Background: Pyogenic flexor tenosynovitis is a closed space
infection involving the digital flexor tendon sheaths of the upper extremity
that can cause considerable morbidity. The purpose of the present report is to
describe the various risk factors leading to poor outcomes and to recommend a
clinical classification system for this condition.
Methods: We studied seventy-five patients with pyogenic flexor
tenosynovitis over a six-year period. The amputation rate and total active
motion were used as outcomes measures. The clinical factors influencing
outcomes were identified and analyzed.
Results: The five risk factors associated with poor outcomes were
(1) an age of more than forty-three years, (2) the presence of diabetes
mellitus, peripheral vascular disease, or renal failure, (3) the presence of
subcutaneous purulence, (4) digital ischemia, and (5) polymicrobial infection.
On the basis of the clinical findings and outcomes, three distinct groups of
patients could be identified, each with a progressively worse outcome.
Patients in Group I had no subcutaneous purulence or digital ischemia; these
patients had the best prognosis, with no amputations and a mean 80% return of
total active motion. Patients in Group II demonstrated the presence of
subcutaneous purulence but no ischemic changes; these patients had an
amputation rate of 8% and a mean 72% recovery of total active motion. Patients
in Group III had both extensive subcutaneous purulence and ischemic changes;
these patients had the worst prognosis, with an amputation rate of 59% and a
mean 49% return of total active motion.
Conclusions: We propose a three-tier clinical classification system
that can aid in prognosis and guidance in the treatment of pyogenic flexor
tenosynovitis of the upper extremity.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.