SEARCH RESULTS FOR: Suppurative-Tenosynovitis

Suppurative Tenosynovitis

Legend: Suppurative Tenosynovitis: Pathogenesis & clinical findings Penetrating trauma involving the tendon sheath (e.g., puncture wounds, human or animal bite, intravenous drug use, other trauma sources) Bacteria spread into the tendon sheath from a nearby infected joint or deep space (less common) Hematogenous spread (bacterial infection travels through the bloodstream to other parts of the body, rare) Authors: Stephen Langor Reviewers: Nojan Mannani Mankirat Bhogal Jessica Revington Kate Elzinga* * MD at time of publication Bacterial infection of the tendon sheath (most commonly Staphylococcus aureus) Bacterial infection of the tendon sheath (e.g., Neisseria gonorrhoeae, mycobacteria) Suppurative Tenosynovitis Severe bacterial infection of the flexor tendon sheath Bacterial infection causes an immune response & subsequently activates macrophages & neutrophils Immune cells & mast cells release vasoactive cytokines (molecules capable of dilating or constricting blood vessels) Immune cells produce pyrogens (fever- inducing substances) & inflammatory cytokines (e.g.,IL-1, IL-6, TNF⍺) ↑ White blood cell count Vasoactive cytokines ↑ vascular permeability during capillary dilation & allow for the outflow of fluid, immune cells, & plasma into surrounding tissues Systemic cytokines (immune messenger proteins) produce ↑ concentrations of non- specific acute-phase reactants (inflammatory markers) Pyrogens stimulate prostaglandin E2 production in the hypothalamus Fluid outflow reaches the synovial space (a fluid-filled sac surrounding tendons). The synovial space is between the visceral epitenon layer (connective tissue sheath immediately covering the tendon) & outer parietal layer of the tendon Infection & corresponding immune response spread from the thumb to the little finger (or vice versa) through the radial & ulnar bursae (fluid-filled sacs surrounding hand flexor tendons) ↑ Serum C- reactive protein ↑ Prostaglandin E2 production disrupts thermoregulation in the hypothalamus & forces body temperature elevation Chills (rare) Fever (rare) Exudate (fluid leaking from nearby blood vessels) continues accumulating in the flexor tendon sheath’s synovial space Dead inflammatory cells also begin accumulating & fill the synovial space with purulent fluid (pus) Fluid accumulation can ↑ pressure in the synovial space & compromise blood flow to the sheath, tendon, & adjacent structures Erythema (redness), swelling, & pain in both the thumb & little finger Tendon necrosis (tissue death) Tendon ischemia (↓ blood flow) Hand horseshoe abscess Fluid leaks into the surrounding tissue & causes swelling. Swelling is more prominent on the ventral (front) side of the affected digit(s) ↑ Synovial space content applies ↑ pressure on the visceral & parietal layers of the tendon sheath ↑ Pressure disrupts tendon blood flow & nutrient supply ↑ Risk of tendon damage & scarring, which may ↑ fibrotic tissue deposition along the tendon ↑ Swelling & pressure cause passive mechanical stretching of digit tissue. Stretch is ↑ in the ventral direction ↑ Pressure activates nociceptors (sensory receptors detecting harmful stimuli) Fibrotic tissue may cause tendon adhesion, thicken joint capsules, & damage the flexor pulley system Fibrotic tissue is stiff & may ↓ tendon elasticity Symmetric enlargement of affected digit(s) Digit slightly flexed at rest ↑ Pain along the tendon with passive extension Kanavel Criteria ↑ Tenderness along the tendon sheath ↓ Range of motion Chronic stiffness Tendon rupture Published November 20, 2025 on www.thecalgaryguide.com Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications