Volar suppurative tenosynovitis, bursitis, and deep space infection
Introduction
Introduction of volar suppurative tenosynovitis, bursitis and deep interstitial infection The volar suppurative tenosynovitis, bursitis, and deep interstitial infection are all purulent infections in the palm of the hand caused by Staphylococcus aureus. The skin of the palm of the hand is thick and keratinized, and there is a dense vertical fibrous tissue bundle under the skin. One end of the fibrous tissue bundle is connected to the dermis layer, the other end is fixed to the periosteum of the phalanx (in the unfinished finger part), the tendon sheath (in the proximal section, the middle section of the finger part) or the palmar fascia (in the palm part), and the fiber will be the subcutaneous tissue of the palmar surface. Divided into a number of tough closed small cavities. After infection, the inflammation is difficult to spread to the surrounding area, so it often causes tenosynovitis and continues to spread to deep tissues, resulting in infection of the synovial sac and hand gap. basic knowledge The proportion of illness: 0.001% - 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: accumulation
Cause
The cause of sputum suppurative tenosynovitis, bursitis and deep interstitial infection
(1) Causes of the disease
The pathogenic bacteria of this disease is Staphylococcus aureus, which is caused by infection after being stabbed in the palm of the hand. For example, stab wound of foreign body, intrathecal injection, etc., bursitis or deep interstitial infection may also occur directly after the injury of the palm.
(two) pathogenesis
The pathogenic bacteria invade the tendon sheath through the wound, causing local inflammatory edema, exudation, leukocyte chemotaxis, suppuration, because the tendon sheath is a closed cavity (the outer layer is the fibrous sheath, the inner layer is the synovial membrane), so the intracavity pressure increases rapidly. Local swelling of the affected finger, severe pain, intrathecal hypertension on the one hand oppresses the local blood vessels, causing blood circulation disorder in the tendon sheath and surrounding tissues, further aggravating cell degeneration and necrosis; on the other hand, infection spreads deep along the tendon sheath: thumb and little finger tendon sheath The infection can spread to the synovial sac of the temporal and ulnar sides respectively; the indication, the middle finger and the ring finger infection of the sacral sheath can spread to the inter-alloy space and the inter-pallid space respectively, resulting in inflammation of the temporal or ulnar sac and the deep space of the palm. Lesions, tissue necrosis.
Prevention
Palmar septic tenosynovitis, bursitis and deep space infection prevention
Pay attention to the treatment of minor trauma to the hand. Intrathecal injection should be strictly aseptic operation procedures, timely detection of early symptoms of finger infection, active early treatment, and control of infection development.
Complication
Complications of pyloric tenosynovitis, bursitis, and deep interstitial infection Complications
1. Tendon necrosis: Intrathecal pus accumulates, the pressure increases rapidly, causing tendon blood supply disorder, necrosis, showing loss of function of the finger.
2. The dysfunction of the index finger: Due to improper selection of the surgical incision, the tendon is prolapsed during the operation, and adhesions and scarring of the skin are caused by postoperative complications.
Symptom
Palmar suppurative tenosynovitis, bursitis and deep interstitial infection symptoms Common symptoms Lymph node enlargement Aversion to cold Joint swelling Fingers stiff pain Painful fingers Can not flex
1. Suppurative tenosynovitis: suffering from pain, swelling in the middle, near the knuckles, the skin is obviously tense, the knuckles are slightly bent, barely stretched, the pain can not be tolerated; touching the tendon also exacerbates the pain, if not treated in time, When the lesion spreads to the deep part of the palm, the tendon may be necrotic and the finger loses function.
2. Suppurative bursitis: sacral bursitis and thumb tenosynovitis, which makes the thumb swollen and slightly flexed, unable to straighten and abduct, the middle part of the thumb and the big fish touch, the ulnar bursitis and the little finger tenosynovitis Connected, the little finger is swollen, and the ring finger is semi-flexible, the little finger and the small fish are tender, and the swelling spreads to the wrist when the inflammation is intensified.
3. Deep interstitial infection: Inter-hepatic infection may be caused by aggravation of tenosynovitis or partial infection of the palm surface. The big fish and the "tiger mouth" (thumb and interdigital fingertips) have swelling, pain and tenderness. With the thumb slightly flexed, when the straightness is severe, the pain in the palm of the hand can be caused by the middle finger, the ring finger sheath inflammation of the ring finger or the infection of the partial palm surface injury. The swelling of the palm makes the original depression flatten, and the skin color is white, pain and Tensile, the swelling of the palmar back and the fingertips is more pronounced than the palm, the middle finger, the ring finger and the little finger are both flexed, and the pain is straight when straight.
Above the suppurative tenosynovitis, bursitis, and deep interstitial infection, the internal pressure of the diseased tissue is high, so it is easy to cause aversion to cold, fever, general malaise and other symptoms, and may also be swollen in the elbow or axillary lymph nodes, tenderness .
Examine
Examination of sputum suppurative tenosynovitis, bursitis and deep interstitial infection
1. White blood cell count: When the symptoms of systemic poisoning are heavier, there may be an increase in white blood cell count.
2. Classification of white blood cells: Neutrophil changes were positively correlated with white blood cell counts.
Diagnosis
Diagnosis and differentiation of scapular purulent tenosynovitis, bursitis and deep interstitial infection
diagnosis
History
There is a history of hand injury in the palm.
2. Local signs
(1) suppurative tenosynovitis: the affected finger is red and swollen, the finger joints are slightly flexed, and the relaxation of the tendon sheath is maintained.
(2) suppurative bursitis: sacral bursitis, the thumb is often swollen and slightly flexed, the middle part of the thumb and the big fish have pain; the ulnar bursitis, the little finger swelling, together with the ring finger is semi-flexible, little finger and small There is pain in the fish.
Differential diagnosis
Generally not confused with other diseases.
