Infectious Flexor Tenosynovitis Following Trigger Finger Release: Incidence and Risk Factors

Abstract

<jats:p> Background: Trigger finger release (TFR) is one of the most commonly performed hand procedures and typically results in restoration of normal finger function. However, uncommon postoperative complications such as deep infection can have devastating consequences. The goal of this study was to evaluate the incidence, risk factors, and characteristics of infectious flexor tenosynovitis occurring after TFR. Methods: We searched billing records for the Current Procedural Terminology code for TFR to identify all adult patients who underwent TFR at our institution over a 10-year period. We defined infectious tenosynovitis as any case where the patient underwent tendon sheath drainage or postoperative wound debridement within 6 months of the index TFR procedure. Medical records were reviewed to obtain patient demographic information, body mass index (BMI), tobacco use, history of diabetes mellitus, surgical setting (clinic vs outpatient surgery center), and surgical digit for all patients. In those patients treated for infection, we recorded hospital length of stay, number of operative procedures, and any culture results. Results: We identified a total of 18 infections out of 2307 procedures (1827 patients), for an incidence of 0.99%. Current smokers had a significantly higher incidence of infection than nonsmokers (1.77% vs 0.29%). On univariate analysis, smoking was closely associated with infection ( P ≤ .05). All infections occurred in overweight or obese patients by BMI criteria, but there was no difference in average BMI between patients with and without infection. History of diabetes, in-office surgery, patient age, and patient sex were not associated with a higher incidence of infection. Patients with infections spent an average of 4.1 days in the hospital, and 40% required multiple surgical procedures. The most common infectious organism cultured was Staphylococcus aureus, which was present in 67% of infections. Patients with isolated methicillin-sensitive S aureus on culture showed signs of infection within 3 weeks of the index procedure, whereas polymicrobial, coagulase-negative staphylococci or beta hemolytic streptococci were identified in patients presenting with infectious symptoms later. Conclusion: Infections after TFR are uncommon but are more likely to occur in patients who are current smokers and overweight or obese by BMI criteria. Methicillin-sensitive S aureus is the most likely causative organism, especially in patients presenting during the early postoperative course. </jats:p>

An Unusual Cause of Tenosynovitis by Group B Streptococcus in the Immunocompromised Patient: A Case Report

“…In 1933, Kanavel developed four cardinal signs to diagnose tenosynovitis, including symmetrical swelling of the whole finger, profound tenderness along the finger's length, semi flexed finger and extreme pain with passive extension of the affected finger. Staphylococcus aureus is the most common cause of tenosynovitis (Stewart & Ward, 2020). However, the incidence of tenosynovitis by GBS is unknown in the local setting.…”

“…Tenosynovitis is most often an infection caused by gram-positive bacterial infections. Most cases of tenosynovitis are caused by Staphylococcus aureus, which accounts for 80% of all cases (Stewart & Ward, 2020). However, group B streptococcal soft tissue infections, which often lead to septicaemia and amputation in immunocompromised patients such as inflammatory arthritis, diabetes, cancer, and others, have been on the rise, which ranged from 13.9% to 38% (Pang et al, 2007;Karunakaran et al, 2009).…”

What’s New in Hand and Wrist Surgery

“…Kirby et al demonstrated a much higher rate of infection after CTR if a corticosteroid injection had been administered preoperatively (mean, 55 days) 44 . Suppurative flexor tenosynovitis is a rare but serious complication after trigger finger release surgery 45 , and corticosteroid injection within 30 days prior to trigger finger release portends an elevated risk of deep infection requiring surgical debridement. In addition, there is an elevated risk of surgical site infection of any type when a corticosteroid injection had been administered within 90 days prior to a trigger finger release surgery 46,47 .…”

Infektionen der Beugesehnenscheide

“…Selten sind auch postoperative Infektionen, z. B. nach A1-Ringbandspaltung [5]. Auch Bissverletzungen durch Tiere oder Menschen sind nicht selten [6].…”