From the Guidelines
Treatment of flexor tenosynovitis requires prompt intervention with antibiotics and possible surgical drainage to prevent morbidity and mortality, and to improve quality of life. The provided evidence does not directly address flexor tenosynovitis treatment, but general principles of tendon injury management can be applied 1. Initial management includes immobilization of the affected digit, elevation of the hand, and empiric antibiotic therapy targeting common pathogens like Staphylococcus aureus.
- For mild to moderate cases, oral antibiotics such as dicloxacillin 500 mg four times daily, cephalexin 500 mg four times daily, or clindamycin 300-450 mg three times daily for 7-10 days may be sufficient.
- For severe infections or diabetic patients, intravenous antibiotics like cefazolin 1-2 g every 8 hours or vancomycin 15-20 mg/kg every 12 hours should be considered. Surgical drainage is indicated for patients who don't respond to antibiotics within 24-48 hours, have purulent collections, or show signs of compartment syndrome.
- The procedure involves careful incision along the affected tendon sheath to evacuate purulent material while preserving the pulley system. Following treatment, early mobilization with hand therapy is crucial to prevent adhesions and restore function.
- Flexor tenosynovitis requires aggressive treatment because the closed tendon sheath system can lead to rapid spread of infection, vascular compromise of the tendon, and permanent functional impairment if not addressed promptly. It is essential to note that rest, icing, and eccentric strengthening exercises are beneficial for tendon healing and pain relief, as mentioned in the context of overuse tendon problems 1. However, these measures may not be sufficient for flexor tenosynovitis, which requires prompt antibiotic therapy and possible surgical intervention to prevent serious complications.
From the Research
Treatment Options for Flexor Tenosynovitis
- Surgical intervention with varied use of antibiotics has been widely described in the treatment of pyogenic flexor tenosynovitis, with studies showing improved range of motion outcomes with the use of antibiotics 2
- Non-surgical management with antibiotics, immobilization, and elevation has also been shown to be effective in some cases, with a mean time to resolution of infective symptoms of 5 days 3
- Corticosteroid injections have been used to treat flexor tenosynovitis, with a prospective study showing that symptoms and signs resolved in 61% of patients after a single injection 4
- The use of a closed-catheter irrigation system with antibiotic and pain control has been reported to improve rehabilitation in outpatient management of flexor tenosynovitis 5
Comparison of Treatment Outcomes
- A systematic review of treatment for pyogenic flexor tenosynovitis found that there is insufficient evidence to support one intervention over another in terms of hospital stay or patient-reported outcomes 6
- The review found that most studies were of poor quality, and that future experimental studies are needed to compare surgical techniques and non-operative management 6
- The use of antibiotics as a component of therapy has been shown to result in improved range of motion outcomes, as well as the use of catheter irrigation rather than open washout 2