Kanavel signs for flexor tenosynovitis

10 May

CLASSIC TEACHING:
Kanavel signs for flexor tenosynovitis

  • pain on passive extension (early finding)
  • finger held in flexion
  • uniform swelling of finger
  • tenderness to percussion along flexor tendon sheath (late finding)



HOW GOOD IS OUR H&P?
–study of 75 patients with flexor tenosynovitis


–incidence of H&P findings 

  • fusiform swelling (97%)
  • pain on passive extension (72%)
  • semiflexed posture (69%)
  • subcutaneous purulence (68%)
  • tenderness along flexor sheath (64%)
  • elevated WBC (59%)
  • diabetes mellitus (35%)
  • skin necrosis (23%)
  • fever (17%)
overall, the 4 signs aren’t perfect, but are there individually in at least 2/3rds of patients

–hard to find data on sensitivity/specificity of these signs combined on brief pubmed biopsy



TREATMENT TOOLBOX:
IV antibiotics: staph and strep coverage, think pasturella for bite-associated infections

–surgery: consult your hand surgeon ASAP


Kanavel signs for flexor tenosynovitis (REVISITED)

  • pain on passive extension (early finding)
  • finger held in flexion
  • uniform swelling of finger
  • tenderness to percussion along flexor tendon sheath (late finding)

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