Infectious Disease Compendium

Tenosynovitis

Diagnosis

Infections of the tendon sheath.

Epidemiologic Risks

Trauma, sex (for some the same thing).

Microbiology

Any penetrating trauma can lead to infection. The nature of the trauma leads to consideration of microbiology. An animal bite is different than a knife. Unless the knife was cleaning a cat's mouth, I suppose.

S. aureus and streptococci are most common; Candida, non-tuberculous Mycobacteria and Sporothrix schenckii, after injection from organic material (the rose thorn is a risk, but overrated, for Sporothrix; any woody material has Sporothrix, except Woody Harrelson).

Disseminated N. gonorrhoeae can present as a migratory tenosynovitis.

Empiric Therapy

First, make the patient NPO and call the surgeon. I&D is the most important intervention (PubMed).

It depends on what caused the infection, but outcomes are associated with prompt therapy.

Acute is usually nafcillin/oxacillin OR cefazolin OR vancomycin PLUS/MINUS third-generation cephalosporins OR quinolone.

How long to treat? Tradition is usually to treat with IV for 2 (streptococcal) to 3 (staphylococcal) weeks but "A single open debridement with irrigation and primary wound closure followed by 10 days of antibiotic treatment resolved uncomplicated pyogenic flexor tenosynovitis (PubMed)."

I have tended to treat with po, but one review (PubMed), all sorts of combinations of iv, po and even no antibiotics were used.

Probably an easy to kill organisms in a normal host with no complications, a rapid change to po. If a hard to kill the organism in a complicated immunosuppressed patient probably needs longer iv.

Steroids. It helps chickens (PubMed) but no human studies

Pearls

Have a very low threshold for surgery, a little inflammation in a tendon sheath can lead to beaucoup problems with movement.

Rants

Treating without debridement is usually destined to failure, disability, and a lawsuit.

Last Update: 02/27/19.