From the Guidelines
For suspected tenosynovitis, the most appropriate initial step is to order laboratory tests including complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood cultures if infection is suspected, and to consider imaging studies such as MRI or ultrasound of the affected area, as recommended by the American College of Radiology 1. The choice of imaging modality depends on the clinical presentation and the availability of local expertise.
- MRI and ultrasound are considered equivalent in the evaluation of suspected bursitis or long head of biceps tenosynovitis, with a rating of 9 on the appropriateness criteria scale 1.
- Treatment depends on the underlying cause, with infectious tenosynovitis requiring empiric antibiotic therapy and possible surgical drainage, and non-infectious inflammatory tenosynovitis managed with rest, immobilization, NSAIDs, and corticosteroid injections. Some key points to consider in the management of tenosynovitis include:
- Rest and immobilization to reduce mechanical irritation and allow the tendon sheath to heal
- Use of NSAIDs such as naproxen or ibuprofen for pain relief and to reduce inflammation
- Consideration of corticosteroid injections for localized symptoms
- Physical therapy to promote healing and prevent recurrence
- Occupational modifications and ergonomic adjustments to prevent further injury. It is also important to note that the natural history of overuse tendinopathies is gradually increasing load-related localized pain, and most patients fully recover within three to six months with relative rest, icing, and eccentric strengthening exercises 1.
From the Research
Labs for Potential Tenosynovitis
- Complete Blood Count (CBC) to check for signs of infection or inflammation 2, 3
- Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (CRP) to assess the level of inflammation 2, 3
- Blood cultures to identify the causative organism in cases of suspected bacterial tenosynovitis 2, 3
- Imaging studies such as X-rays, ultrasound, or MRI to evaluate the extent of tendon and surrounding tissue involvement 2, 3
Treatment for Potential Tenosynovitis
- Antibiotic therapy, such as intravenous or oral antibiotics, to treat bacterial infections 2, 3, 4
- Immobilization and elevation of the affected limb to reduce inflammation and promote healing 4
- Pain management with analgesics or anti-inflammatory medications as needed 2, 3, 4
- Hand therapy to maintain range of motion and prevent stiffness 4
- Surgical intervention may be necessary in severe cases or when conservative treatment fails 2, 3
- Avoiding certain medications that may exacerbate tendinopathy, such as fluoroquinolones or cephalosporins 5