Kanavel signs for flexor tenosynovitis

CLASSIC TEACHING:
--Kanavel signs for flexor tenosynovitis

• pain on passive extension (early finding)
• finger held in flexion
• uniform swelling of finger
• tenderness to percussion along flexor tendon sheath (late finding)

HOW GOOD IS OUR H&P?
--study of 75 patients with flexor tenosynovitis


--incidence of H&P findings 

• fusiform swelling (97%)
• pain on passive extension (72%)
• semiflexed posture (69%)
• subcutaneous purulence (68%)
• tenderness along flexor sheath (64%)
• elevated WBC (59%)
• diabetes mellitus (35%)
• skin necrosis (23%)
• fever (17%)

--overall, the 4 signs aren't perfect, but are there individually in at least 2/3rds of patients

--hard to find data on sensitivity/specificity of these signs combined on brief pubmed biopsy

TREATMENT TOOLBOX:
--IV antibiotics: staph and strep coverage, think pasturella for bite-associated infections

--surgery: consult your hand surgeon ASAP

Kanavel signs for flexor tenosynovitis (REVISITED)

• pain on passive extension (early finding)
• finger held in flexion
• uniform swelling of finger
• tenderness to percussion along flexor tendon sheath (late finding)

Reference(s): uptodate.com: infectious tenosynovitis; study; picture.