From the Research
Infectious flexor tenosynovitis requires prompt treatment with a combination of antibiotics and surgical intervention, with the most recent and highest quality study suggesting that surgical drainage and irrigation can be effectively performed via either open drainage or closed-catheter irrigation 1. The initial management should include hospital admission, elevation of the affected hand, and immediate empiric intravenous antibiotics such as vancomycin 15-20 mg/kg every 12 hours plus either piperacillin-tazobactam 3.375 g every 6 hours or ceftriaxone 1-2 g daily with metronidazole 500 mg every 8 hours to cover common pathogens including Staphylococcus aureus, Streptococcus species, and gram-negative organisms. Some key points to consider in the treatment of infectious flexor tenosynovitis include:
- The use of antibiotics as a component of therapy has been shown to result in improved range of motion outcomes 2
- Catheter irrigation rather than open washout has also been shown to result in improved outcomes 2
- Factors that can lead to poor outcomes include Staphylococcus aureus infection, prolonged time to receiving antibiotics, and smoking 1
- Early treatment and systemic antibiotic use are essential in the management of pyogenic flexor tenosynovitis 2 Following surgery, continue antibiotics for 7-14 days, adjusting based on culture results. Initiate early protected range of motion exercises within 24-48 hours post-surgery to prevent adhesions. This aggressive approach is necessary because the closed tendon sheath environment allows rapid bacterial proliferation with potential for tissue necrosis, adhesion formation, and permanent functional impairment if treatment is delayed. Close monitoring for improvement is essential, with consideration for repeat surgical intervention if clinical response is inadequate within 24-48 hours. It is also important to note that while some studies have suggested that non-surgical management with antibiotics, immobilization, and elevation may be effective in some cases of early infectious flexor tenosynovitis 3, the majority of the evidence supports the use of surgical intervention in the treatment of this condition.