Tenosynovitisis theinflammationof thefluid-filled sheath(called thesynovium) that surrounds atendon,typically leading tojoint pain,swelling,andstiffness.Tenosynovitis can be either infectious or noninfectious. Common clinical manifestations of noninfectious tenosynovitis includede Quervain tendinopathyandstenosing tenosynovitis(more commonly known astrigger finger).[1]
| Tenosynovitis | |
|---|---|
| Other names | tendosynovitis |
 | |
| Congenitalstenosing tenosynovitisof the thumb in a 3-year-old child. The thumb is unable to be straightened. | |
| Specialty | Physical medicine and rehabilitation |
Signs and symptoms
editInfectious tenosynovitis in 2.5% to 9.4% of all hand infections.Kanavel's cardinal signsare used to diagnose infectious tenosynovitis. They are: tenderness to touch along the flexor aspect of the finger, fusiform enlargement of the affected finger, the finger being held in slight flexion at rest, and severe pain with passive extension.[2][3]Fever may also be present, but is uncommon.[4]
Pathogenesis
editInfectious tenosynovitis is the infection of closedsynovial sheathsin the flexor tendons of the fingers. It is usually caused by trauma, but bacteria can spread from other sites of the body. Although tenosynovitis usually affects the flexor tendon of the fingers, the disease can also affect the extensor tendons occasionally.[5]The clinical presentation is therefore as acute infection following trauma. The infection can be mono- or polymicrobial and can vary depending on the nature of the trauma. The most common pathogenic agent isStaphylococcus aureusintroduced from the skin.[6]Other bacteria linked to infectious tenosynovitis includePasteurella multocida(associated with animal bites),Eikenellaspp. (associated with IV drug use), andMycobacterium marinum(associated with wounds exposed to fresh or salt water).[7]Additionally, sexually active patients are at risk for hematogenous spread due toNeisseria gonorrhoeae(seeinfectious arthritis).
Common noninfectious tenosynovitis are:stenosing tenosynovitis,intersection syndrome,extensor pollicis longus(EPL) tenosynovitis,de Quervain'sand fourth compartment tenosynovitis.[8]
Diagnosis
editDiagnosis of tenosynovitis is typically made clinically after a thorough patient history and physical exam. Aspirated fluid can also beculturedto identify the infectious organism. X-rays are typically unremarkable but can help rule out a broken bone or a foreign body[1]
Treatment
editThe mainstay of treatment for infectious tenosynovitis includes symptom relief, antibiotic therapy, and surgery. Early recognition of the disease with early initiation of antibiotics are important for better range of movement of the affected finger. Minimally invasive procedures into the flexor tendon sheath such as catheter irrigation give better outcomes (74% chance of good outcome) when compared to open surgery (26% chance of good outcome). However, wound irrigation with antibiotics has no clear benefits.[2]Most infectious tenosynovitis cases should be managed with tendon sheath irrigation and drainage, with or without debridement of surrounding necrotic tissue, along with treatment withbroad-spectrum antibiotics.[5]In severe cases, amputation may even be necessary to prevent the further spread of infection. Following surgical intervention, antibiotic therapy is continued and adjusted based on the results of the fluid culture.[5]
Prognosis
editThe earlier the condition is identified, the better the chance of getting full range of motion of the finger. However, finger stiffness,Boutonniere deformity,deep space infection, tendon necrosis, adhesions, persistent infection, and need for amputation of the finger can occur. Tendon adhesion and finger stiffness are caused by the violation of the flexor tendon sheath.[2]
See also
editNotes
edit- ^abSexton, MD, Daniel."Infectious Tenosynovitis".Uptodate.
- ^abcAvira M, Giladi; Sunitha, Malay; Kevin, C Chung (23 March 2016)."Management of acute pyogenic flexor tenosynovitis: Literature review and current trends".Journal of Hand Surgery (European Volume).40(7):720–728.doi:10.1177/1753193415570248.PMC4804717.PMID25670687.
- ^Pang, HN; Teoh, LC; Yam, AK; Lee, JY; Puhaindran, ME; Tan, AB (August 2007). "Factors affecting the prognosis of pyogenic flexor tenosynovitis".The Journal of Bone and Joint Surgery. American Volume.89(8):1742–8.doi:10.2106/JBJS.F.01356.PMID17671013.
- ^Nikkhah, D; Rodrigues, J; Osman, K; Dejager, L (2012). "Pyogenic flexor tenosynovitis: one year's experience at a UK hand unit and a review of the current literature".Hand Surgery.17(2):199–203.doi:10.1142/S0218810412500190.PMID22745083.
- ^abcSmall, LN; Ross, JJ (December 2005). "Suppurative tenosynovitis and septic bursitis".Infectious Disease Clinics of North America.19(4):991–1005, xi.doi:10.1016/j.idc.2005.08.002.PMID16297744.
- ^Moses MD, Scott."Suppurative Tenosynovitis".fpnotebook.
- ^Tsai, E; Failla, JM (May 1999). "Hand infections in the trauma patient".Hand Clinics.15(2):373–86.doi:10.1016/S0749-0712(21)00470-4.PMID10361644.
- ^Travis, D Blood; Nathan T, Morrell; Arnold Peter, C Weiss (29 March 2016). "Tenosynovitis of the Hand and Wrist".Journal of Bone and Joint Surgery.4(3):e71 –e78.doi:10.2106/JBJS.RVW.O.00061.PMID27500430.S2CID29942149.