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Radiographic Soft Tissue Thickness Differentiating Pyogenic Flexor Tenosynovitis From Other Finger Infections
Anthony Yi1, Colin Kennedy1, Benjamin Chia1
1Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA.
The Journal of Hand Surgery
|February 25, 2019
Summary
Characteristic swelling does not reliably distinguish pyogenic flexor tenosynovitis (PFT). Radiographic measurement of volar versus dorsal soft tissue thickness at the proximal phalanx can differentiate PFT from other finger infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Radiology
Background:
- Pyogenic flexor tenosynovitis (PFT) is a serious infection of the finger.
- Characteristic swelling is often cited as a key diagnostic sign of PFT.
- The diagnostic value of swelling in PFT has not been previously validated.
Purpose of the Study:
- To compare radiographic soft tissue dimensions in adult patients with finger infections.
- To determine if radiographic soft tissue thickness measurements can differentiate PFT from non-PFT finger infections.
Main Methods:
- Retrospective study of 62 adult patients with finger infections (31 PFT, 31 non-PFT).
- Radiographic measurements of soft tissue dimensions were performed on all digits.
- Bivariate analysis and logistic regression were used to identify predictors of PFT.
Main Results:
- Diffuse swelling was present in all finger infections, not specific to PFT.
- Differential volar minus dorsal soft tissue thickness at the proximal phalanx distinguished PFT (9 ± 1 mm) from non-PFT (5 ± 1 mm).
- A difference of ≥7 mm had 82% positive predictive value for PFT.
Conclusions:
- Uniform finger swelling is not a reliable differentiator for PFT.
- Differential volar versus dorsal soft tissue thickness on radiographs is a key indicator of acute PFT.
- The term "fusiform swelling" is inaccurate for acute PFT presentation.
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