabang sa apat, matinding sakit kapag dahan-dahang itinuwid ng isang tao ang daliri [1].

Halos isang siglo ang nakalipas, ang apat na signs na ito pa rin ang ginagamit kung paano ginagawa ang diagnosis, at ang kanilang sensitivity, specificity at interobserver reliability ay hindi kailanman wastong naitatag [1]. Isang kapansin-pansing pagkukulang ito para sa isang diagnosis kung saan ang pagkaantala ay nagreresulta sa pagkawala ng mga daliri.

Ang praktikal na konsekwensya ay ang bahaging dapat tandaan: hindi lahat ng apat na signs ay lumalabas sa bawat kaso, lalo na sa mga bata, at ang kawalan ng isa o higit pa ay hindi nag-e-exclude sa diagnosis [1]. Ang isang daliri na hindi pumasa sa isa lamang sa mga test ni Kanavel ay hindi nangangahulugang ligtas ang daliri.

Ang paraan ng pag-drain ay nakakaapekto sa kung gaano kahusay ang paggalaw ng daliri pagkatapos

Kapag nagawa na ang diagnosis, kailangang i-decompress ang sheath, at mayroong dalawang pangunahing paraan upang gawin ito: buksan ang sheath sa pamamagitan ng operasyon, o magpasok ng isang fine catheter dito at mag-irrigate sa pamamagitan ng isang mas maliit na sugat.

Isang systematic review na sumasaklaw sa 763 pasyente ang nakatuklas na ang catheter irrigation ay nagresulta sa mas mabuting range of motion kaysa sa open washout, at ang paggamit ng antibiotics bilang bahagi ng gamutan, sa halip na umasa lamang sa drainage, ay nakapagpahusay din ng paggalaw [2].

Tandaan na ito ay kabaligtaran ng posisyon sa isang felon, kung saan ang isang pulp abscess na maayos na na-drain ay hindi nangangailangan ng antibiotic. Ang pagkakaiba ay ang anatomy: ang felon ay isang closed pocket na maaari mong ubusin nang kumpleto, habang ang sheath ay isang mahabang tubo na nababalutan ng mismong surface kung saan dapat dumulas ang tendon. Hindi mo ito maaaring i-debride nang malinis nang hindi nasisira ang sinusubukan mong isalba, kaya ginagawa ng antibiotic ang trabahong hindi kayang gawin ng operasyon.

Ang panganib ng pagkawala ng daliri ay pangunahing katangian ng pasyente

Ito ang pinaka-hindi komportableng natuklasan at ang pinaka-kapaki-pakinabang. Sa pinagsama-samang serye, ang mga rate ng amputasyon ay higit na itinulak ng background health kaysa sa surgical technique: 39% sa mga pasyenteng may diabetes, 64% na may renal failure, at 71% na may peripheral vascular disease, lahat ay statistically significant [2].

Inilalarawan ng mga numerong iyon ang isang ibang sakit mula sa sakit na mayroon ang isang malusog na tao na may splinter injury. Sila ang dahilan kung bakit ang isang infected sheath sa isang taong may diabetes o mahinang sirkulasyon ay ginagamot nang may higit na urgency at mas mababang threshold para sa repeat washout, at kung bakit ang tapat na sagot sa "mapapanatili ko ba ang daliri" ay mas nakadepende sa sagot sa "ano pa ang nangyayari sa iyong kalusugan" kaysa sa anumang nangyayari sa theatre.

Bakit mas mahalaga ang pagkaantala kaysa sa halos anumang bagay

Ang sheath ay isang saradong espasyo na may mahinang supply ng dugo at may tendon sa loob nito na nakadepende sa pag-glide. Ang nana sa ilalim ng pressure sa loob ng espasyong iyon ay gumagawa ng dalawang bagay nang sabay: sinasakal nito ang supply ng dugo ng tendon, at nagtatanim ito ng mga adhesion na kalaunan ay naglilimita sa paggalaw. Parehong nakadepende ang mga ito sa oras, kung kaya't ang maagang paggamot ay palaging nagpapabuti sa mga outcome [2] at kung bakit ang standard na payo para sa partikular na infeksyong ito ay ang emergency department sa halip na appointment sa GP [3].

Ang paninigas pagkatapos ay karaniwan kahit na ang lahat ay ginawa nang tama at agad. Kung gaano kalala ang paninigas ay nakadepende nang malaki sa kung gaano katagal ang sheath sa ilalim ng pressure, na siyang tanging variable na maaaring maimpluwensyahan ng isang pasyente, sa pamamagitan ng pagpunta nang maaga.

Mga Sanggunian

[1] Kennedy CD, Huang JI, Hanel DP. In brief: Kanavel's signs and pyogenic flexor tenosynovitis. Clin Orthop Relat Res. 2016;474(1):280-284. https://doi.org/10.1007/s11999-015-4367-x

[2] Giladi AM, Malay S, Chung KC. A systematic review of the management of acute pyogenic flexor tenosynovitis. J Hand Surg Eur Vol. 2015;40(7):720-728. https://doi.org/10.1177/1753193415570248

[3] Goyal K, Speeckaert AL. Pyogenic flexor tenosynovitis: evaluation and management. Hand Clin. 2020;36(3):323-329. https://doi.org/10.1016/j.hcl.2020.03.005

Reviewed by AI synthesis (v2) — pending human review · 19 August 2026.

Want the clinical detail? Read the clinician version.

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For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Pyogenic flexor tenosynovitis is an uncommon closed-space infection of the hand [2].
  • Pyogenic flexor tenosynovitis can result in severe stiffness and other sequela [2].
  • Acute flexor tendon sheath infections are associated with significant morbidity [3].
  • 43% of patients with acute flexor tendon sheath infections have a poor result [3].
  • The consequences of pyogenic flexor tenosynovitis can include destruction of the tendon sheath [6].
  • The consequences of pyogenic flexor tenosynovitis can include scarring and inflammation causing oedema of the soft tissues of the finger [6].
  • The consequences of pyogenic flexor tenosynovitis can include resultant finger stiffness [6].
  • The consequences of pyogenic flexor tenosynovitis can occasionally include compartment syndrome [6].
  • Sonographic evidence of a swollen tendon and fluid in the flexor sheath correlates strongly with the diagnosis of acute suppurative tenosynovitis [4].
  • Sonographic evidence of a swollen tendon and fluid in the flexor sheath should prompt early surgical drainage [4].
  • Any suspicion of flexor tendon sheath phlegmon should lead to urgent surgical exploration [10].
  • Any suspicion of flexor tendon sheath phlegmon should not lead to blind antibiotic prescription [10].
  • The absence of pain on passive extension in advanced stages is a grave prognostic sign indicating tissue necrosis rather than improvement [7].

Anatomy & Pathophysiology

Flexor Tendon Anatomy and Sheath Structure

  • The extrinsic finger flexors consist of the flexor digitorum profundus and the flexor digitorum superficialis [13].
  • The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx, flexing the distal interphalangeal joint as well as the proximal interphalangeal and metacarpophalangeal joints [13].
  • The flexor digitorum superficialis acts as a flexor of the proximal interphalangeal and metacarpophalangeal joints [13].
  • As flexor tendons pass distal to the metacarpal neck, they enter the fibroosseous tunnel, or digital flexor sheath [24].
  • The fibroosseous tunnel extends distally to the proximal aspect of the distal phalanx [24].
  • The tendinous sheath consists of annular pulleys, which provide mechanical stability, and cruciate pulleys, which provide flexibility [24].
  • The first, third, and fifth annular pulleys (A1, A3, and A5) are located over the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively [24].
  • The second and fourth pulleys (A2 and A4) are situated over the middle portion of the proximal and middle phalanges [24].
  • The A2 and A4 pulleys are the most essential in maintaining the mechanical advantage of the flexor tendons [24].
  • The tenosynovium that lines the fibroosseous tunnel supplies both nutrition and lubrication to the poorly vascularized flexor tendons [24].
  • Within the sheath, tendon vascularity is supplied via the vincula system: the vinculum longus and brevis [24].
  • The tenosynovial sheath of the flexor pollicis longus is continuous with the radial bursa [24].
  • The tenosynovial sheath to the little finger is continuous with the ulnar digital bursa [24].
  • In some patients, the radial and ulnar bursae communicate, allowing a so-called horseshoe abscess to spread between the thumb and little finger if infection occurs in the flexor tendon sheath of either one of these digits [24].

Pathophysiology of Pyogenic Flexor Tenosynovitis

  • Pyogenic flexor tenosynovitis (PFT) is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela [2].
  • Acute flexor tendon sheath infections are associated with significant morbidity, with 43% of patients having a poor result [3].
  • The consequences of pyogenic flexor tenosynovitis can be destruction of the tendon sheath, scarring and inflammation causing oedema of the soft tissues of the finger with resultant finger stiffness or, occasionally, compartment syndrome [6].
  • Sonographic evidence of a swollen tendon and fluid in the flexor sheath correlates strongly with the diagnosis of acute suppurative tenosynovitis and should prompt early surgical drainage [4].
  • Any suspicion of flexor tendon sheath phlegmon should lead to urgent surgical exploration, not blind antibiotic prescription [10].
  • Although unusual, nonsuppurative tenosynovitis secondary to foreign body migration may occasionally account for an otherwise unexplained mild but persistent tenosynovitis [11].

Classification

  • Nonsuppurative tenosynovitis secondary to foreign body migration may occasionally account for an otherwise unexplained mild but persistent tenosynovitis [11].

Investigations

  • A careful physical examination is essential to direct care and future testing if indicated [12].
  • Diagnostic tests such as imaging and serum laboratory studies are useful in the determination of pathology but can be expensive, time consuming, and often nonspecific [12].

Treatment

Operative

  • A minimally invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique was effective in 65% of cases [1].
  • A minimally invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique was safe in 100% of cases [1].
  • Any suspicion of flexor tendon sheath phlegmon should not be managed with blind antibiotic prescription [10].
  • Placement of irrigation catheters in ulnar or radial bursitis may be facilitated by passing an irrigation catheter over a previously placed guide wire [9].

Outcomes and Prognosis

  • No patient had a recurrence of the infection following closed tendon sheath irrigation for pyogenic flexor tenosynovitis [5].
  • Use of a protocol for the treatment of severe infections of the hand resulted in a shorter hospital stay compared with patients treated before the protocol's institution [8].
  • Use of a protocol for the treatment of severe infections of the hand resulted in faster healing compared with patients treated before the protocol's institution [8].
  • Use of a protocol for the treatment of severe infections of the hand resulted in fewer complications, including recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis, compared with patients treated before the protocol's institution [8].

Complications

  • Pyogenic flexor tenosynovitis is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela [2].
  • Complications associated with severe hand infections include recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis [8].

Recovery

  • The consequences of pyogenic flexor tenosynovitis can be destruction of the tendon sheath [6].
  • The consequences of pyogenic flexor tenosynovitis can be scarring and inflammation causing oedema of the soft tissues of the finger with resultant finger stiffness [6].
  • The consequences of pyogenic flexor tenosynovitis can occasionally be compartment syndrome [6].
  • Use of a treatment protocol resulted in a shorter hospital stay compared with patients treated before the protocol's institution [8].
  • Use of a treatment protocol resulted in faster healing compared with patients treated before the protocol's institution [8].
  • Use of a treatment protocol resulted in fewer complications, including recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis, compared with patients treated before the protocol's institution [8].
  • No patient had a recurrence of the infection following closed tendon sheath irrigation [5].

Key Evidence

  • [L5] Our results have shown that this minimally invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique was effective in 65% of cases and safe in 100% of cases. [1] (10.1016/j.hansur.2018.12.001)
  • [L5] Pyogenic flexor tenosynovitis (PFT) is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela. [2] (10.2106/jbjs.rvw.26.00015)
  • [L4] Acute flexor tendon sheath infections are associated with significant morbidity, with 43% of patients having a poor result. [3] (10.1016/0363-5023(90)90064-x)
  • [L4] Sonographic evidence of a swollen tendon and fluid in the flexor sheath correlates strongly with the diagnosis of acute suppurative tenosynovitis and should prompt early surgical drainage. [4] (10.1016/0363-5023(89)90027-0)
  • [L4] No patient had a recurrence of the infection. [5] (10.1016/s0363-5023(78)80141-5)
  • [L5] The consequences of pyogenic flexor tenosynovitis can be destruction of the tendon sheath, scarring and inflammation causing oedema of the soft tissues of the finger with resultant finger stiffness or, occasionally, compartment syndrome. [6] (10.1016/j.jhsb.2006.02.019)
  • [L3] The absence of pain on passive extension in advanced stages is a grave prognostic sign indicating tissue necrosis rather than improvement. [7] (10.1016/j.injury.2026.113631)
  • [L3] Use of the protocol resulted in a shorter hospital stay, faster healing, and fewer complications (recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis) when compared with 107 patients who were treated before institution of the protocol. [8] (10.1016/s0363-5023(88)80060-1)
  • [L5] Placement of irrigation catheters in other closed space infections such as in ulnar or radial bursitis may also be facilitated by passing an irrigation catheter over a previously placed guide wire. [9] (10.1016/s0266-7681(97)80290-2)
  • [L4] Any suspicion of flexor tendon sheath phlegmon should lead to urgent surgical exploration, not blind antibiotic prescription. [10] (10.1016/j.main.2011.10.025)
  • [L5] Although unusual, the situation described may occasionally account for an otherwise unexplained mild but persistent tenosynovitis. [11] (10.1016/s0363-5023(83)80176-2)

References

[1] Designing a minimally-invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique: a cadaver study. Hand Surgery and Rehabilitation. 2019. DOI: 10.1016/j.hansur.2018.12.001

[2] Management of Pyogenic Flexor Tenosynovitis. JBJS Reviews. 2026. DOI: 10.2106/jbjs.rvw.26.00015

[3] Acute flexor tendon sheath infections. The Journal of Hand Surgery. 1990. DOI: 10.1016/0363-5023(90)90064-x

[4] Use of sonography in the early detection of suppurative flexor tensosynovitis. The Journal of Hand Surgery. 1989. DOI: 10.1016/0363-5023(89)90027-0

[5] Closed tendon sheath irrigation for pyogenic flexor tenosynovitis. The Journal of Hand Surgery. 1978. DOI: 10.1016/s0363-5023(78)80141-5

[6] MRSA Pyogenic Flexor Tenosynovitis Leading to Digital Ischaemic Necrosis and Amputation. Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsb.2006.02.019

[7] Predictive Factors for Outcomes in Pyogenic Flexor Tenosynovitis: A 10-Year Analysis of 341 Patients. Injury. 2026. DOI: 10.1016/j.injury.2026.113631

[8] A protocol for the treatment of severe infections of the hand. The Journal of Hand Surgery. 1988. DOI: 10.1016/s0363-5023(88)80060-1

[9] Passage of an Irrigation Catheter with the Aid of a Guide Wire for Pyogenic Flexor Tenosynovitis. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80290-2

[10] Phlegmons des gaines des tendons fléchisseurs des doigts : étude de 120 cas. Chirurgie de la Main. 2011. DOI: 10.1016/j.main.2011.10.025

[11] Nonsuppurative tenosynovitis secondary to foreign body migration. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80176-2

[12] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[13] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > Image DISORDERS OF THE MUSCULATURE OF THE HAND.

[24] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

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