Definition

Suppurative tenosynovitis is an infection of the tendon and its protective sheath. In this condition, abscesses, or pus-filled pockets, can form around the tendon. The pus can spread to surrounding areas and destroy tissue. Damaged tendons can make it difficult to move the affected body part.

Tendons are flexible connective tissues that connect muscles to bones. For example, the tendon that connects the forearm muscles to the finger bones allows finger movement when the forearm muscles contract. Tendons are usually covered by a sheath that helps them move smoothly, aiding in fluid movement.

This infection most commonly occurs in the fingers (particularly the index, middle, and ring fingers), hands, or wrists. Suppurative tenosynovitis accounts for about 10% of all hand infections and can become a serious condition. Prompt treatment can help prevent permanent tissue damage.

Causes

Risk Factor

Suppurative tenosynovitis is a common condition, with varying prevalence depending on the cause. Several factors can increase the risk of developing this condition, including:

• Diabetes mellitus. A metabolic disease characterized by prolonged high blood sugar levels due to the body's inability to respond normally to insulin.
• Intravenous drug abuse.
• Immune system disorders, for example, in patients with HIV, cancer, or other autoimmune diseases
• Regular therapy with immunosuppressive drugs, such as steroids
• Frequent use of hands in daily activities or work, such as farming, gardening, construction, or factory work

Symptoms

Symptoms of infection typically appear within one week after injury. Since this condition is most commonly found in the hands and fingers, symptoms of suppurative tenosynovitis may include:

• Swelling and redness
• Severe pain, especially when moving the finger, leading to restricted movement
• The finger may rest in a slightly flexed position
• Difficulty using the hand or finger
• Fever (though not always present)

Diagnosis

Suppurative tenosynovitis is a clinical diagnosis, meaning that the doctor can diagnose it based on a physical examination. One key sign, called Kanavel's signs, is used to distinguish suppurative tenosynovitis from other infections. These signs include:

• A swollen finger that looks like a sausage
• The finger rests in a slightly flexed position toward the palm
• Severe pain along the tendon sheath, especially when touched
• Extreme pain when the finger is straightened

However, doctors may sometimes recommend diagnostic tests, such as X-rays, to detect any foreign objects hidden under the skin. To identify the type of bacteria causing the infection, a sample of pus from the abscess can be taken and examined in a laboratory.

Blood tests that may assist in diagnosis by indicating signs of inflammation or infection include:

• White blood cell count
• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP) levels

Management

Suppurative tenosynovitis requires immediate treatment. However, even with prompt therapy, potential complications may not be fully preventable.

Treatment may include:

• Medications

Antibiotics are prescribed to fight bacterial infections and are usually given through an IV. Therefore, you will likely be hospitalized. The choice of antibiotics will depend on the cause of the wound. Some studies suggest that prompt treatment can lead to recovery within 2-11 days after IV antibiotic administration. In addition to medication, elevating the injured hand above heart level and limiting movement with a brace can also help.

• Surgery

In other cases, more aggressive treatment may be necessary. Depending on the severity of the infection, treatment options may include several types of surgery:

• • Creating an incision to drain and irrigate (clean) the tendon sheath.
  • Opening the tendon sheath to clean the infection.
  • Removing dead tissue so that healthy tissue can heal.
  • Administering oral antibiotics after surgery.

Surgery is generally considered if:

• • Symptoms of suppurative tenosynovitis have been present for more than 48 hours.
  • There is no improvement within 24 hours of starting antibiotics.
  • There is pain when the finger is straightened.

After the infection heals, you may need the help of a therapist to regain mobility in the hand affected by suppurative tenosynovitis.

Complications

Suppurative tenosynovitis can take several months to a year to heal completely. Delayed treatment, smoking, diabetes, and a weakened immune system are associated with more severe infections.

Severe infection complications include:

• Tendon rupture requiring surgical repair.
• Decreased blood flow and tissue death in the bones, as well as bone infections.
• Joint stiffness and reduced range of motion, which may be permanent. Some studies report a 10-20% incidence of persistent finger stiffness after a suppurative tenosynovitis episode.
• Amputation (removal of the dead body part). Untreated suppurative tenosynovitis can lead to tissue death due to infection. If a significant amount of tissue dies, the limb may need to be amputated. Factors increasing the likelihood of amputation include delayed treatment, age over 43 years, and a history of diseases such as diabetes mellitus, kidney failure, and peripheral vascular disease.
• Untreated infection can spread to nearby tissues or into the bloodstream, leading to a severe, life-threatening infection.

Prevention

To prevent suppurative tenosynovitis, clean wounds thoroughly immediately after injury. Cleaning the wound aims to remove as many microorganisms as possible that can cause infection.

Additionally, if the injury to the fingers, hands, or wrists is deep or dirty, professional wound cleaning by a healthcare provider is usually necessary to ensure the wound is clean and to administer medications to reduce the risk of infection.

When to See a Doctor?

Contact a doctor immediately if you experience any of the following symptoms:

• Fever of 38°C (100.4°F) or higher
• Redness, warmth, pain, or foul-smelling discharge from a wound or surgical incision
• Swelling or pain that worsens
• Changes in skin color
• Symptoms that do not improve or worsen
• Any new symptoms you experience

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