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Tenosynovitis

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

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Basics

Description

  • 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

Etiology

  • 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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Citation

Rosen, Peter, et al., editors. "Tenosynovitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis.
Tenosynovitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis. Accessed April 26, 2019.
Tenosynovitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis
Tenosynovitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tenosynovitis ID - 307108 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307108/all/Tenosynovitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -