From the Guidelines
The treatment for hand tenosynovitis after a traumatic knife injury should prioritize immobilization, elevation, and the administration of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain, with consideration for antibiotic therapy if infection is suspected, as evidenced by 1. The initial management involves immobilizing the affected hand with a splint or brace to minimize movement and allow the inflamed tendon sheath to heal. NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 7-14 days can help reduce inflammation and pain. Elevation of the hand above heart level and application of ice packs for 15-20 minutes several times daily during the first 48-72 hours can further reduce swelling. Key considerations in the treatment plan include:
- Immobilization to reduce movement and stress on the injured tendon sheath
- Use of NSAIDs for pain and inflammation management
- Elevation and ice application to reduce swelling
- Potential use of antibiotics such as cephalexin or amoxicillin-clavulanate if there's evidence of infection, as suggested by 1
- Physical therapy to restore range of motion and strength once acute inflammation subsides, typically after 1-2 weeks
- Surgical intervention may be necessary in cases of significant tendon sheath damage or lack of improvement with conservative treatment after 4-6 weeks, highlighting the importance of close monitoring and adjustment of the treatment plan as needed, based on the principles outlined in 1.
From the Research
Treatment for Hand Tenosynovitis after Traumatic Injury from a Knife
- The treatment for hand tenosynovitis after a traumatic injury from a knife typically involves a combination of antibiotic therapy and surgical intervention 2, 3, 4, 5.
- Antibiotic therapy is crucial in treating infectious tenosynovitis, and the choice of antibiotic depends on the causative organism 2, 3, 4, 5.
- In cases where the infection is caused by a specific bacterium, such as Erysipelothrix rhusiopathiae or Neisseria gonorrhoeae, targeted antibiotic therapy is essential 2, 3.
- Surgical intervention, including debridement and irrigation of the tendon sheath, may be necessary to remove infected tissue and promote healing 2, 3.
- The duration of antibiotic therapy can vary, but studies have shown that shorter courses of treatment (2-5 days) can be effective in preventing infection in contaminated traumatic wounds 4, 5.
Antibiotic Therapy Options
- Cephalexin is a commonly used antibiotic for treating skin and soft tissue infections, including tenosynovitis 6, 4, 5.
- Retapamulin is a topical antibiotic that has been shown to be effective in treating secondarily infected traumatic lesions of the skin 5.
- Other antibiotics, such as those effective against Neisseria gonorrhoeae, may be necessary in cases where the infection is caused by this bacterium 3.