From the Guidelines
The initial management for stenosing tenosynovitis should focus on conservative measures, including rest, activity modification, and potentially guiding therapeutic injections with ultrasound (US) as needed, as US is useful for examining extra-articular soft tissues and guiding injections 1. When managing stenosing tenosynovitis, it's crucial to consider the role of imaging in diagnosis and treatment.
- Ultrasound (US) of the wrist is beneficial for examining extra-articular soft tissues, such as suspected ganglion cysts, and for diagnosing abnormalities of the flexor and extensor tendons and tendon sheaths 1.
- US can also be used to guide therapeutic intra-articular and other soft-tissue injections, which may be necessary for managing stenosing tenosynovitis 1. Key aspects of initial management include:
- Rest and activity modification to reduce repetitive movements that aggravate the condition
- Potential use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, though this is not directly mentioned in the provided evidence
- The use of US to guide injections or diagnose the condition, as it provides valuable information on the tendon and its sheath, which can influence treatment decisions 1. Given the information from the study on the usefulness of US in managing conditions like stenosing tenosynovitis, the most appropriate initial step would involve assessing the condition with US to determine the best course of action, which may include guided injections or other conservative measures 1.
From the Research
Initial Management for Stenosing Tenosynovitis
The initial management for stenosing tenosynovitis, also known as trigger finger, typically involves conservative approaches before considering surgical options. Some key points to consider include:
- Conservative treatment can effectively relieve pain and improve wrist motion in the acute phase, although it may have little difference on long-term effect and can lead to recurrence 2.
- The use of anti-inflammatory drugs and corticosteroids is a common initial management strategy for stenosing tenosynovitis 3, 4, 5.
- Corticosteroid injections can be effective in treating trigger digits, with studies showing that up to three injections can be safe and effective without increasing morbidity 5.
- Patient-related factors, such as osteoarthritis in the fingers and a longer duration of symptoms, may be protective against eventual progression to surgery 6.
Treatment Options
Some treatment options for stenosing tenosynovitis include:
- Oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications 4.
- Splintage 4.
- Steroid injection, which can be effective in treating trigger digits, with quicker relief compared to NSAID injections 4.
- Percutaneous and open release of the A1 pulley, which may be considered if conservative treatment is unsuccessful 3, 4.
- The Eastwood technique, a minimally invasive surgical approach with a shorter recovery time, which can be effective in treating trigger finger 3.
Considerations
When considering the initial management for stenosing tenosynovitis, it is essential to:
- Assess the patient's overall health and medical history, including the presence of chronic diseases such as diabetes 3, 4, 6.
- Evaluate the severity of symptoms and the impact on daily activities 2.
- Discuss the potential risks and benefits of different treatment options with the patient, including the possibility of recurrence and the need for further intervention 6.