EpistemisHand flexor tenosynovitis
Specialty: Musculoskeletal.
Why it occurs
- Repetitive biomechanical overload due to intense hand-gripping activities
- Rheumatoid arthritis (synovial infiltration of the flexor sheaths)
- Infectious flexor tenosynovitis due to a palmar puncture wound (classically due to Staphylococcus aureus or Pasteurella after a cat bite)
- Extrapulmonary tuberculosis (rice-grain tuberculous tenosynovitis)
- Gout or pseudogout of the tendon sheaths of the wrist and hand
- Sarcoidosis affecting tendon sheaths
Initial workup
High resolution ultrasound of the palmar aspect of the hand and fingers (demonstrates fluid effusion within the flexor sheath, Doppler hyperemia and thickening of the tendons) | Analysis of synovial fluid obtained by puncture if there is suspicion of infection | AP and oblique hand x-ray.
red flags
Kanavel signs present: finger kept in slight flexion, uniform swelling of the entire finger (sausage finger), exquisite pain along the entire flexor tendon sheath and intense pain on passive extension of the finger (surgical emergency of infectious tenosynovitis due to risk of tendon necrosis).
Standard management
- Cefazolin — 1-2 g IV every 8 hours in case of suspected acute infectious tenosynovitis
- Meloxicam — 15 mg once daily orally if the etiology is rheumatic or non-infectious mechanical
- Methotrexate — 15 mg/week orally if it is a secondary manifestation of rheumatoid arthritis
- Methylprednisolone (infiltration of 10 mg into the sheath under strict ultrasound control, contraindicated if there is suspicion of infection).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4