Conservative treatment for pyogenic flexor tenosynovitis: a single institution experience.

Pyogenic flexor tenosynovitis (PFT) of the hand is a common infection which is clinically diagnosed using Kanavel's signs. Delay in diagnosis and treatment may lead to devastating outcomes, including reduced range of motion (ROM), deformities, tendon impairment or even amputation. While the gold standard for treatment is irrigation and debridement of the flexor sheath, little is known about the outcomes of conservative treatment with intravenous (IV) antibiotics. Patients treated conservatively for PFT between 2000 and 2013 were included. Demographic information, co-morbidities and clinical features at presentation such as Kanavel's signs and inflammatory markers levels were gathered. Treatment course, length of stay (LOS), functional outcomes and complications were collected. Fifty-four (54) patients presented with PFT in the study period. Forty-six (46) patients, ages 19-84 years old, who were treated conservatively were included. Average time from symptoms onset to presentation was 4.6 ± 7.1 days. Fourteen (14) patients failed to improve with course of oral antibiotics prior to presentation. The average number of Kanavel's signs was 3 ± 0.7. Inflammatory markers were elevated in 82.2% of patients. The mean LOS was 4.7 ± 2 days. Forty-four (44) patients continued follow-up for 55 ± 45 months. Final flexion ROM was full or minimally limited in 69% of patients. Three patients were eventually operated. Complication rate for the entire cohort was 4.3% and no fingers were lost. This retrospective case series indicate that inpatient empirical IV antibiotic therapy can be considered for patients presenting with uncomplicated PFT, provided it is practiced under a hand specialist's surveillance.

Radiation Exposure From Computed Tomography Of The Upper Limbs.

To investigate exposure to radiation we identified a cohort of 312 patients who underwent standardized CT of an upper limb within a three years period. The effective dose per dose length product coefficient was used to calculate the effective doses of radiation. Mean effective doses were as follows: shoulder CT, 10.83 (SD 6.36) mSv; wrist CT, 0.15 (SD 0.07) mSv; elbow CT performed with the arm above the head, 0.21 (SD 0.11) mSv and with the arm adjacent to the torso, 13.1 (SD 10.8) mSv. The corresponding lifetime attributable risk of cancer was 0.6/1000 for males and 0.73/1000 for females for shoulder CT and 0.75/1000 for males and 0.96/1000 for females for elbow CT with the arm adjacent to torso. The effective doses for CT scans of the wrist and of the elbow performed with the arm above the head were low. For elbow CT scans, elevating the arm above the head decreases the radiation doses.