The cardinal feature of flexor tenosynovitis is pain along the tendon sheath, with associated swelling around the joint adjacent. The finger is usually flexed slightly and there is pain on passive movement along the tendon.

In infectious tenosynovitis there may be associated fever. In gonococcal tenosynovitis, not associated penile or vaginal discharge occurs and the wrist, hand and sometimes the ankle are the most common sites. In traumatic cases the site of inoculation may be overtly infected, but many times there is no obvious wound [7].

• Pain

  Ankle pain is a frequent chief complaint, and although peroneal tendon disorders are relatively uncommon, if treated inappropriately they may cause persistent pain and dysfunction. [ncbi.nlm.nih.gov]

  Anti-inflammatory medications may help decrease the pain to some degree, but they in no way reverse the dynamic that got you to a painful place. Pain Relief Cream, on a good day, -may- decrease pain a little. [tendonitisexpert.com]

  Painful thumb and/or wrist movements. Squeaking/clicking of the painful area during movement. What can I do? Rest – refrain from doing the repetitive actions which cause the pain. Protect the thumb by wearing a splint. [tbihealth.co.nz]

• Swelling

  In the previous year, she underwent surgery at a local hospital for the swelling in her right metacarpophalangeal joint, the information of which was not known precisely, but the swelling subsided in due course after an operation. [ncbi.nlm.nih.gov]

  From Wikidata Jump to navigation Jump to search inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness Inflammation of tendon sheath tendon sheathitis Tenosynovitides [wikidata.org]

  Joint: The symptoms are typically pain or swelling often together but one may predominate. They tend to give stiffness and reduced function. Tendon sheath: The symptoms again are typically pain or swelling often together but one may predominate. [handtoelbow.com]

  The word "tendinosis" refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. [orthoinfo.aaos.org]

  Non-surgical therapy includes avoiding activities that increase pain and swelling, applying ice, using a splint to support and immobilize the hand, and physical therapy. Anti-inflammatory drugs are helpful in relieving pain and swelling. [orthonw.com]

• Finger Pain

  We report a case of a 65-year-old woman receiving chronic anticoagulation who presented with acute onset of severe long finger pain and was supratherapeutic on Coumadin. Her examination was consistent with early septic flexor tenosynovitis. [ncbi.nlm.nih.gov]

  Fusiform swelling (sausage finger) Pain with passive extension *this is the earliest finding It is usually caused by some sort of inoculation, but this can be something very small and the patient may not be aware that he/she had ever been injured (can [sketchymedicine.com]

  For this test your doctor will ask you to make a fist with your fingers covering the thumb and bend the wrist towards the little finger. Pain during this movement will confirm the condition. [orthonw.com]

• Dog Bite

  A 4-year-old girl presented to the emergency department for evaluation of finger swelling after a dog bite. [ncbi.nlm.nih.gov]

  Infecting organisms include the following Staphylococcus aureus and Streptococcus [most common etiologic agents], Pasteurella multocida [mostly after a cat bite], Eikenella corrodens, anaerobes, Capnocytophaga canimorsus [ dog bites], Mycobacterium [bacteriae [boneandspine.com]

  […] be isolated after dog bites Miscellaneous gram-negative organisms Mycobacterium tuberculosis Other Mycobacterium species Clostridium difficile - Case reported following antibiotic treatment for ear infection in a child [14] Pseudomonas aeruginosa Listeria [emedicine.com]

• Localized Pain

  The most common clinical presentation was subacute localized pain, swelling, and erythema consistent with tenosynovitis. The diagnosis was delayed by a median of 6 months (range, 0-48 mo). [ncbi.nlm.nih.gov]

  History and Symptoms of de Quervain’s Tenosynovitis De Quervain’s tenosynovitis can have a gradual or sudden onset of localized pain or tenderness over the thumb side of the wrist which is most noticeable with thumb and wrist motion. [healthfitchiro.com]

• Wrist Pain

  DeQuervain's tenosynovitis is a common cause of radial-sided wrist pain. Symptoms result from a narrow first dorsal compartment and associated tendinosis of the enclosed extensor pollicis brevis and/or abductor pollicis longus (APL). [ncbi.nlm.nih.gov]

  […] heavy objects Chronic illnesses such as rheumatoid arthritis and diabetes Pregnancy Symptoms of De Quervain Tenosynovitis Common signs and symptoms of de Quervain tenosynovitis include: Wrist pain on the thumb side Thumb and wrist pain with twisting [uofmhealth.org]

  […] deviation of the wrist with the fist closed over the flexed thumb illicits pain over the dorsoradial aspect of the wrist. [radsource.us]

  This can lead to altered biomechanics of the wrist accompanied by pain. [physio-pedia.com]

• Joint Tenderness

  Symptoms of tenosynovitis can include: Difficulty moving a joint and pain Swelling in the area of the affected joint Tenderness or pain around a joint Redness running along the length of the tendon The most common type of tenosynovitis is de Quervain’ [abilityrehabilitation.com]

  If you develop this condition, you may have the following symptoms: joint stiffness, making it difficult to move joint swelling joint pain joint tenderness redness of the skin that overlies the tendon in question Some people may develop a fever. [healthline.com]

• Tendon Disorder

  Peroneal tendon disorders, including the tendon sheath inflammatory condition tenosynovitis, are a major cause of chronic lateral ankle pain. [ncbi.nlm.nih.gov]

  Some people may be hereditary predisposed to tendon disorders. Symptoms of Tenosynovitis and Tenovaginitis The symptoms appear as: Pain which is present at rest, but sharply exacerbated by the use of the tendon. Narrowing of the tendon sheath. [musclesandjoints.com]

  [abstract] Rees JD, Wilson AM, Wolman RL; Current concepts in the management of tendon disorders. Rheumatology (Oxford). 2006 May;45(5):508-21. Epub 2006 Feb 20. [orthohyd.com]

• Arthralgia

  Patients who progressed to RA had experienced arthralgia and morning stiffness more frequently than patients who did not develop RA, possibly because all patients who developed RA had tenosyovitis in more than 2 areas. [rheumatologyadvisor.com]

  Local inflammation and fibrosis may affect the dermis, connective tissue, muscle and bone, giving rise to arthralgias, tenosynovitis, contracture, undergrowth of the limb, and nodulosis. [academic.oup.com]

  […] development of clinical arthritis and erosions.16 The notion that tenosynovitis is a very early feature of RA is further supported by the consistent finding that tenosynovitis is an independent predictor for developing RA in patients with clinically suspect arthralgia [ard.bmj.com]

Laboratory diagnosis

• The diagnosis may be made on clinical grounds. If there is associated discharge then a swab for gram stain and culture should be sent. Aspiration may also be required. The samples should be sent for exam for the usual bacteria including fungal causes and mycobacterium. 
• If there is an associated joint effusion it should be aspirated and sent for white cell count, glucose levels, gram stain and cultures. 
• Other tests like a complete cell count should be done if an infectious cause is suspected. Other tests such as rheumatoid factor and other autoimmune markers should be asked for if there is a suspicion. 
• A biopsy should be done if the cause is not found to rule out causes such as mycobacterium which has a protracted culture time.

Imaging

Plain radiographs should be done to rule out bone involvement. Magnetic resonance imaging (MRI) is an accurate modality for diagnosis.

• Vibrio Vulnificus

  vulnificus [stings from sea creatures], Neisseria gonorrhoeae [also called gonococcal tenosynovitis] In some patients, the cause of the disease cannot be determined. [boneandspine.com]

  vulnificus - Stings from marine life Mycobacterium Several Mycobacterium species have been cultured following animal contacts or simple lacerations/puncture wounds, including the following: M terrae M marinum M intracellulare M avium M kansasii M asiatica [emedicine.com]

• Capnocytophaga Canimorsus

  Infecting organisms include the following Staphylococcus aureus and Streptococcus [most common etiologic agents], Pasteurella multocida [mostly after a cat bite], Eikenella corrodens, anaerobes, Capnocytophaga canimorsus [ dog bites], Mycobacterium [bacteriae [boneandspine.com]

  canimorsus - Can infrequently be isolated after dog bites Miscellaneous gram-negative organisms Mycobacterium tuberculosis Other Mycobacterium species Clostridium difficile - Case reported following antibiotic treatment for ear infection in a child [ [emedicine.com]

• Capnocytophaga

  Infecting organisms include the following Staphylococcus aureus and Streptococcus [most common etiologic agents], Pasteurella multocida [mostly after a cat bite], Eikenella corrodens, anaerobes, Capnocytophaga canimorsus [ dog bites], Mycobacterium [bacteriae [boneandspine.com]

  […] develops within 24 hours after a cat bite Eikenella corrodens - Higher incidence with human bite wounds ( Staphylococcus and Streptococcus species still most common cause) Anaerobes - Bacteroides and Fusobacterium species most common Haemophilus species Capnocytophaga [emedicine.com]

• Ischemic Changes

  Patients in Group II demonstrated the presence of subcutaneous purulence but no ischemic changes; these patients had an amputation rate of 8% and a mean 72% recovery of total active motion. [doi.org]

  The tendon also may be weakened by direct invasion of the rheumatoid tenosynovium or by ischemic necrosis secondary to surrounding pressures and diminished vascular supply. [emedicine.com]

Usually the treatment includes surgery and antibiotics. For stage 1, irrigation and drainage are necessary. Stage 2 or 3 may be treated with surgical debridement and irrigation, amputation if necessary. Depending on the results of fluid and gram stain, antibiotics should be started promptly, a drug that covers Staphylococcus aureus and streptococci will be advisable; this includes ciprofloxacin or a third generation cephalosporin. Vancomycin may be used if a methicillin-resistant species is suspected.

The inflammatory causes respond to anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, but an infectious etiology must be ruled out. The involved joint should be immobilised [8] [9] [10].

Infectious causes who present early and get treatment, will have an excellent outcome. Those who have chronic infection and disseminated disease will have a poorer outcome. Poor outcomes include loss of range of movement and tendon rupture. Other comorbidities such as a decreased immunity or diabetes are a poor prognostic markers, and tend to have multiple tendons and joints involved.

Most of the time the cause is not known, but the etiology may be divided into infectious and non-infectious.

Infectious 

• Streptococcus and Staphylococcus aureus (most common)
• Mycobacterium tuberculosis
• Pseudomonas aeruginosa
• Nesseria gonorrhoeae (secondary infection from the genital tract, rectum or pharynx) 

Non-infectious

• Rheumatoid arthritis 
• Systemic lupus erythematosus
• Diabetes mellitus
• Ankylosing spondylitis
• Overuse 
• Sarcoidosis [1] [2] [3]

There is very little data on the incidence of this condition, but it has been noted that up to one third of the patients are diabetic. Gonococcal tenosynovitis is usually common in the young sexually active individuals. Also this condition is very common in rheumatoid arthritis sufferers [4].

Infectious

The infection occurs by various mechanisms: Trauma with inoculation into the tendon, contagious spread from infected adjacent soft tissues, and through the blood stream. Most infections will occur acutely after inoculation except for a few organisms such as mycobacterium which may have a subacute presentation. Usually animal bites and lacerations are associated with polymicrobial infections including gram negative bacteria. Different forms of trauma have associated bacteria, such as puncture wounds form thorns and trees may result in fungal infections, while animal bites may give rise to polymicrobial infections with Pasteurella multocida and others [5]. Infections to tendon from other sites via hematogenous spread, is common for Mycobacterium and Nesseria gonorrhoeae.

The infections usually progresses in stages:

• Stage 1: Distension of the tendon sheath with an exudate.
• Stage 2: Distension of the tendon sheath with an purulent fluid.
• Stage 3: Septic necrosis [6]

Non-Infectious

This occurs due to a different mechanism. There is fibrous proliferation, until there is impingement and constriction of movement.

Prompt treatment of the underlying cause is the best mode to avoid complications. Since most cases of infectious causes are related to trauma, necessary protective gear and equipment should be used at potentially dangerous sites. For gonococcal infections, protected intercourse is the best prevention.

The most common sites for tenosynovitis are the shoulder, the tendon of the long head of the biceps, popliteus tendon, Achilles tendon and the abductor pollicis longus. It is thought that continuous microtears and degenerative changes are the most common cause of the condition.

• Definition: Tenosynovitis is a disease that affects the tendons in your body. Tendons are the strong band that connect your muscles to your bones to allow movement. The most common places are the hands and shoulder.
• Cause: There are two main causes, infection and overuse. Other causes may be due to underlying diseases that may affect your tendons such as rheumatoid arthritis. Infections are caused by direct inoculation via trauma. 
• Symptoms: There will be pain around the site of the diseased tendon, with pain on movement. There also may be a discharge if there is associated trauma like from an animal bite.
• Diagnosis: Usually diagnosis is clinical but extra tests will be required to find out the cause especially if the cause if infectious. The doctor will take sample form the infected site for tests. The may be other blood tests to find out other underlying cause. Your doctor may order X-rays to make sure the bone is not infected. They may also order a magnetic resonance image (MRI) of the affected site 
• Treatment: The treatment for infected tendons is urgent surgery and antibiotics to kill the infection. The type of surgery and extent will depend how bad the infection is. For non-infectious causes the doctor will prescribe anti-inflammatory drugs or steroids to help reduce the pain and discomfort. You will also be told to rest the joint and a sling may be ordered for you.

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10. Kanavel, AB. Infections of the hand: a guide to the surgical treatment of acute and chronic suppurative processes of the fingers, hand, and forearm. Lea and Febiger, Philadelphia, 1912.