Treatment

Management is dependent on whether the patient has an infective or non-infective tenosynovitis.

Infective tenosynovitis

• any suspicion of infective flexor hand tenosynovitis should lead to an emergency surgical review (1)
• management of infectious tenosynovitis depends on the organism identified; but when unknown, emperical antibiotics employed include vancomycin, or a 3^rd-generation cephalosporin (2)
  • duration of antibiotics depends on clinical signs, the presence of systemic infection, and infection source
    • Stage 1 infection is managed with sheath washing either by tube-directed therapy or open lavage
    • Stage 2 or 3 infections usually require an open lavage

Non-infective tenosynovitis

• initial treatment is by rest, but if this fails a local injection of hydrocortisone may be considered under local anaesthetic (3,4)
  • care should be taken with this injection, which should be performed with low pressure, to avoid injecting into the tendon itself.
• disease-modifying antirheumatic drugs (DMARDs) such as glucocorticoids may be additionally helpful in patients in patients who fail a trial of NSAIDs (4)

Reference

1. Mamane W, Lippmann S, Israel D, et al. Infectious flexor hand tenosynovitis: State of knowledge. A study of 120 cases. Journal of Orthopaedics. 2018 Jun;15(2):701-706.
2. Muthu S, Annamalai S, Kandasamy V. Tenosynovitis of hand: Causes and complications. World J Clin Cases. 2024 Feb 6;12(4):671-676.
3. Wagner ER, Gottschalk MB. Tendinopathies of the Forearm, Wrist, and Hand. Clin Plast Surg. 2019 Jul;46(3):317-327.
4. Hammer HB, Kvien TK, Terslev L. Tenosynovitis in rheumatoid arthritis patients on biologic treatment: involvement and sensitivity to change compared to joint inflammation. Clin Exp Rheumatol. 2017 Nov-Dec;35(6):959-96