Pyogenic flexor tenosynovitis

Acute pyogenic flexor tenosynovitis usually occurs following a penetrating injury of the digital flexor tendon sheath. The most common pathogenic orga nisms are gram positive, although gram-negative and mixed-organism infectio ns are being encountered with increasing frequency in the immunocompromised patient. The clinical findings originally described by Kanavel include ten derness along the sheath, a flexed posture of the involved digit, pain on p assive extension, and fusiform symmetrical digital swelling. Treatment is d ependent on several factors, but typically involves surgical drainage, appr opriate antibiotics, and early rehabilitation. This review article addresse s the pathophysiology, bacteriology, differential diagnosis, contemporary t reatment approaches, and complications of acute pyogenic flexor tendon shea th infections.