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Posted by deglen on Apr 27 2006
What is described is a hand infection, not tenosynovitis. As Mike said, that's a different disease process as is commonly considered in the medical community, although the 'translation' of the term itself does mean inflammation (not infection) of the tendon.
The flexor surface (palm side) of the hand contains many delicate tendons and parts which require special expertise to repair because of the potential dire consequences (such as this infection) which may result. This area is known to doctors as 'no man's land' because you (as a doctor) don't want to be working in this area unless you are really knowledgable and skilled. It's best to refer these cases to a hand specialist (like the general orthopedist in Anchorage did). Such infections can get started because when bacteria are allowed entry into a wound that communicates directly with a tendon (i.e. inside the protective tendon sheath which acts like a lubricated sleeve inside which the tendon can slide) they can readily spread thoughout the sleeve like a tunnel. This happens because on this side of the hand you usually get the cut with your hand flexed (making a fist). when you relax, the tendon slides back up the sheath taking the contamination (bacteria) with it, thus the infection spreads. What type of bacteria are there will determine how severe the infection may get. Of course most of these have multiple kinds of bacteria which may turn into a very bad problem if the initial antibiotic therapy doesn't cover (kill) all the various types of bacteria in the wound. It doesn't take long for this kind of infection to destroy a hand. If the initial wound closes (like this one did) it actually may progress faster because there is nowhere for the swelling to dissipate or the pus to flow other than internally.
How to prevent these? Wear hand protection. Be careful with your knife. Avoid touching the knife to areas that look like the animal has an infection. Wash your hands with soap (or disinfectant). If you do get cut, wash the hell out of it. Keep an eye on the area. Go to the doctor if it gets red, swollen, warm or hurts. Am I a doctor - yes. is this professional advice - no. It's common sense.
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