Pyogenic Flexor Tenosynovitis (PFT)
Pyogenic flexor tenosynovitis (PFT) is a purulent infection of a flexor tendon and its synovial sheath. It is a time‑critical surgical emergency - delays in diagnosis or source control risk tendon necrosis, loss of motion, digital ischemia, gangrene and amputation.
Early recognition in the emergency department, prompt antimicrobial therapy and urgent hand‑surgical review are priorities. Use local hand‑surgery pathways and antimicrobial policies together with NICE guidance on skin and soft tissue infections and bites (NG141 and NG184).
Pathophysiology and aetiology
- Infection reaches the sheath by direct inoculation (penetrating trauma, bites, thorn injuries, IV drug use), contiguous spread from adjacent infection, or less commonly haematogenous seeding.
- The tendon sheath is a closed space; purulent accumulation rapidly increases intra‑sheath pressure, impairing tendon perfusion and causing severe pain, adhesions and tendon damage.
- Common organisms include Staphylococcus aureus and streptococci.
- Bite‑related infections commonly involve Eikenella corrodens (human bites) and Pasteurella spp. (animal bites).
- Contaminated wounds, aquatic injuries and immunosuppression increase the likelihood of polymicrobial or atypical organisms.
- Host factors associated with worse outcome include diabetes, peripheral vascular disease, immunosuppression and delayed presentation.
Clinical presentation and diagnosis
Diagnosis is predominantly clinical. Onset is usually over hours to days; severe cases can progress quickly. The absence of one or more typical signs does not exclude PFT.
Key clinical features