suppurative tenosynovitis
Introduction
Introduction to suppurative tenosynovitis Suppurative tenosynovitis is mostly caused by stab wounds in the palmar lateral striate, while blood-borne infections are rare. The sheath is rich in synovial fluid, moist and less blood, providing favorable conditions for infection. Once infection occurs, inflammation It quickly spreads throughout the sheath. The infection of the thumb and little finger can also spread to the temporal or ulnar sac and can spread to the forearm. In the narrow cavity of the fibrous sheath, the inflammation itself and the tension of the exudate can destroy the blood circulation of the tendon, leading to tendon necrosis. Even if the tendon is not necrotic, the adhesion often occurs after the inflammation, which seriously affects the function of the finger. basic knowledge The proportion of illness: the incidence rate is about 0.006%-0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: extensor tendon injury
Cause
Cause of suppurative tenosynovitis
Cause:
It is caused by a stab wound on the palm side of the palm. The palm of the hand has a thicker keratinized layer with a thicker fat pad under the skin. There are many vertical fiber trabeculae that connect the skin to the palmar membrane, tendon sheath and phalanx periosteum, making the temporal skin less slippery. Conducive to pinching and holding movements. However, in the case of skin defects, it is not easy to suture directly, and it is often necessary to cover the wound with skin graft or flap transfer. In the nipple layer of the skin of the fingertips, there are very rich sensory nerve endings and receptors, which are very sensitive.
Prevention
Suppurative tenosynovitis prevention
1. Fix the patient's hand in the functional position and hang it with a sling. The hand is raised when sleeping.
2. Soak in warm sterile liquid before each dressing change.
3. Give appropriate antibiotics.
4. Immediately after the infection control, practice automatic or passive activities to prevent the knuckles from being stiff. After the incision and drainage of tenosynovitis, early activity can reduce tendon adhesion, and physical therapy can promote functional recovery.
5. If the drainage is smooth, but the wound does not heal for a long time, check for bone or joint infection, or tendon necrosis. X-ray examination if necessary.
Complication
Suppurative tenosynovitis complications Complications, tendon injury
Severe cases can lead to tendon necrosis. The sources of tendon blood supply are: tendon - muscle abdomen transition has more blood vessels into the tendon, tendons attached to the lining of the bone or periosteum, a few branches into the tendon, in the non-sheathed part of the blood transport from the periorbital tissue; The part of the synovial sheath is wrapped around the tendon through the mesentery. It should be judged according to the specific circumstances.
Symptom
Suppurative tendon sheath inflammation common symptoms nausea high fever chills leukocytosis
Suppurative tenosynovitis is a serious infection in the hand, and the disease is rapid. When the pus is not formed in the sheath, obvious systemic symptoms such as high fever, chills, nausea, vomiting, and increased white blood cells can occur.
Typical symptoms are: the affected finger is even red and swollen, similar to the sausage; the finger is in a semi-flexed state; the main, passively straightening the finger can cause severe pain; there is significant tenderness along the entire sheath.
Examine
Examination of suppurative tenosynovitis
The white blood cell count can be increased. X-ray examination, no positive findings.
Diagnosis
Diagnosis and differentiation of suppurative tenosynovitis
(1) stenotic tenosynovitis: occurs mostly in the extensor hallucis longus and the long abductor tendon sheath, which is called stenotic tenosynovitis of the sacral styloid process, and the flexor tendon that occurs in the thumb or finger is called the "trigger finger". Although the sphincter synovium secretes synovial fluid to lubricate the tendon sheath, repeated rubbing of certain special actions is inevitable, such as woodworking, weightlifting, restaurant waiters, manual operators, and the like. Because the above-mentioned tendon sheath plays the role of the pulley, the friction is the largest and the most vulnerable, which is characterized by the thickening of the tendon sheath, which affects the normal activity of the tendon. Stenotic tenosynovitis may also be the result of certain quiescent or subclinical collagen diseases.
(2) Acute fibrous tenosynovitis: also known as fricative synovitis. The lesion is located in the connective tissue around the synovial membrane, showing edema, congestion, leukocyte and plasma cell infiltration. The disease is characterized by a soft rubbing sound due to the friction of connective tissue fibrils around the edema tendons. The most common part is the upper part of the wrist. It is characterized by the shortness of the tendon of the ankle and the long abductor muscle of the thumb and the abdomen of the extensor muscle of the thumb. It is also the most common type of tenosynovitis.
