eMedicine Specialties > Emergency Medicine > Rheumatology
Tenosynovitis
Updated: Mar 31, 2008
Introduction
Background
Tenosynovitis involves inflammation of the tendon and tendon sheath. Examples of tenosynovitis include de Quervain tenosynovitis of the wrist (ie, abductor pollicis longus and extensor pollicis brevis tendons), volar flexor tenosynovitis (ie, trigger finger), pyogenic flexor tenosynovitis, which can be from gonococcal (GC) infections and other infectious etiologies.
Pathophysiology
Flexor tendons of the hand run in tight fibroosseous tunnels. Visceral and parietal layers of synovium lubricate and nourish the tendons. These layers usually are collapsed unless infection, which follows the path of least resistance along the tendon sheaths or inflammation, is present.
Infection can be introduced directly into the tendon sheaths through a skin wound (most often) or via hematogenous spread, as occurs with gonococcal tenosynovitis. Gonococcal infection originates as a mucosal infection of the genital tract, rectum, or pharynx. Dissemination occurs in approximately 1-3% of patients with mucosal infection. Approximately two thirds of patients with disseminated gonococcal infection develop tenosynovitis.
A history of recent trauma to the involved area is not uncommon and is believed to be a predisposing factor for the development of pyogenic flexor tenosynovitis. Overuse leads to inflammation in de Quervain tenosynovitis. Etiology of volar flexor tenosynovitis is unknown.
Mortality/Morbidity
One complication of infectious tenosynovitis is a loss of active range of motion. A less frequent complication of infectious tenosynovitis is digit amputation, which occurs most commonly in very advanced cases. Pang et al conducted a review of 75 patients with pyogenic flexor tenosynovitis and found that the following risk factors were associated with poorer outcomes: (1) age older than 45 years; (2) presence of diabetes mellitus, renal failure, or peripheral vascular disease; (3) ischemic changes at the time of presentation; (4) subcutaneous purulence; and (5) polymicrobial infection at the time of surgery.1
Clinical
History
- de Quervain tenosynovitis
- Patients have a history of repetitive pinching motion of the thumb and fingers (eg, assembly line work, driving in screws, weeding).
- Pain in the radial aspect of the wrist becomes worse with activity and better with rest. Onset of pain is typically gradual in nature with no history of acute trauma.
- Most common in middle-aged women
- Volar flexor tenosynovitis (ie, trigger finger)
- This type of tenosynovitis most commonly affects the thumb or ring finger.
- Most common in middle-aged women
- More common in patients with diabetes
- Locking of involved finger in flexion is followed by sudden release (hence the name trigger finger); hand pain radiates to fingers. In more severe cases, the finger may require passive manipulation to regain extension.
- Gonococcal tenosynovitis
- This type of inflammation most commonly affects teenagers and young adults; gonococcal tenosynovitis is more common in women, especially during pregnancy or after menstruation, when dissemination of gonorrhea is more likely to occur.
- Interval from sexual exposure to onset of symptoms of dissemination can vary from 1 day to several weeks.
- Vaginal or penile discharges are usually absent; fever, chills, malaise, and polyarthralgias are common.
- Most common sites affected are the dorsum of the wrist, hand, and ankle.
- Nongonococcal infectious tenosynovitis
- A puncture wound, dry cracked skin, laceration, bite, or high-pressure injection injury (eg, paint, grease gun) may be present.
- Frequently no obvious portal of injury is present.
- Pain and swelling occur along affected tendon; flexor hand tendons are involved most commonly.
Physical
- de Quervain tenosynovitis
- Pain occurs on palpation along the radial aspect of the wrist.
- Pain occurs with passive range of motion of the thumb.
- Pain occurs with ulnar deviation of the wrist with the thumb cupped in a closed fist (ie, Finkelstein test).
- Volar flexor tenosynovitis (ie, trigger finger)
- Tenderness is present at the proximal end of the tendon sheath, in the distal palm (just proximal to metacarpal head).
- Palpable tendon thickening and nodularity may be present.
- Crepitation and catching of the tendon may be appreciated when the finger is flexed.
- Gonococcal tenosynovitis
- Erythema, tenderness to palpation, and painful range of motion of the involved tendon(s) are present.
- Fever is common.
- Dermatitis is also common (occurs in approximately two thirds of disseminated gonococcal) and is characterized by hemorrhagic macules or papules on the distal extremities or trunk.
- Nongonococcal infectious tenosynovitis
- Tenderness, erythema, and painful range of motion of the involved tendon(s) are present.
- Cardinal signs of Kanavel include the following: (1) fusiform swelling of the finger (swelling along the whole digit), (2) flexed position of the finger, (3) severe pain with passive extension of the finger, and (4) tenderness and swelling along and limited to the flexor tendon sheath.
Causes
- de Quervain tenosynovitis: Overuse leads to thickening of the extensor retinaculum of the first dorsal compartment and narrowing of the fibroosseous canal.
- Volar flexor tenosynovitis (ie, trigger finger): Overuse is thought to be the most common cause, but multiple etiologies have been identified. The triggering phenomenon is thought to be caused by hypertrophy of the first annular pulley.
- Gonococcal tenosynovitis -Neisseria gonorrhoeae
- Nongonococcal infectious tenosynovitis
- Staphylococcus aureus and Streptococcus species are the most common etiologic agents, but infection frequently is mixed (aerobic and anaerobic).
- Pasteurella multocida is common with cat bites; Eikenella corrodens occurs with human bites. However, human and animal bites may have a mixture of aerobic and anaerobic flora.
- Predisposing factors include diabetes mellitus, intravenous (IV) drug abuse, debility, and arteriosclerosis obliterans.
- Mycobacterium species also can cause tenosynovitis, particularly in immunocompromised patients.
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.
Treatment
Emergency Department Care
- de Quervain tenosynovitis
- Prescribe rest, nonsteroidal anti-inflammatory agents, and thumb spica wrist splint for those with minimal symptoms.
- Peritendinous lidocaine/corticosteroid injection is considered by many to be the initial treatment of choice for de Quervain tenosynovitis. One review of the literature showed corticosteroid treatment to have a cure rate greater than 80% and concluded that corticosteroid injection is safe.2
- A study published in 2007 examined triamcinolone injections for de Quervain tenosynovitis and achieved an efficacy rate of 89%.3 In this study, patients could receive a maximum of 3 injections separated 2 weeks apart. A favorable result was measured by a questionnaire indicating no disruption in daily life.
- One retrospective review concluded that, in patients with more than minimal symptoms in de Quervain tenosynovitis, steroids are superior to nonsteroidal anti-inflammatory agents and splinting.4
- Surgical therapy is an option if conservative management fails.
- Volar flexor tenosynovitis (ie, trigger finger)
- Activity modification (ie, avoiding activities that cause triggering) and nonsteroidal anti-inflammatory drugs are used.
- Peritendinous lidocaine/corticosteroid injection is the treatment of choice for volar flexor tenosynovitis (ie, trigger finger). A recent randomized placebo-controlled trial compared corticosteroid injections with placebo.5 In this study, subjects treated with corticosteroid injection showed a statistically significant reduction in severity of pain, frequency of triggering, and perceived patient improvement as compared with placebo. The short-term effects were maintained during the 12-month follow-up phase.
- Splinting is another treatment modality that has been studied. This is appropriate for patients who do not want to have a steroid injection.
- Consider surgical tendon release if injection fails. Surgical release for trigger finger has success rates greater than 90%.
- Gonococcal tenosynovitis
- Admit to hospital with IV or intramuscular (IM) antibiotics (eg, ceftriaxone, spectinomycin)
- Surgical drainage may be indicated if antibiotic therapy does not significantly improve condition within 48 hours.
- Nongonococcal infectious tenosynovitis
- If the diagnosis is equivocal, admission to a hand specialist (eg, plastic surgery, orthopedics), elevation, and broad-spectrum antibiotics to include staphylococcal and/or streptococcal bacterial coverage are necessary.
- Add anaerobic coverage if anaerobic infection is likely (ie, with cat or human bites). If the diagnosis of tenosynovitis is definite, refer to hand specialist for urgent surgical incision and drainage.
Consultations
- Primary care or hand specialty outpatient referral for follow-up care of de Quervain tenosynovitis and volar flexor tenosynovitis
- Emergent medical or hand specialty consultation for suspected GC tenosynovitis for hospital admission and IV antibiotics
- Emergent hand specialty consultation for nongonococcal infectious tenosynovitis for hospital admission, IV antibiotics, and possible surgical drainage
Medication
The goals of therapy are to reduce pain and eradicate infection.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Most commonly used for relief of mild to moderate pain. Although effects of NSAIDs in treatment of pain tend to be patient specific, ibuprofen usually is the DOC for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam. NSAIDs are used primarily for de Quervain and volar flexor tenosynovitis.
Ibuprofen (Motrin, Advil, Ibuprin, Nuprin)
Usually DOC for treatment of mild to moderate pain if no contraindications exist.
Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which results in inhibition of prostaglandin synthesis.
Dosing
Adult
400 mg PO q4-6h, 600 mg PO q6h, or 800 mg PO q8h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 10-70 mg/kg/d PO divided tid/qid; start at lower end of dosing range and titrate upward; not to exceed 2.4 g/d
>12 years: Administer as in adults
Interactions
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and possibly toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Contraindications
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy
Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)
Used for relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which results in prostaglandin synthesis.
Dosing
Adult
250 mg PO q6-8h or 500 mg bid; not to exceed 1.25 g/d; may increase to 1.5 g/d for limited periods
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Interactions
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and possibly toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Contraindications
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Ceftriaxone (Rocephin)
Third-generation cephalosporin that has 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.
Used because of increasing prevalence of penicillinase producing N gonorrhoeae.
Dosing
Adult
1-2 g IV/IM qd or divided bid; not to exceed 4 g/d
Pediatric
<7 days: Not established
>7 days: 25-50 mg/kg/d IV; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV divided q12h; not to exceed 2 g/d
Interactions
Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; caution in breastfeeding women and those with allergy to penicillin
Spectinomycin (Trobicin)
Inhibits protein synthesis in bacterial cells. Site of action is 30S ribosomal subunit; structurally different from related aminoglycosides.
Used as alternative antimicrobial in treatment of urethral, endocervical, or rectal GC infections in patients who cannot take cephalosporins or fluoroquinolones.
Can be administered to pregnant women who are allergic to cephalosporins.
Dosing
Adult
2 g IM q12h
Pediatric
<45 kg and cannot tolerate ceftriaxone: 40 mg/kg/d IM divided q12h or once; not to exceed 2 g/dose
>45 kg and cannot tolerate ceftriaxone: Administer as in adults
Interactions
None reported
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Benzyl alcohol used as diluent associated with fatal gasping syndrome in infants; antibiotics may mask or delay symptoms of incubating syphilis; perform a serologic test for syphilis in all patients with gonorrhea at time of diagnosis followed by additional test after 3 mo; monitor clinical effectiveness to detect resistance by N gonorrhoeae
Ciprofloxacin (Cipro)
Bactericidal antibiotic that inhibits bacterial DNA synthesis and consequently growth by inhibiting DNA-gyrase in susceptible organisms.
Duration of treatment depends upon severity of infection. Continue treatment for at least 2 d after signs and symptoms of infection have disappeared. Usual treatment duration is 7-14 d.
Dosing
Adult
250-500 mg PO bid for 7-14 d
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Interactions
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Ampicillin and sulbactam (Unasyn)
Drug combination that uses beta-lactamase inhibitor with ampicillin; covers skin, enteric flora, and anaerobes.
Used for treatment of nongonococcal infectious tenosynovitis.
Coverage includes Staphylococcus species, Streptococcus species, and anaerobes.
Dosing
Adult
1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6-8h; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Pediatric
<3 months: Not established
3 months to 12 years: Ampicillin 100-200 mg/kg/d (150-300 mg Unasyn) IV divided q6h
>12 years: Administer as in adults; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Interactions
Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
Cefazolin (Ancef)
First-generation semisynthetic cephalosporin, which by binding to 1 or more of the penicillin-binding proteins arrests bacterial cell wall synthesis and inhibits bacterial growth; primarily active against skin flora, including S aureus. Typically, used alone for skin and skin-structure coverage.
Total daily dosages are the same for IV and IM administrations.
Used for suspected staphylococcal and/or streptococcal tenosynovitis (anaerobes not suspected).
Dosing
Adult
250 mg to 2 g IV/IM q6-12h depending on severity of infection; not to exceed 12 g/d
Pediatric
25-100 mg/kg/d IV/IM divided q6-8h depending on severity of infection; not to exceed 6 g/d
Interactions
Probenecid prolongs effect of cefazolin; coadministration with aminoglycosides may increase renal toxicity; may yield false-positive urine-dip test for glucose
Contraindications
Documented hypersensitivity
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Corticosteroids
These agents have both anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids have profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Dexamethasone acetate (Decadron, AK-Dex, Alba-Dex, Dexone)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Dosage varies with degree of inflammation and size of affected area.
Dosing
Adult
4-16 mg intralesionally (0.5-1) mL mixed with equal or double volume of 1% local anesthetic (ie, lidocaine)
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Interactions
Effects decrease with coadministration of barbiturates, phenytoin, and rifampin; decreases effect of salicylates and vaccines used for immunization
Contraindications
Documented hypersensitivity; active bacterial or fungal infection
Precautions
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Increases risk of multiple complications, including severe infections; monitor adrenal insufficiency when tapering drug; abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, PUD, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections are possible complications of glucocorticoid use
Methylprednisolone acetate (Solu-Medrol, Depo-Medrol, Medrol)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Use 0.5-1 mL (40 mg/mL) mixed with equal or double volume of 1% local anesthetic (ie, lidocaine).
Dosage varies with degree of inflammation and size of affected area.
Dosing
Adult
Tendon sheath inflammation: 4-30 mg intralesionally
Pediatric
Not established
Interactions
Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels of methylprednisolone; phenobarbital, phenytoin, and rifampin may decrease levels of methylprednisolone (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics
Contraindications
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hyperglycemia, edema, osteonecrosis, PUD, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use
Hydrocortisone acetate (Solu-Cortef, Cortef)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Use 0.5-1 mL (25 or 50 mg/mL) mixed with equal or double volume of 1% local anesthetic (ie, lidocaine).
Dosage varies with degree of inflammation and size of affected area.
Dosing
Adult
5-12.5 mg intralesionally
Pediatric
Not established
Interactions
Corticosteroid clearance may decrease with estrogens; may increase digitalis toxicity secondary to hypokalemia
Contraindications
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Precautions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hyperthyroidism, osteoporosis, peptic ulcer, cirrhosis, nonspecific ulcerative colitis, diabetes, and myasthenia gravis
Follow-up
Further Inpatient Care
- Hospitalization is required for gonococcal and other infectious tenosynovitis.
- Repetitive joint aspirations may be required if septic arthritis is associated with infectious tenosynovitis.
Transfer
- Unavailability of hospital beds, operative capability, or specialty consultation is reason to transfer the patient to another facility.
Complications
- Chronic disability/decreased range of motion
- Chronic pain
- Amputation can be a complication of advanced pyogenic flexor tenosynovitis.
Prognosis
- de Quervain tenosynovitis - Very good with conservative therapy
- Volar flexor tenosynovitis - Good with corticosteroid injection
- Gonococcal tenosynovitis
- Good with antibiotic therapy
- Destruction of tendon, cartilage, or bone rare with disseminated gonococcal infection
- Nongonococcal infectious tenosynovitis - Only fair, even with early surgical intervention and antibiotic therapy
Miscellaneous
Medicolegal Pitfalls
- Failure to consider gonococcal infection in sexually active patients with symptoms and signs of tendinitis and/or tenosynovitis
- Failure to diagnose and emergently refer patients with pyogenic flexor tenosynovitis to appropriate hand specialist for possible surgical drainage
References
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Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K. Treatment of de Quervain disease with triamcinolone injection with or without Nimesulide. J Bone Joint Surg Am. 2004;86-A:2700-06. [Medline].
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Nimigan AS, Ross DC, Gan BS. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil. Jan 2006;85(1):36-43. [Medline].
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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
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.
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Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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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
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