TENDONS, BURSIE, AND FASCIIE, DISEASES OF.
Tenosynovitis, or Thecitis. — Inflam mation of a tendon or tendon-sheath may either be acute, when it is the result of injury, or chronic, when it is clue to tuberculous infection.
ACUTE TENOSYNOVITIS.—In this form traumatism may give rise to suppurative inflammation, owing to the invasion of pyogenic microbes, the result, in many cases, of insufficient attention to antisep sis when the wound is dressed, or to the presence near the injury of a suppura tive process. It may also result from re peated, though slight, contusions, such as those to which the hand is exposed in many occupations. Injuries of this kind in the palm of the hand are well known under the term palmar abscess. (See be low.) Acute tenosynovitis may also ap pear as a complication of syphilis, gonor rhoea, and rheumatism. It is termed whitlow, felon, or panaris (see below) when the tendon-sheath of a finger is the seat of the acute suppurative process.
Palmar abscess may be due, as stated, to repeated contusions, but also to ex tension of tenosynovitis of the fingers, especially when the abscess is located on the flexor side of the little finger and the thumb, owing to the connection of their synovial sheaths with the general sheath common to the tendons of the palm. The three other fingers, as is well known, possess separate sheaths. When sup purative inflammation is present in the palm, high fever may occur, and the pain is severe in proportion to the resistance of the overlying tissue. Here, again, the pus may burrow in various directions or insinuate itself between the metacarpals to the dorsum, and passing beneath the annular ligament reach the tissues of the forearm and beyond. Death has been known to ensue in such cases from pyx mic infection. The palmar lesion may, in turn, become aggravated; necrosis of the carpus may occur and dangerous haemorrhages suddenly appear through involvement of a large vessel in the sup purative process.
Felon, or Whitlow.—The term "felon"
is often applied to a superficial inflam mation of the finger or toes around the nail and sometimes causing loss of the latter. This variety has been treated under NAILS, DISEASES OF (volume iv). The form considered here is that to which "felon" more properly belongs: inflammation of the deeper tissues, in cluding the tendon and its sheath of the distal phalanx. This is usually due to traumatism,—a blow or crush,—and de velops soon after the receipt of the in jury, though sometimes only toward the end of the second day. Severe pain, heat, throbbing, and more or less fever betoken the presence of quite an acute inflammatory process. The pain be comes extremely severe and almost un bearable if surgical measures are not re sorted to. If the abscess be allowed to proceed without relief, extension toward the hand may follow or the pus gradually works its way toward the surface, form ing a volcano-like mass, which, upon healing, leaves the thumb deformed— sufficiently in some cases to impair its usefulness.
Treatment.—The treatment depends, of course, upon the condition presented at the time the case is seen. In its in cipient stage an acute tenosynovitis may sometimes be cured by rest, elevation of the part, and application of cold coin presses or prolonged baths in a solution of borate of sodium, especially if small doses of iodide of potassium are given internally—with copious draughts of water. In the vast majority of cases, however, such a favorable result is not reached, and the inflammatory process proceeds to suppuration. A free incision including the tendinous sheath, exposure of all sinuosities that appear suspicious, and curetting, all performed under strict antiseptic precautions, represent the only safe procedures. Thoroughness at this time avoids not only a repetition of the operation, which otherwise often be comes necessary, and the likelihood of a deformity is greatly reduced. General anesthesia is to be preferred.