From the Guidelines
For tenosynovitis and mild AC joint widening from a month-old injury, I recommend a conservative management approach. This approach is based on the most recent and highest quality study available, which suggests that most soft-tissue injuries, including tenosynovitis, can undergo a period of conservative management before considering surgery 1. The goal of conservative management is to reduce inflammation, promote healing, and improve function.
Key Components of Conservative Management
- Rest and activity modification to avoid movements that aggravate symptoms
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for 7-10 days to reduce inflammation and pain
- Ice application for 15-20 minutes several times daily, especially after activity
- Gentle range-of-motion exercises after acute pain subsides, followed by gradual strengthening exercises focusing on rotator cuff and scapular muscles
- Consider physical therapy for 4-6 weeks to ensure proper rehabilitation
- A compression sleeve or kinesiology tape may provide support during recovery
Rationale for Conservative Management
The conservative approach is supported by studies that show most patients with overuse tendinopathies fully recover within three to six months with relative rest, icing, and eccentric strengthening exercises 1. Additionally, imaging studies such as plain radiography, ultrasonography, and MRI can be helpful in assessing the extent of the injury and guiding treatment 1.
Monitoring and Follow-up
If symptoms persist beyond 2-3 weeks of this regimen, it is essential to consult a healthcare provider as corticosteroid injections might be considered for persistent tenosynovitis. Regular follow-up appointments will help monitor progress and adjust the treatment plan as needed. By prioritizing conservative management, patients can reduce the risk of further injury and promote natural healing processes, ultimately improving morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: ... Acute nonspecific tenosynovitis
Rheumatic Disorders
The recommended management for minimal tenosynovitis and mild acromioclavicular (AC) joint widening after a traumatic injury one month prior may include short-term administration of prednisone as an adjunctive therapy to tide the patient over the acute episode or exacerbation of tenosynovitis 2. However, the use of prednisone for AC joint widening is not directly mentioned in the label.
- Key considerations:
- The patient's condition is described as minimal tenosynovitis and mild AC joint widening, which may not require aggressive treatment.
- The FDA label does not provide explicit guidance on the management of AC joint widening.
- The decision to use prednisone should be made on a case-by-case basis, taking into account the patient's overall clinical picture and medical history.
From the Research
Management of Minimal Tenosynovitis and Mild Acromioclavicular Joint Widening
- The recommended management for minimal tenosynovitis and mild acromioclavicular joint widening after a traumatic injury is not directly addressed in the provided studies.
- However, the management of tenosynovitis in general can be considered:
- Conservative treatment, such as physical modalities, can be effective in relieving pain and improving motion in the acute phase 3.
- Corticosteroid injections can be used to treat stenosing tenosynovitis, with multiple injections being safe and effective in increasing the overall remission rate without increasing morbidity 4.
- Surgical treatment, such as tenosynovectomy, can be considered for recalcitrant cases or when conservative treatment fails 5, 6.
- For acromioclavicular joint widening, there is no specific guidance provided in the studies.
- It is essential to note that the management of tenosynovitis and acromioclavicular joint widening should be individualized and based on the specific condition and patient factors, as emphasized in the study on physical modalities for conservative treatment of wrist and hand's tenosynovitis 3.
Considerations for Treatment
- The duration of symptoms can impact the effectiveness of treatment, with symptoms lasting 3 months or less being more likely to respond to nonoperative therapy 4.
- The use of ultrasound and other imaging modalities can assist in the diagnosis and management of tenosynovitis 7.
- Surgical treatment should be considered carefully, taking into account the specific condition and potential complications, such as tendon rupture or infection 5, 4.