Outpatient management of flexor tenosynovitis: use of On-Q system to deliver constant antibiotic irrigation and pain control improves rehabilitation.

Abstract

Flexor tenosynovitis accounts for nearly 10% of all hand infections and, if untreated, can have devastating consequences. Late presentation often requires operative intervention that requires open drainage and irrigation of the flexor tendon sheath with prolonged rehabilitation. We report the use of closed-catheter irrigation system with the On-Q delivery system that allows for simultaneous in situ antibiotic and pain control for outpatient treatment of flexor tenosynovitis. The On-Q delivery system was placed in 6 consecutive patients who met the criteria of all 4 Knavel signs. They all underwent open drainage and closed irrigation system with 0.25% bupivacaine and 250 mg cefazolin over a 1-week period. In all 6 patients, there was no use of narcotic analgesics or oral antibiotics upon discharge. Postoperative hand therapy and range of motion was initiated on postoperative day 1. There was satisfactory progression of range of motion and hand therapy. This initial clinical case series supports the use of the closed irrigation delivery system with in situ antibiotic and analgesic delivery for more rapid rehabilitation of patients with flexor tenosynovitis.