RMO MS P36 21 Juni - Tenosynovitis & Scoliosis

A 45-year-old man comes to the emergency department with severe pain, redness, and swelling from the tip to the base of his right middle finger, accompanied by fever and inability to move the finger. He mentions a scratch injury 3 days ago from a rusty wire. Examination shows the finger looks like a 'sausage', passive flexion is limited, and there is tenderness along the flexor tendon. What is the most likely diagnosis?

• De Quervain tenosynovitis

• Rheumatoid arthritis

• Flexor tenosynovitis supuratif

• Septic arthritis MCP

• Stenosing tenosynovitis

In cases of suppurative flexor tenosynovitis, one of the Kanavel signs that can be used for clinical confirmation is:

• Tenderness on the MCP joint without tendon involvement

• Finger in passive flexion and pain on passive extension

• Increased Tinel sign on the infected finger

• Loss of sensation at the tip of the affected finger

• Pain only when actively moved

A patient with suppurative flexor tenosynovitis without MRSA risk factors is planned to receive empirical antibiotics. Which of the following combinations is most appropriate?

• Vancomycin and Metronidazole

• Amoxicillin and Ciprofloxacin

• Cefazolin or Nafcillin monotherapy

• Piperacillin-tazobactam and Gentamicin

• Clindamycin and Levofloxacin

A patient experiences suppurative tenosynovitis with systemic symptoms and is suspected of having sepsis. After initial stabilization, what is the first appropriate operative management step?

• Open tenosynovectomy and external fixator placement

• Deep debridement and secondary tendon reconstruction

• Total excision of necrotic tissue

• Incision, drainage, and irrigation of the tendon sheath

• Aspiration of fluid and permanent immobilization

A patient post-treatment for suppurative tenosynovitis experiences decreased finger flexibility. Rehabilitation therapy begins. What exercise is most recommended to prevent tendon adhesion?

• Total passive mobilization with CPM device

• Isotonic resistive exercises from day one

• Long-term immobilization with night splint

• Full finger extension with added weight

• Tendon gliding exercises like hook, fist, and tabletop

A 47-year-old carpenter presents to the emergency department with intense pain, swelling, and redness along the entire length of his right middle finger. He reports an injury three days ago when a rusty nail punctured his fingertip while working. Since then, the pain has worsened, especially when trying to move the finger. On examination, the finger is held in a flexed position, appears diffusely swollen ('sausage digit'), and is exquisitely tender along the volar aspect. Passive extension causes severe pain. What is the most appropriate initial management?

• Oral antibiotics and home wound care

• Immobilization with splint and NSAIDs

• Surgical drainage and intravenous antibiotics

• High-dose corticosteroids and topical antiseptics

• Intra-articular steroid injection

A 40-year-old diabetic male presents with fever and inability to move his left index finger. He recalls sustaining a minor cut from a dirty fish scale while cooking two days ago. On physical examination, his finger is warm, red, and swollen, and he cannot extend it actively. He holds it slightly flexed and complains of pain when the digit is passively extended. Laboratory results show leukocytosis with neutrophilia and elevated CRP. Which of the following diagnostic features best supports the diagnosis of suppurative flexor tenosynovitis?

• Hyperextension deformity and positive Phalen's test

• Joint effusion on ultrasonography of MCP joint

• Bone erosion on plain radiograph of phalanx

• Diffuse fusiform swelling and tenderness along the flexor sheath

• Reduced capillary refill time in the fingertip

A 52-year-old man is admitted with suspected hand infection. He works in a steel factory and suffered a puncture injury with a metal wire. Within 48 hours, he develops fever and severe finger pain. Physical examination reveals the four classic Kanavel signs. His medical history includes prior MRSA colonization. Which empirical antibiotic regimen is most appropriate at this point?

• Amoxicillin-clavulanate monotherapy

• Intravenous vancomycin

• Ceftriaxone and doxycycline

• Amikacin and ciprofloxacin

• Clindamycin oral therapy

A patient is diagnosed with acute flexor tenosynovitis and undergoes incision and drainage of the tendon sheath. Postoperatively, the physician emphasizes the importance of rehabilitation to prevent adhesions and restore hand function. What is the most effective physical therapy intervention during early recovery?

• Application of moist heat packs and massage

• Delayed active motion until 4 weeks post-surgery

• Initiation of progressive tendon gliding exercises

• Use of static splints to maintain full flexion

• Strength training with resistance bands immediately

A 45-year-old woman presents with pain and swelling in her ring finger after a rose thorn injury 72 hours earlier. She delayed seeking treatment. On exam, the digit is erythematous, diffusely swollen, and tender along the flexor sheath. Passive extension elicits significant discomfort. She is febrile (38.5°C) and tachycardic. Which imaging modality would provide the most detailed visualization of tendon sheath involvement in this case?

• Plain radiograph of the hand

• High-resolution Doppler ultrasonography

• Bone scintigraphy

• Magnetic resonance imaging (MRI)

• Computed tomography (CT) of the finger