Tenosynovitis Medication

Updated: Oct 05, 2015
  • Author: Mark R Foster, MD, PhD, FACS; Chief Editor: Harris Gellman, MD  more...
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Medication

Medication Summary

The goals of tenosynovitis therapy are to reduce pain and eradicate infection. Initial treatment for suspected infectious FT may include IV antibiotics if the patient presents very early.

In inflammatory FT resulting from an overuse syndrome, NSAIDs can be administered if tolerated by the patient. Flexor tendon sheath or carpal tunnel corticosteroid injections can be administered to decrease pain and the inflammatory response. However, corticosteroid injections should be used with caution, as they are detrimental if injected directly into the tendon or ligament. Multiple injections also can weaken the tendon and lead to rupture in patients with diabetes or inflammatory arthritis.

Pharmacologic treatment for rheumatoid inflammatory FT includes NSAIDs, hydroxychloroquine, gold, penicillamine, and methotrexate. Persistent cases may require oral steroid treatment. For acute flares of FT in patients with rheumatoid arthritis, corticosteroid injections may provide prompt relief.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs are most commonly used for the relief of mild to moderate pain. Although the effects of NSAIDs in pain treatment tend to be patient specific, ibuprofen usually is the drug of choice (DOC) for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam. NSAIDs are primarily used for de Quervain and volar flexor tenosynovitis.

Ibuprofen (Motrin, Advil, NeoProfen)

This agent inhibits inflammatory reactions and pain, probably by decreasing the activity of the enzyme cyclooxygenase (COX), in this way inhibiting prostaglandin synthesis. Ibuprofen is usually the DOC for the treatment of mild to moderate pain if no contraindications exist.

Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)

Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of the enzyme COX.

Ketoprofen

Ketoprofen inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. Smaller initial dosages are particularly indicated in elderly patients and in those with renal or liver dysfunction. Doses higher than 75 mg do not improve the therapeutic response and may be associated with a higher incidence of adverse effects.

Meclofenamate

Meclofenamate inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. Compared with other NSAIDs, it is associated with a higher incidence of diarrhea.

Mefenamic acid (Ponstel)

Mefenamic acid inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. Compared with other NSAIDs, it is associated with a higher incidence of diarrhea.

Flurbiprofen

Flurbiprofen may inhibit cyclooxygenase, thereby inhibiting prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Fenoprofen (Nalfon)

Fenoprofen decreases the formation of prostaglandin precursors by inhibiting cyclooxygenase 1 and 2 enzymes. It may also inhibit neutrophil aggregation/activation, inhibit chemotaxis, alter lymphocyte activity, and decrease proinflammatory cytokine levels.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin that has a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. By binding to 1 or more of the penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits bacterial growth. Ceftriaxone is used because of an increasing prevalence of penicillinase-producing N gonorrhoeae.

Ciprofloxacin (Cipro)

This is a bactericidal antibiotic that inhibits bacterial DNA synthesis and (consequently) growth by inhibiting DNA-gyrase in susceptible organisms. The duration of treatment depends on the severity of the infection.

Ampicillin and sulbactam (Unasyn)

This drug combination uses a beta-lactamase inhibitor with ampicillin; it covers skin, enteric flora, and anaerobes. Ampicillin/sulbactam is used for the treatment of nongonococcal infectious tenosynovitis. Its coverage includes Staphylococcus and Streptococcus species, as well as anaerobes.

Cefazolin

Cefazolin is a first-generation, semisynthetic cephalosporin that, by binding to 1 or more of the penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth. It is active primarily against skin flora, including Staphylococcus aureus. It is typically used alone for skin and skin-structure coverage. Cefazolin is administered for the treatment of suspected staphylococcal and/or streptococcal tenosynovitis (anaerobes not suspected).

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Corticosteroids

Class Summary

These agents have anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids have profound and varied metabolic effects. In addition, these drugs modify the body's immune response to diverse stimuli.

Dexamethasone acetate (Baycadron)

This agent decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reducing capillary permeability. Dosage varies with the degree of inflammation and the size of the affected area.

Methylprednisolone acetate (Depo-Medrol, Medrol, Solu-Medrol, A-Methapred)

Methylprednisolone acetate decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Dosage varies with the degree of inflammation and the size of the affected area.

Hydrocortisone acetate (Solu-Cortef, Cortef, A-Hydrocort)

Hydrocortisone acetate decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Dosage varies with the degree of inflammation and the size of the affected area.

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