TENDOSYNOVITIS.
Acute inflammation of a tendon sheath is known as tendovaginitis or tendosynovitis. It always implies an infection, and occurs about the hands and feet. It is a frequent complication of felons. Many felons begin in such a manner that it is difficult to decide which part of the fibrous structures of the finger is first involved. Infection having once occurred within a tendon sheath will travel rapidly until it meets with a natural barrier. The frequency of these lesions makes it important to recall here the anatomy of the tendon sheaths of the hand. There is a common palmar tendon cavity, which connects with the thumb and little finger and the space above the annular ligament, but communication with the first, second, and third fingers is ordinarily destroyed. This accounts for the apparent vagaries of cases where infection beginning in the thumb spreads to the little finger before the others are involved. It will also show the location where incisions should be made.
Fig. 112
Cicatricial contraction and deformity resulting from consequences of neglected phlegmon and osteomyelitis of hand. (Lexer.)
Suppurative Tendosynovitis.
—Suppurative tendosynovitis needs prompt intervention, as adhesions may result from retention of exudate, or lest necrosis of tendon occur from perversion of its nutritive supply. Ordinarily it is the result of a local infection, perhaps through a small, trifling surface irritation, but it results occasionally as a metastatic expression of gonorrhea, or distinct septic infection. A gonorrheal tendosynovitis is, however, less likely to suppurate, but more likely to assume the plastic form and interfere with function by producing adhesions between a tendon and its sheath. The combination of virulent bacteria and susceptible tissues will produce local destruction in almost as short a time as in the appendix. The pain is intense, because of the inelasticity of the structures.
Fig. 113
Suppurative tendosynovitis (felon), with sloughing tendons and necrotic bone. Unfortunately poulticed for two weeks. (Lexer.)