Rosh Review A1.1


Q. Which of the following is classically seen in flexor tenosynovitis?

A. Extended position of the involved digit

B. Fusiform swelling of the digit

C. Tenderness over the extensor sheath

D. Vesicular eruption over the flexor surface

The flexor tendons of the fingers are covered by a double layer of synovium to promote gliding of the tendon underneath. Infections in the synovial spaces in the hand tend to spread along the course of the flexor tendon sheaths and may extend proximally to the hand. Infections are usually due to penetrating trauma involving the sheath, but occasionally from hematogenous spread. There are four cardinal signs of acute flexor tenosynovitis that are usually present to help distinguish tenosynovitis from other hand infections. These criteria are referred to as the Kanavel signs.

Kanaval Criteria for Flexor Tenosynovitis
Tenderness along the course of the flexor tendon
Fusiform or symmetrical swelling of the finger
Pain with passive range of motion
A flexed posture of the finger

Flexor tenosynovitis is a surgical emergency. Consultation with a hand surgeon is warranted along with intravenous antibiotics.

The affected digit is held in a flexed (A), not extended posture. The tenderness is over the flexor (C) sheath, not extensor. Vesicles (D) are not commonly associated with flexor tenosynovitis. A localized herpes simplex infection may cause vesicles to form on a digit.

Ref: Lyn ET, Mailhot T: Hand, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch)47:p 521-522.

All Questions are taken from

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