Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

Kanavel Signs (Flexor Tendon Sheath Infection)

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Definition

• Kanavel signs are a group of four clinical findings suggestive of:
  • Pyogenic Flexor Tenosynovitis

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Clinical Significance

• Critical for early diagnosis of flexor tendon sheath infections
• Helps guide urgent management decisions

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The Four Kanavel Signs

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1. Uniform Swelling of the Finger

• Entire finger appears:
  • Fusiform (sausage-shaped)
• Swelling follows the flexor tendon sheath

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2. Finger Held in Flexion

• Finger rests in a slightly flexed position

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Reason

• Flexion:
  • Reduces pressure within tendon sheath
  • Minimizes pain

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3. Pain on Passive Extension

• Attempting to extend the finger causes:
  • Severe pain

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Key Feature

• Most sensitive clinical sign

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4. Tenderness Along Flexor Tendon Sheath

• Marked tenderness along:
  • Palmar aspect of the finger

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Location

• Along the course of:
  • Flexor tendons

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Clinical Importance

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• Early recognition is essential to prevent:
  • Tendon necrosis
  • Spread of infection
  • Loss of finger function

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Complications of Delayed Treatment

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• Tendon damage
• Deep space infection
• Reduced range of motion
• Permanent disability

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Key Clinical Point

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• Presence of all four signs = strong suspicion of flexor tendon sheath infection

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Management Implication

• Requires:
  • Urgent evaluation
  • Early antibiotics
  • Possible surgical drainage