From the Research
A positive Kanavel sign indicates a flexor tenosynovitis infection in the hand, characterized by four cardinal signs: finger held in slight flexion, uniform swelling of the entire finger, tenderness along the flexor tendon sheath, and severe pain on passive extension of the finger.
Diagnosis and Treatment
The diagnosis of flexor tenosynovitis is primarily clinical, relying on the presence of Kanavel's signs, which include symmetrical swelling of the entire digit, a digit with semi-flexed posture, exquisite tenderness along the course of the tendon sheath, and pain with attempted passive extension of the digit 1.
Treatment Approach
Treatment requires prompt surgical intervention with incision and drainage of the infected tendon sheath, combined with intravenous antibiotics, as evidenced by a case report in 2022 1. Initial empiric antibiotic therapy typically includes coverage for Staphylococcus aureus and Streptococcus species.
- Key considerations in management include:
- Early diagnosis and aggressive treatment to prevent complications like tendon necrosis, adhesions, or finger contractures.
- The use of antibiotics, which are usually continued for 10-14 days, transitioning to oral therapy once clinical improvement occurs.
- Following surgery, hand elevation, splinting in the functional position, and early protected range of motion exercises under the guidance of a hand therapist are crucial for optimal recovery.
Recent Evidence
A study from 2022 highlights the importance of prompt diagnosis and treatment to prevent poor clinical outcomes, including the need for ray amputation of the affected finger in severe cases 1.
- The study emphasizes that flexor tendon sheath infections require immediate diagnosis and treatment.
- It also notes that elevated levels of inflammation markers such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are often found in such cases.
Clinical Decision Making
Given the potential for severe outcomes with delayed treatment, any suspicion of flexor tenosynovitis warrants immediate surgical consultation. The presence of Kanavel's signs, particularly tenderness along the flexor tendon sheath and pain with passive extension, are highly suggestive of the diagnosis 2.
- Clinical prediction algorithms that combine relevant factors may be helpful in optimizing emergency hand care systems.
- Further prospective study is needed to refine diagnostic and treatment approaches for flexor tenosynovitis.