Which physical findings suggest infectious tenosynovitis?

Updated: Aug 27, 2018
  • Author: Mark R Foster, MD, PhD, FACS; Chief Editor: Harris Gellman, MD  more...
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Patients with infectious flexor tenosynovitis (FT) can present at any time after a penetrating injury, with complaints of pain, redness, and fever. Physical examination reveals Kanavel signs of flexor tendon sheath infection, which are as follows:

  • Finger held in slight flexion
  • Fusiform swelling
  • Tenderness along the flexor tendon sheath
  • Pain with passive extension of the digit

However, Kanavel signs may be absent in patients with the following:

  • Recently administered antibiotics
  • Early manifestations of the condition
  • Immunocompromised state
  • Chronic infections

Additionally, patients with immunocompromising conditions may present with a rather innocuous injury, such as a small puncture wound from a foreign body. Presenting symptoms may be vague in certain indolent infectious states.

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