D.H.Zaini kufa- university. Acute Supportive Teno-synovitis. Surgery 4 th Stage Lecture(2) . Acute Supportive Teno - synovitis. Surgery... D.H.Zaini Kufa - university 4 th stage -Lecture (2).
4th Stage Lecture(2)
Acute Supportive Teno- synovitis
Kufa - university
4th stage -Lecture (2)
Inf. of sheath of flexor tendon due to bact. (staph. Avreoll or st. poogen )
. This produced by point of needle or sharp object penetrating the hand.
. This is the must feared infection of hand.
. Pus within sheath destroy the gliding mechanism Adhesion this create adhesion lead to loss of tendon function & reduce movement.
1- symmetrical swelling of entire fingers.
2- flexion of fingers with sever pain on extension (Hook sign).
3- tenderness over the sheath.
transverse incision at the opposite end of tendon sheath with thorough irrigation with normal saline
in late cases need excision of necrotic tissue.
1- the forearm through the hand through ulnor & radial bursa, so must do drainage.
2- if infection continue for 14 days, x-ray of the hand to look for evidence of bone necrosis with possibility of no opaque foreign body that localized only by u\s.
bursa is a synovial sheath cover the tendon.
if x-ray several signs or features of osteomylitis (rosefication) & this need not only irrigation & drainage , But also need curatio which is mean remove this necrosis to prevent frequent pus discharge .
3- supportive arthritis & if not treated well stiff joint stiff digit (functionless).
4- paralysis of median N. by compression .by distended radial or ulnar bursa.
Herpes simplex infection look like Acute paronychia but with multiple vesicles that filled with infected fluid ( serous) rich with viral Ag.
Specially in housewives - tea workers} ch. Paronychiaeg. Yeast infection.
But in the Barbers occur between 3rd & 4th finger in web space ...in work the hair enfer this area & with organisms produce chronic infection & discharge.
Rx *excision of area is must.
*primary closure is C.I.
*give anti- tetanus toxioids
*prophylactic broad spectrum antibiotics.
Foot Infection joint stiff digit (functionless).
Drainage open wound & drain
Aspiration by syringe
(1) look for lymph drainage which is mainly in the grain , but also should look for political fessa.
(2) the urine must be examined for the sugar.
(3) examine fully for arterial by examine pulse or Doppler.
Treatment joint stiff digit (functionless).
1- aggressive washing of foot by water &salt because hypertonic detergent may cause abrasions or burn that more liable for infection because of distortion of skin protective barer . No detol or provident iodine.
2- bed rest.
3- elevation of the foot specially for sever infection.
4- infected blisters (from ill fitting shoes ) should be a spirited by syringe.
if clear fluid no problem.
if purulent & thick infected pus &should use AB mainly anti-staph ( floxacillin).
Ingrowing joint stiff digit (functionless). toenail
Rx (1) conservative . daily wash with water & salt
. change the shock (very imp.)
. if there is evidence of infection
pus with sever pain give antibiotic
mainly anti-staph &some times
add metronidazole for anaerobic
infection specially indiabetes
(2) Wedge resection of nail (1\3 or 1\4 of the nail with nail base to prevent recurrence) & at the sometime use phenol ( to destroy the remaining cells that may produce recurrence)-applied phenol for at least 3 min.
Note nail base is the growing site & if not exiced this lead to recurrence.
Note nail base to prevent recurrence) & at the sometime use phenol ( to destroy the remaining cells that may produce recurrence)-applied phenol for at least 3 min.Ingrowing toe nail:-
A painful condition of a toe (usually big toe) in which , or both edges of the nail press into adjacent skin(usually in medial side of the toe).
This produce inflammation, redress, tenderness &throbbing pain, &may complicate by infection later.
medical or late. Sides of the heel , not in the heel because this lead to scar & so pt. will not be able to stand .
But critical cases such as diabetic foot septicemia.