Tenosynovitis
Basics
Description
Description
- Definition:
- Inflammation and pain of the tendon and tendon sheath
- Caused by acute or chronic inflammation, overuse, or infection
- Can lead to pain, decreased ROM, necrosis, and tendon rupture
- Anatomy:
- Synovial sheaths cover tendons as they pass through osseofibrous tunnels
- Visceral and parietal layers of the synovium lubricate and nourish the tendons
- Pathophysiology:
- Inflammation: Proliferation of fibrous tissue causing painful friction, impingement/constriction of the tendon. High association with DM and RA
- Overuse: Repetitive microtrauma resulting in inflammation and fibrosis
- Infection: Most common in acute setting:
- Introduced into tendon sheath via:
- Skin wound/puncture is most common
- Hematogenous spread
- Introduced into tendon sheath via:
- Flexor tenosynovitis (FTS) of hand: Closed space infection of the flexor tendons. An orthopedic emergency
- Most common mechanism is penetrating injury at flexion creases of the finger
- Causes include:
- Penetrating trauma
- Bites
- High-pressure injection (Paint sprayer, grease gun)
- Air tools
- Hydraulic equipment: May appear minor on the surface but are associated with high incidence of FTS
- Hematogenous or direct spread from deep space or joint infection
Etiology
Etiology
- de Quervain tenosynovitis:
- Caused by overuse
- Inflammatory in nature
- Two thumb tendons: The abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
- Near the thumb base, the APL and EPB traverse together through a thick fibrous sheath forming a tunnel at the radial styloid process
- Overuse causes thickening of extensor retinaculum and subsequent canal narrowing
- Nongonococcal infectious tenosynovitis:
- Staphylococcus aureus and Streptococci are most common in penetrating injuries, but often polymicrobial
- Pasteurella multocida associated with cat bites
- Eikenella corrodens associated with human bites
- Pseudomonas is seen in patients with diabetes or marine-associated injuries
- Mycobacterium species may occur in immunocompromised patients. Suspect in chronic, indolent infections
- Gonococcal tenosynovitis:
- Disseminated Neisseria gonorrhoeae
- Fungal tenosynovitis may occur from puncture wounds due to thorns or woody plants
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Citation
Schaider, Jeffrey J., et al., editors. "Tenosynovitis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis.
Tenosynovitis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis. Accessed December 10, 2024.
Tenosynovitis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis
Tenosynovitis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis.
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