Kanavel signs for flexor tenosynovitis

12 Mar

(some via an old post, but came up recently, and was the most basic evidence found on a pubmed biopsy.  if anyone knows of any larger data/studies, please share in the comments section)

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?
incidence of H&P findings in 75 patients with flexor tenosynovitis

  • 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

one study of 41 patients with flexor tenosynovitis:

  • all patients had tenderness along the flexor tendon sheath and pain with passive extension.
  • only 22/41 patients (54%) had all four Kanavel signs

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)
 

Reference(s): uptodate.com: infectious tenosynovitis; study; picture.; article

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