What is the treatment for tenosynovitis?

From the Guidelines

Treatment for tenosynovitis should prioritize relative rest, reduced activity, and cryotherapy to prevent further damage and promote healing and pain relief. The management of tenosynovitis involves a multifaceted approach, including:

• Relative rest and reduced activity to prevent further damage and promote healing and pain relief, as recommended by 1
• Cryotherapy, such as repeated applications of melting ice water through a wet towel for 10-minute periods, to provide acute relief of tendinopathy pain, as supported by 1
• Eccentric strengthening as an effective treatment to reverse degenerative changes, as evidenced by 1
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, although they have no effect on long-term outcomes, as noted in 1
• Topical NSAIDs as an alternative with potentially fewer systemic side effects, as mentioned in 1
• Locally injected corticosteroids for acute-phase pain relief, but with no alteration in long-term outcomes, as reported in 1
• Consideration of surgical intervention in carefully selected patients who have failed three to six months of conservative therapy, as suggested by 1

It is essential to tailor the treatment approach to the individual patient's needs and preferences, taking into account the severity of the condition, the presence of any underlying health issues, and the patient's lifestyle and goals. By prioritizing a combination of rest, cryotherapy, and physical therapy, patients with tenosynovitis can effectively manage their symptoms and promote recovery.

From the FDA Drug Label

For relief of the signs and symptoms of tendonitis The treatment for tenosynovitis is naproxen.

• The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
• The initial total daily dose should not exceed 1250 mg of naproxen.
• Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2. Naproxen is indicated for the relief of the signs and symptoms of tendonitis 2.

From the Research

Treatment for Tenosynovitis

• The treatment for tenosynovitis is not directly mentioned in the provided studies, but we can look at the treatment for similar conditions such as tendinitis and tendinosis for guidance 3.
• Conservative management of tendinitis consists of rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the biceps tendon sheath 3.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but evidence for this treatment is lacking, and little is known regarding effects of NSAIDs on human tendinopathic tendon 4.
• The use of NSAIDs may have adverse effects on various organs, including gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary complications 5.
• Rest, ice, compression, and elevation (RICE) is an established combination to prevent swelling, and the addition of negative pressure therapy (RICE+) may stimulate lymphatic flow and reduce postoperative swelling 6.

Medication and Therapy

• Local anesthetic injections into the biceps tendon sheath may be therapeutic and diagnostic for biceps tendinitis 3.
• Corticosteroid injections into the biceps tendon sheath may be used as part of conservative management for tendinitis 3.
• NSAIDs, such as ibuprofen, may be used to treat tendinopathy, but their effectiveness and potential side effects should be carefully considered 4, 5.

Additional Considerations

• Surgery should be considered if conservative measures fail after three months, or if there is severe damage to the biceps tendon 3.
• The treatment for tenosynovitis may vary depending on the specific condition and individual patient, and further research is needed to determine the most effective treatment options.