Acute suppurative tenosynovitis

　　1. Common surface tenosynovitis of the hand:It is usually caused by deep wound infection, and can also be caused by the spread of infection from nearby tissues. The pathogenic bacteria are mostly Staphylococcus aureus. Infection of the extensor tendons of the palm is rare.

　　2. Staphylococcus aureus:It is an important pathogen of humans, belonging to the genus Staphylococcus, with the nickname 'carnivorous bacteria', and is a representative of Gram-positive bacteria, which can cause many serious infections.

　　Early treatment is the same as purulent phalangeal炎, if there is no improvement after active treatment, and if there is no early decompression, tendinous avulsion and necrosis may occur.

　　Purulent phalangeal炎: It refers to the suppurative infection of the subcutaneous tissue of the distal phalanx of the finger. It is often caused by secondary bacterial infection due to minor injury or foreign bodies. The main pathogen is Staphylococcus aureus. In the early stage, there is only mild pain at the tip of the finger, and there is no obvious swelling. Hot water immersion, hot compress, physical therapy, elevation of the affected limb, external application of traditional Chinese medicine, and the use of antibiotics can be adopted. About half of the patients can resolve the inflammation. If there is severe pain at the tip of the finger, purulent phalangeal炎 incision and drainage, obvious swelling, palpation shows increased tension of the finger pulp, incision and drainage should be performed to relieve the high pressure in the finger cavity, reduce pain, and prevent bone destruction and osteomyelitis.

　　The condition of this disease develops rapidly, and after 24 hours, the pain and local inflammatory response are obvious. The typical signs of tenosynovitis are:

　　1. The affected finger, except for the distal phalanx, is obviously swollen with extremely tense skin.

　　2. All the joints of the affected finger are slightly flexed, often in a relaxed position of the tenosynovium to reduce pain.

　　3. Any slight assisted extension movement of the finger can cause severe pain.

　　4. During the examination, there is tenderness along the entire tenosynovium, and the suppurative inflammation is localized within the firm sheath, so there is no fluctuation.

　　5. Since the infection occurs within the tenosynovium, like purulent phalangeal炎, the pain is very severe, the patient cannot sleep all night, and there are often systemic symptoms. If purulent tenosynovitis is not drained or decompressed in time, the pus in the sheath will accumulate, and the pressure will increase rapidly, leading to tendinous necrosis, loss of function of the affected finger, and inflammation can also spread to the deep spaces of the hand, or through the synovial bursa to the wrist and forearm. The infection of the ulnar and radial synovial bursae often originates from the ulnar and thumb tenosynovitis, respectively.

　　(1) Ulnar synovial bursitis: Tenderness in the hypothenar area and the ulnar tenosynovial region, especially at the junction of the hypothenar eminence and the palmar transverse crease, with the little finger and ring finger in a semi-flexed position. If you try to extend them, it will cause severe pain.

　　(2) Radial synovial bursitis: Swelling of the thumb, slightly flexed, unable to abduct and extend, with tenderness in the thumb and thenar eminence. Hand common tenosynovitis often occurs due to deep injury infection, or it can also be caused by the spread of infection from nearby tissues. The causative bacteria are mostly Staphylococcus aureus. Infection of the extensor tendons on the back of the hand is rare.

　　6. Staphylococcus aureus: It is an important pathogen for humans, belonging to the genus Staphylococcus, also known as 'flesh-loving bacteria', and is a representative of Gram-positive bacteria, which can cause many serious infections.

　　The most important thing for the patients with this disease is to pay attention to postoperative care:

　　1. Fix the patient's hand in a functional position and hang it up with a sling. Elevate the hand while sleeping.

　　2. Soak the affected area in warm, sterile liquid before each dressing change.

　　3. Administer appropriate antibiotics.

　　4. After infection control, begin to practice automatic or passive activities immediately to prevent joint rigidity of the fingers. Early activity can reduce tendinous adhesion after tenosynovitis incision and drainage, and physical therapy can promote functional recovery.

　　5. If the drainage is unobstructed but the wound does not heal for a long time, check for bone or joint infection, or tendinous necrosis. X-ray imaging examination may be necessary if necessary.

　　What foods should not be eaten for acute purulent tenosynovitis:

　　Avoid spicy foods, smoking, and alcohol. The patient's diet should be light and easy to digest, with more fruits and vegetables, a reasonable diet, and attention to adequate nutrition. In addition, the patient should also pay attention to avoiding spicy, greasy, and cold foods.

　　1. Early treatment is the same as for purulent felon, and if there is no improvement after active treatment, early incision and decompression should be performed to prevent the tendons from rising empty and dying.

　　2. Make a long incision on the side of the finger, parallel to the long axis of the finger. Do not make an incision in the center of the palm, otherwise it is easy to cause tendons to slip out, adhesion, and skin scar contracture, affecting the straightening of the affected finger. Be careful to identify the sheath during surgery, do not injure blood vessels and nerves. When the ulnar and radial synovial sacs are infected, make the incisions on the small thenar and the large thenar. The proximal end of the incision should be at least 1.5 cm away from the wrist to avoid cutting the branches of the median nerve. Another method is to make two small incisions on the sheath and bursa, drain the pus, and then insert thin plastic tubes for irrigation. After surgery, continue to drip antibiotic solution through one thin plastic tube, and the other as an outlet for body fluids, which has good efficacy and less pain for the patient.

　　(1) Incisions for purulent tenosynovitis of the index finger and thenar space infection.

　　(2) Incisions for purulent tenosynovitis of the fingers, ulnar bursitis, and radial bursitis.

　　(3) Incisions for interpalmar space infection and thenar space infection.

　　(4) Surgical incisions for tendinitis of the flexor digitorum profundus, bursitis, and deep palm space infections.