Flexor tenosynovitis – a name only a hand surgeon could love

We have made it to the DFW area.. but not without one BIG – small incident.

On Saturday, as we were driving through El Paso, TX… Dexter (our 9yo Corgi boy) became distressed.  We believe he got one of his nails hung in something, but we’re not quite sure.  He was yelping in pain, so.. like any caring person would do, Lehnanne reached in to help free him from his bindings.  Unfortunately, Dexter didn’t realize it was her, and associated her touch with the trigger of his pain, and Lehnanne got bit.  Dexter is a good boy… as soon as he recognized it was his mom that he had, he released and allowed her to free him of his painful predicament.

The damage, however… was done. Lehnanne was bleeding from the middle finger on her right hand (she jokingly stated she used that finger a lot).  She immediately rinsed the bite with alcohol, applied antibiotic ointment and wrapped the finger in gauze.  This would prove to be insufficient.  Over the course of the next 24 hrs, her finger swelled and the pain increased.  Frequent washing / bandage changes didn’t help.  It seemed like such a small wound.. a puncture on the inside of the knuckle and a graze on the outside of it.  However, the throbbing and swelling were too much to ignore.  We arrived in Burleson, TX and after getting things settled, headed to the Emergency Room (ER of Burleson to be precise).

We expected to wait for hours, be seen by a heavily distracted nurse / doctor core… given a prescription for a course of antibiotics and be on our dreary way.  None of this however was the case.

The ER of Burleson was spectacular…  There was NO wait, the staff were attentive and cared about her well being, and this was obvious from the first interaction to the last.  The Dr on duty was concise in his communications, no sugar coating, no dodging the tough questions, none of that..  We were however not in for a quick visit.

It turns out the bite had punctured into the fluid-filled sheath (called the synovium) that surrounds the flexor tendon which introduced bacteria to this well protected, warm, nutrient rich walled garden.  The ER Dr immediately began calling to consult with hand specialists throughout the area.  And was recommended she be seen as soon as possible by a hand surgeon and recommended for surgery.  Due to a stroke of luck (good and bad), all “close” facilities that had a hand specialist were full and not accepting ER patient transfers… so we would drive to and be admitted to ‘The Medical Center of Plano’ in Plano Texas (about 1 hour and 10 minutes drive).  After about an hour of time spent in the ER (about 20 to 30 minutes in the waiting room, and about the same amount of time in a private room), she was transferred to her deluxe accommodations… no sarcasm in that statement.  Her room is actually a suite.  Dedicated bathroom, bedroom and living room.  Heck, it’s nicer than many a hotel I’ve stayed at on business travel!

This gets us to midnight.  We then proceeded to answer many questions to ensure they had an accurate medical history and then met the hand doctor.  He confirmed the diagnosis of ‘flexor tenosynovitis’.  An inflammation of the synovium due to the introduction of bacteria via the puncture.  He went on to explain the process of relief and recovery.

• Surgery — specifically:
  • making a small incision at the entrance to the synovium (in the palm near the base of the finger)
  • lacerating the entire length of the finger
  • making 3 holes in the synovium along the length of the finger
  • flushing the synovium with an antibiotic laced saline solution until the drainage runs clear
• Leaving the laceration open:
  • yes, open… the Dr explained that bacteria being bacteria, the flush wouldn’t rid all of them out of the synovium.
  • wicks will be inserted to prevent the finger from healing and closing the opening.
  • The wicks and other dressing will be changed 3 times per day
  • During the dressing changes, her hand will be submerged into a betadine and saline solution for a minimum of 5 minutes
  • Rinse (literally) and repeat.. for 5 days
• Remain on IV antibiotics for 5 to 7 days
  • This is honestly the hardest part for Lehnanne.  This means that she will be in the hospital for 5 to 7 days after the procedure.
• Physical therapy
  • During the 5 days of dressing changes and betadine/saline soaks, her finger will be manipulated to ensure she retains her range of motion.

The Dr advises that due to the close proximity of the opening along the length of the finger to the neurovascular bundle ( the nerve / blood vessel that runs along each side of your finger )… the dressing changes will be very painful.  They will however, become less and less painful as the 5 days progress.

Lehnanne is currently scheduled for surgery this morning, at 10am CST.  I’ll be sure to update the blog whenever she’s out of surgery.

Here are some photos of the digit in question.. and a loopy Loupie (she got dilauded for the pain)