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Bedside ultrasound identification of infectious flexor tenosynovitis in the emergency department.

Padrez K, Bress J, Johnson B, Nagdev A - West J Emerg Med (2015)

Bottom Line: Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement.We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand.Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

View Article: PubMed Central - PubMed

Affiliation: University of California, San Francisco, School of Medicine, San Francisco, California.

ABSTRACT
Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement. Despite the growing use of point-of-care ultrasound (POCUS) by emergency physicians there is only one reported case of the use of POCUS for the diagnosis of infectious FTS in the emergency department setting. We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand. Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

No MeSH data available.


Related in: MedlinePlus

Ultrasound technique and visualization. (A) Appropriate placement of the linear transducer (13MHz to 6MHz) at the wrist crease in transverse plane to evaluate for flexor tenosynovitis. (B) Ultrasound image in transverse view showing normal flexor tendons (highlighted in yellow) with no surrounding edema. The flexor tendons should lie anterior to the carpal bones identified by arrows for reference.
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f2-wjem-16-260: Ultrasound technique and visualization. (A) Appropriate placement of the linear transducer (13MHz to 6MHz) at the wrist crease in transverse plane to evaluate for flexor tenosynovitis. (B) Ultrasound image in transverse view showing normal flexor tendons (highlighted in yellow) with no surrounding edema. The flexor tendons should lie anterior to the carpal bones identified by arrows for reference.

Mentions: Hand radiographs are often obtained in cases of suspected infectious FTS to look for trauma, retained foreign bodies, or bone erosion. However, radiograph cannot make the diagnosis of infectious FTS. Magnetic resonance imaging (MRI) and ultrasound are better imaging modalities for the diagnosis.6,7 While MRI is not typically available in a prompt fashion in the ED, ultrasound is often available to ED providers.8 Ultrasound has been shown to be more sensitive than clinical exam for detecting tenosynovitis.5,9 However, there is only one case in the literature describing the use of ED POCUS to diagnosis infectious FTS.10 Common ultrasound findings for FTS are hypoechoic or anechoic edema with a potentially thickened tendon sheath, as well as the presence of abnormal hypoechoic material within the synovial sheath.9,11 Typically this can be performed using a linear probe and rocking the transducer to achieve perpendicular orientation of the tendon sheath (not the skin) in the transverse and longitudinal plane (Figure 2).9


Bedside ultrasound identification of infectious flexor tenosynovitis in the emergency department.

Padrez K, Bress J, Johnson B, Nagdev A - West J Emerg Med (2015)

Ultrasound technique and visualization. (A) Appropriate placement of the linear transducer (13MHz to 6MHz) at the wrist crease in transverse plane to evaluate for flexor tenosynovitis. (B) Ultrasound image in transverse view showing normal flexor tendons (highlighted in yellow) with no surrounding edema. The flexor tendons should lie anterior to the carpal bones identified by arrows for reference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4380376&req=5

f2-wjem-16-260: Ultrasound technique and visualization. (A) Appropriate placement of the linear transducer (13MHz to 6MHz) at the wrist crease in transverse plane to evaluate for flexor tenosynovitis. (B) Ultrasound image in transverse view showing normal flexor tendons (highlighted in yellow) with no surrounding edema. The flexor tendons should lie anterior to the carpal bones identified by arrows for reference.
Mentions: Hand radiographs are often obtained in cases of suspected infectious FTS to look for trauma, retained foreign bodies, or bone erosion. However, radiograph cannot make the diagnosis of infectious FTS. Magnetic resonance imaging (MRI) and ultrasound are better imaging modalities for the diagnosis.6,7 While MRI is not typically available in a prompt fashion in the ED, ultrasound is often available to ED providers.8 Ultrasound has been shown to be more sensitive than clinical exam for detecting tenosynovitis.5,9 However, there is only one case in the literature describing the use of ED POCUS to diagnosis infectious FTS.10 Common ultrasound findings for FTS are hypoechoic or anechoic edema with a potentially thickened tendon sheath, as well as the presence of abnormal hypoechoic material within the synovial sheath.9,11 Typically this can be performed using a linear probe and rocking the transducer to achieve perpendicular orientation of the tendon sheath (not the skin) in the transverse and longitudinal plane (Figure 2).9

Bottom Line: Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement.We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand.Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

View Article: PubMed Central - PubMed

Affiliation: University of California, San Francisco, School of Medicine, San Francisco, California.

ABSTRACT
Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement. Despite the growing use of point-of-care ultrasound (POCUS) by emergency physicians there is only one reported case of the use of POCUS for the diagnosis of infectious FTS in the emergency department setting. We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand. Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

No MeSH data available.


Related in: MedlinePlus