Pyogenic Flexor Tenosynovitis
50-year-old man, kidney transplant, with post-transplant diabetes. Inpatient for pneumonia. It evolves with delirium, so it requires physical containment with mitt-type gloves. The next day, he complains of pain in his fingers. On physical examination, fusiform swelling, tenderness along the palmar aspect of the finger and pain with passive extension are noted
The patient met 3 of the 4 Kanavel criteria for pyogenic flexor tenosynovitis of the hand : fusiform swelling, tenderness in the tendon, pain with passive extension and finger in slight flexion. MRI confirmed the diagnosis and traumatology was consulted for debridement. He underwent an urgent amputation. Early recognition of pyogenic flexor tenosynovitis is important as it behaves as an abscess and can extend into the arm through the compartments of the hand.
#Flexor #Tenosynovitis #Hand #Finger #Clinical #Photo
This 66M w h/o DM2, renal transplant presented with severe volar hand and wrist pain x 1 wk, afebrile. From this clip of his index finger, what's the diagnosis?
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Flexor tenosynovitis! Pt taken to OR for I&D, carpal tunnel release. Interesting, all cultures negative, likely acute on chronic infection. Pt dc'd on 6 wks of IV vanc/cefepime.
Here's a transverse view of the volar wrist showing extensive fluid surrounding flexor tendons.
UAB Emergency US @UAB_Sono
#Clinical #POCUS #Flexor #Tenosynovitis #Transverse
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This 66M w h/o DM2, renal transplant presented with severe volar hand and wrist pain x 1 wk, afebrile. From this clip of his index finger, what's the diagnosis?
...
Flexor tenosynovitis! Pt taken to OR for I&D, carpal tunnel release. Interesting, all cultures negative, likely acute on chronic infection. Pt dc'd on 6 wks of IV vanc/cefepime.
UAB Emergency US @UAB_Sono
#Clinical #POCUS #Flexor #Tenosynovitis #LongAxis
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Trigger Finger - Stenosing flexor tendon tenosynovitis
There is a change in the slip between the tendon and the A1 pulley, causing the movement to become blocked. Most of the time it is due to pulley or tendon hypertrophy, but in some cases it may be due to pulley or tendon cyst.
It is more common in women than in men, and diabetes is a risk factor.
The classic frame is the one shown in the video, with locking when flexing the finger. In the lightest cases, the patient may have only pain at the pulley site, without locking; and in the most advanced cases you may not be able to perform active extension, only with assistance or even not be able to extend.
The diagnosis is clinical, and can be complemented with ultrasound. Ultrasound can show the presence of an associated cyst, which decreases the success rate of non-surgical treatment.
Treatment can be conservative or surgical, and the decision is on a case-by-case basis.
By Dr. Gabriel Oliveira @ortopediaesaude
#Trigger #Finger #Stenosing #flexor #tendon #tenosynovitis #msk #clinical #physicalexam #orthopedics #rheumatology
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Pelvic Inflammatory Disease (PID) - CDC Criteria for Diagnosis
Minimum Criteria (at least one needed for diagnosis):
- Cervical motion tenderness
- Uterine tenderness
- Adnexal tenderness
Additional Criteria (support a diagnosis of PID)
- Oral temperature >101°F, or 38.3°C
- Abnormal vaginal or cervical discharge
- White blood cells on saline wet mount (>10 polymorphonuclear leukocytes per high-power field [101])
- Elevated erythrocyte sedimentation rate (> 15 mm/??)
- Elevated C-reactive protein,
- Elevated white blood cell count > 10,000 cells/mL
- Laboratory evidence of Neisseria gonorrhoaea or Chlamydia trachomatis infection
Definitive Criteria (confirm the diagnosis of PID)
- Histopathologic evidence of endometritis
- Imaging showing thickened, fluid-filled tubes, with or without pelvic free fluid or tubo-ovarian complex,
- Doppler studies suggesting pelvic infection,
- Intra-abdominal findings consistent with PID on laparoscopy
#Pelvic #Inflammatory #Disease #PID #CDC #Criteria #Diagnosis #gynecology #obgyn
