Pyogenic Flexor Tenosynovitis by Point-of-care Ultrasound in the Emergency Department

Area of Science:

• Emergency Medicine
• Musculoskeletal Ultrasound
• Infectious Disease

Background:

• Pyogenic flexor tenosynovitis (PFT) diagnosis is challenging due to inconsistent clinical signs.
• Previous research links hypoechoic fluid around flexor tendons to PFT.
• Point-of-care ultrasound (POCUS) utility by emergency physicians (EPs) for PFT diagnosis requires investigation.

Observation:

• A retrospective case series of seven patients with suspected PFT was analyzed.
• EPs utilized POCUS to identify hypoechoic or anechoic fluid surrounding the flexor tendon.
• Patient data included demographics, trauma history, Kanavel's signs, and treatment outcomes.

Findings:

• EPs successfully identified peri-tendon fluid on POCUS in patients with suspected PFT.
• All seven patients exhibited at least two of Kanavel's signs.
• 57% of patients required surgical intervention, while others were treated with antibiotics or bedside drainage.

Implications:

• EPs can effectively use POCUS to detect a key sonographic finding in PFT.
• POCUS may improve the diagnostic accuracy and speed of PFT management in the emergency department.
• This supports the integration of POCUS into the diagnostic workflow for hand infections.