eMedicine Specialties > Emergency Medicine > Rheumatology

Tenosynovitis: Differential Diagnoses & Workup

Author: Jeffrey G Norvell, MD, Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine
Coauthor(s): Mark Steele, MD, Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City
Contributor Information and Disclosures

Updated: Mar 31, 2008

Differential Diagnoses

Abdominal Pain in Elderly Persons
Gonorrhea
Ankle Injury, Soft Tissue
Gout and Pseudogout
Arthritis, Rheumatoid
Hand Infections
Bursitis
Hand Injury, High Pressure
Carpal Tunnel Syndrome
Hand Injury, Soft Tissue
Cellulitis
Knee Injury, Soft Tissue
Compartment Syndrome, Extremity
Reactive Arthritis
Endocarditis
Rheumatic Fever
Felon

Other Problems to Be Considered

Osteoarthritis
Subcutaneous abscess

Workup

Laboratory Studies

  • Gonococcal cultures of the urethra or cervix, rectum, and pharynx are appropriate if gonococcal tenosynovitis is suspected. One of these cultures is positive in approximately 80% of patients.
  • Complete blood count (CBC) with differential is appropriate if an infectious etiology is suspected.
  • Erythrocyte sedimentation rate (ESR) is appropriate if an infectious etiology is suspected.
  • Transiently elevated liver function studies have been described with disseminated gonococcal infection.

Imaging Studies

  • Radiographs are low yield, unless a retained radiopaque soft tissue foreign body is suspected or if they are needed to rule out a fracture.
  • Magnetic resonance imaging (MRI) has proven accurate in assisting the diagnosis of tenosynovitis; however, it is expensive and generally unnecessary since the diagnosis is usually clinically evident.

Procedures

  • Diagnostic arthrocentesis is indicated if joint effusion is present with tenosynovitis because most patients with disseminated gonococcal infection have coexistent septic arthritis.
    • Sterile fluid is common with gonococcal arthritis; cultures are negative in 50% of patients.
    • Most gonococcal arthritis is monoarticular; approximately 25% is polyarticular.
    • Joint fluid glucose usually is normal.
    • White blood cell (WBC) counts usually are less than 50,000, and a Gram stain is positive in only 25% of patients.

More on Tenosynovitis

Overview: Tenosynovitis
Differential Diagnoses & Workup: Tenosynovitis
Treatment & Medication: Tenosynovitis
Follow-up: Tenosynovitis
References
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References

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  8. Goldenberg DL. Gonococcal arthritis. In: McCarty DJ, ed. Arthritis and Allied Conditions: A Textbook of Rheumatology. 11th ed. Philadelphia, Pa: Lea and Febiger; 1989.

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Further Reading

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Keywords

de Quervain tenosynovitis of the wrist, abductor pollicis longus tendons, extensor pollicis brevis tendons, volar flexor tenosynovitis, stenosing tenosynovitis, trigger finger, gonococcal tenosynovitis, GC tenosynovitis, Finkelstein test, nongonococcal infectious tenosynovitis, suppurative tenosynovitis, pyogenic flexor tenosynovitis, cardinal signs of Kanavel, Neisseria gonorrhoeae, Staphylococcus aureus, Streptococcus species, Pasteurellamultocida, cat bites, Eikenella corrodens, human bites, Mycobacterium species, diabetes mellitus, intravenous drug abuse, IV drug abuse, arteriosclerosis obliterans

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Contributor Information and Disclosures

Author

Jeffrey G Norvell, MD, Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine
Jeffrey G Norvell, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Steele, MD, Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City
Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard S Krause, MD, Clinical Assistant Professor, Residency Program Director, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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