Hand infection drainage is an emergency operation to wash out and drain infection from the flexor tendon sheath (flexor tenosynovitis), deep palmar spaces, or other compartments of the hand. Delay risks tendon necrosis and permanent loss of finger function.
For flexor sheath infection: incisions at each end of the tendon sheath (proximal palmar and distal finger). A catheter is inserted and the sheath is irrigated with saline until the fluid runs clear. For deep space infections: the infected compartment is opened, pus drained, necrotic tissue debrided, and the wound washed. The wound may be left open or loosely closed. The hand is splinted in the position of safety. The operation takes 30–60 minutes.
Flexor tenosynovitis is identified by Kanavel's signs: fusiform (sausage-shaped) swelling, flexed posture, tenderness along the sheath, and pain on passive extension. It is a surgical emergency — delay beyond 24–48 hours risks tendon necrosis and a stiff, functionless finger.
Very early cellulitis without Kanavel's signs may respond to IV antibiotics and elevation with close monitoring (reassessment every six to twelve hours). Established flexor sheath infection requires surgery.
This is an emergency. IV antibiotics started in A&E. X-ray to exclude foreign body or osteomyelitis. Blood tests. The hand is elevated and splinted.
Clearance of infection, preservation of the tendon, and restoration of finger function. When treated within 24 hours, most patients regain good function. Delayed treatment leads to tendon adhesions, necrosis, and stiffness.
Flexor tendon adhesions from infection and surgery.
Repeat washout may be needed.
IV antibiotics for several days to weeks.
The tendon may be destroyed by infection, particularly if delayed.
Rarely needed for severe, neglected infections.
Spread of infection to bone.
Systemic spread.
A stiff, contracted finger despite treatment.
General or regional arm block anaesthesia. Emergency case.
IV antibiotics for 48 hours minimum then transition to oral. Elevation for 48 hours. Hand therapy begins at 48–72 hours once infection is controlled. Splinting in the position of safety between exercises. Full rehabilitation takes weeks to months.
Daily wound review while inpatient. Hand therapy from 48–72 hours. Surgeon review at one week and two weeks.
Four classic signs of flexor tenosynovitis: the finger is swollen in a sausage shape, held in a slightly bent position, tender along the whole tendon sheath, and extremely painful when someone tries to straighten it. The presence of three or four signs strongly suggests sheath infection.
Usually through a puncture wound, cut, or thorn prick — even a very small wound. Animal bites, particularly cat bites, are notorious causes. Sometimes no wound is identified.