Episode 126.0 – Flexor Tenosynovitis

Flexor tenosynovitis requires prompt recognition in patients presenting with atraumatic finger pain, as delayed treatment leads to significant morbidity. Diagnosis remains primarily clinical, centered on Kanavel's four signs: tenderness along the flexor tendon, symmetric "sausage digit" swelling, pain upon passive extension, and a flexed resting posture. Among these, pain with passive extension serves as the most critical diagnostic indicator. Initial management involves broad-spectrum antibiotic coverage for *Staphylococcus aureus*, streptococcal species, and gram-negative organisms, especially in immunocompromised patients. Because these infections frequently progress to deep tissue involvement, urgent surgical consultation for potential incision, drainage, and washout is mandatory. While laboratory markers like white blood cell counts and inflammatory markers may be elevated, they remain non-specific and should not supersede clinical judgment or delay necessary surgical intervention.