Tendon Sheath and Palmar Space Infections

Acute Tenosynovitis

Pain on extension

Swelling and tenderness along tendon sheath

Swelling and tenderness along tendon sheath

Finger held in slight flexion

Infection of the flexor tendon sheaths (acute tenosynovitis) may follow local injury, even of apparently trivial nature. Unlike in arthritis, tenderness and swelling develop not in the joint but along the course of the tendon sheath, from the distal phalanx to the level of the metacarpophalangeal joint. The finger is held in slight flexion; attempts to extend it are very painful.

Acute Tenosynovitis and Thenar Space Involvement

Puncture wound

Tender, swollen

Puncture wound

Tender, swollen

If the infection progresses, it may escape the bounds of the tendon sheath to involve one of the adjacent fascial spaces within the palm. Infections of the index finger and thenar space are illustrated. Early diagnosis and treatment are important.


Dupuytren's Contracture

Puncture wound

Swollen, tender, dusky red

Injury to the fingertip may result in infection in the enclosed fascial spaces of the finger pad. Severe pain, localized tenderness, swelling, and dusky redness are characteristic. Early diagnosis and treatment are important.


Flexion contraction The ft"5* siSn of a Dupuytren's contracture is a thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger at the level of the distal palmar crease. Subsequently, the skin in this area puckers, and a thickened fibrotic cord develops between palm and finger. Flexion contracture of the fingers may gradually ensue.

Trigger Finger

A trigger finger is caused by a painless nodule in a flexor tendon in the palm, near the head of the metacarpal. The nodule is too big to enter easily into the tendon sheath when the person tries to extend the fingers from a flexed position. With extra effort or assistance, the finger extends with a palpable and audible snap as the nodule pops into the tendon sheath. This snap may also be evident during flexion. Watch and listen as the patient flexes and extends the fingers, and feel for both the nodule and the snap.

Thenar Atrophy

- Normal hypothenar eminence

Muscular atrophy localized to the thenar eminence suggests a disorder of the median nerve or its components. Pressure on the nerve at the wrist is a common cause (carpal tunnel syndrome). Hypothenar atrophy suggests an ulnar nerve disorder.

• Flattened thenar eminence en cx> to

TABLE 15-7 ■ Abnormalities of the Feet and Toes a c

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