Infection within tendon sheath, tracking up palm + arm

Aetiology

• Can occur from direct penetrating trauma e.g. knife wound
• Haematogenous spread e.g. from dental infection

Clinical features

Symptoms

• Extremely painful
• Limited extension (including passive) due to pain

Signs

Kanavel's cardinal signs:

• Affected finger held in fixed flexion
• Fusiform swelling over finger
• Painful to percuss over sheath
• Painful on passive extension

Investigations

• X-ray
• Microbiology: culture of drainage/surgical sample

Management

• Elevation and high dose antibiotics
• Emergency surgery - washout tendon sheath, opening up A1 and A5 pulleys