Hospital Stay for Tenosynovitis
Most cases of tenosynovitis do not require hospitalization at all and are managed entirely as outpatients. However, when hospitalization is necessary for infectious (septic) tenosynovitis requiring surgical debridement, the typical stay is brief, with most patients discharged within days after initial surgical intervention.
Outpatient Management (Most Common)
The vast majority of tenosynovitis cases are non-infectious conditions that never require hospital admission 1, 2:
- Stenosing tenosynovitis (trigger finger, de Quervain's) is managed with splinting, anti-inflammatory medications, corticosteroid injections, and physical therapy 2, 3
- Conservative treatment duration typically spans 6 weeks to 3 months before considering surgical release 4
- Even when surgery is performed for stenosing tenosynovitis, it is done as an outpatient procedure with same-day discharge 3
Infectious Tenosynovitis Requiring Hospitalization
When septic tenosynovitis necessitates admission, the hospital course is relatively short 1, 5:
Initial Hospitalization Duration
- Patients receive initial surgical debridement followed by intravenous antibiotics 1, 5
- Once clinically improved, transition to oral antibiotics occurs, allowing discharge 1
- The evidence does not specify exact length of stay, but the treatment paradigm suggests discharge within 2-5 days after initial debridement once IV-to-oral antibiotic transition criteria are met 1
Total Antibiotic Course
- Total antibiotic duration is 2-3 weeks for uncomplicated infectious tenosynovitis 1
- In one study, the median antibiotic duration was 15 days (range 7-82 days), though this includes both inpatient and outpatient therapy 5
Risk Factors for Prolonged Stay or Readmission
Presence of subcutaneous abscess significantly increases the likelihood of requiring additional surgical debridement (odds ratio 4.6), which would extend total hospital time 5:
- 18 of 126 patients (14%) required at least one additional surgical intervention beyond the initial debridement 5
- Patients requiring multiple debridements would have longer cumulative hospital stays, though specific durations are not reported 5
Clinical Pitfalls
Do not assume all hand infections can be managed outpatient - infectious tenosynovitis requires prompt surgical consultation and typically necessitates initial hospitalization for IV antibiotics and surgical drainage 1, 5. The key distinguishing features requiring admission include:
- Systemic signs of toxicity 1
- Purulent drainage or abscess formation 5
- Failure of outpatient management with progressive infection 1
Outpatient reassessment within 24 hours is mandatory for those initially managed without admission, as progression despite appropriate therapy requires hospitalization 1, 6.