Tenosynovitis is a topic covered in the 5-Minute Emergency Consult.

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  • Definition
    • Inflammation of the tendon and tendon sheath
  • Caused by inflammation, overuse, or infection
  • Synovial sheaths cover tendons as they pass through osseofibrous tunnels:
    • Visceral and parietal layers of the synovium lubricate and nourish the tendons.
    • Infection can be introduced into tendon sheath.
  • Skin wound
  • Hematogenous spread
  • Flexor tenosynovitis (FTS) of hand:
    • Typically infectious etiology
    • Penetrating injury especially at flexion creases of the finger is the most common mechanism.
    • High-pressure “injection” injury to fingers
  • Air tools
  • Paint sprayers
  • Hydraulic equipment
  • May appear minor on the surface but are associated with high incidence of FTS


  • De Quervain tenosynovitis:
    • Caused by overuse
    • Inflammatory in nature
    • 2 thumb tendons: The abductor pollicis longus (APL) and extensor pollicis brevis (EPB).
    • On their way to the thumb, the APL and EPB traverse side-by-side through a thick fibrous sheath that forms a tunnel at the radial styloid process
  • GC tenosynovitis:
    • Neisseria gonorrhea
  • Nongonococcal infectious tenosynovitis:
    • Staphylococcus aureus and Streptococci are most common in penetrating injuries.
    • Pasteurella multocida is common with cat bites.
    • Eikenella corrodens is common in human bites.
    • Pseudomonas is seen in patients with diabetes or marine-associated injuries.
    • Mycobacterium species may occur in immunocompromised patients.
    • Fungal tenosynovitis may occur from puncture wounds due to thorns or woody plants

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