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Tenosynovitis (suppurative, hand flexor tendons)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Suppurative tenosynovitis of the hand is a rare condition of serious consequence. The affected finger is painful on passive extension, restricted in movement, flexed at rest, swollen and tender to palpation. Sings of inflammation may be localised to the volar aspect of the digit.

The index, middle and ring fingers are most frequently affected. Very rare thumb and little finger infections can progress to infection of the radial and ulnar bursa.

Staphylococcus aureus entering through a perforating wound is the most common cause. Caught early, splinting, elevation and intravenous antibiotics may suffice. The first line antibiotic is flucloxacillin, or metronidazole for bite wounds.

Surgery is considered if:

  • the patient presents more than 48 hours after the onset of symptoms
  • there is no improvement with 24 hours of antibiotics
  • there is pain on extension of the finger

Dangerous complications are necrosis of the tendon, adhesion formation and loss of finger function.

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