Tenosynovitis
Conditions
Keywords
irrigation, tenosynovitis, purulent, closed-catheter, flexor tendon
Brief summary
This study evaluates the effect of postoperative intermittent closed-catheter irrigation on the recovery from the purulent flexor tenosynovitis. One group of patients suffering from acute purulent flexor tenosynovitis is treated using intraoperative irrigation only and the other group having both intra- and postoperative irrigation.
Detailed description
The foundation of the successful management of purulent flexor tenosynovitis is the surgical debridement followed by an intravenous antibiotic treatment. Several surgical methods have been described to remove the purulent debris from the flexor tendon sheath. Closed-catheter irrigation involves irrigation of the tendon sheath from proximal to distal direction facilitated by two small incisions; one proximal to A1 pulley and one distal to A4 pulley. Lille et al. (J Hand Surg Br. 2000;25(3):304-307) conducted a retrospective study that implied that intraoperative closed-catheter irrigation without postoperative irrigation might be as effective as the combination of intra- and postoperative irrigation. The hypothesis of this prospective randomized trial is that the intraoperative closed-catheter irrigation alone is as effective as the combination of intraoperative and postoperative intermittent closed-catheter irrigation in the treatment of purulent flexor tenosynovitis.
Interventions
PROCEDUREIntraoperative flexor tendon sheath irrigation
PROCEDUREPostoperative flexor tendon sheath irrigation
Sponsors
Tampere University Hospital
Tampere University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* clinical diagnosis of purulent flexor tenosynovitis with all four positive Kanavel's signs: * symmetric swelling of the entire digit * exquisite tenderness along the course of the tendon sheath * semiflexed posture of the digit * pain with attempted passive extension of the digit * age over 18 years * patient's willingness to participate in the study
Exclusion criteria
* High-pressure, foreign body or chemical injuries, which require open debridement * prisoner, military serviceman, mental retardation or other factors which may affect one's decision making
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Active range of movement of the most affected finger | 3 months postoperatively | The total active range of movement is calculated as: (active flexion of MCPJ + PIPJ + DIPJ) - (extension deficit of MCPJ + PIPJ + DIPJ). MCPJ, metacarpophalangeal joint; PIPJ, proximal interphalangeal joint; DIPJ, distal interphalangeal joint. |
Secondary
| Measure | Time frame |
|---|---|
| Need for reoperation | 3 months postoperatively |
Other
| Measure | Time frame | Description |
|---|---|---|
| QuickDASH score | 4 weeks and 3 months postoperatively | — |
| Pain at rest | 4 weeks and 3 months postoperatively | Pain at rest (Visual analog scale) |
Countries
Finland
Outcome results
None listed