What is the treatment for tenosynovitis?

From the Guidelines

Tenosynovitis treatment should initially focus on conservative measures, including relative rest, icing, and eccentric strengthening exercises, as most patients fully recover within three to six months with these methods 1. When considering treatment options for tenosynovitis, it's essential to prioritize approaches that minimize morbidity, mortality, and improve quality of life. The primary goal is to reduce inflammation and promote healing of the tendon sheath.

Conservative Management

• Relative rest of the affected area to avoid exacerbating the condition
• Icing to reduce pain and inflammation
• Eccentric strengthening exercises to promote tendon healing and strength
• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for acute pain relief, although their long-term use should be cautious due to potential side effects 1

Diagnostic Approaches

For cases where the diagnosis is unclear, imaging studies such as plain radiography, ultrasonography, or magnetic resonance imaging (MRI) can be helpful 1. MRI, in particular, is useful for diagnosing infectious and noninfectious tenosynovitis, especially in the wrist compartments 1.

Advanced Treatment Options

• Corticosteroid injections can relieve pain but should be used with caution due to potential side effects 1
• Surgery is an effective treatment option but should be reserved for patients who have failed conservative therapy 1

Key Considerations

• Most patients with overuse tendinopathies, including tenosynovitis, recover fully within three to six months with appropriate conservative management 1
• Accurate diagnosis is crucial and involves recognizing historical features, anatomy, and useful physical examination maneuvers for common tendon problems 1

From the FDA Drug Label

For relief of the signs and symptoms of tendonitis 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 treatment for tenosynovitis is naproxen. The recommended dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.

• The initial total daily dose should not exceed 1250 mg of naproxen.
• Thereafter, the total daily dose should not exceed 1000 mg of naproxen. Naproxen is indicated for the relief of the signs and symptoms of tendonitis 2.

From the Research

Treatment Options for Tenosynovitis

• Corticosteroid injections are an effective treatment for tenosynovitis, with a success rate of nearly 90% in some cases 3
• Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to treat tenosynovitis, but their use should be cautious and situation-specific, with consideration of potential side effects 4
• Eccentric exercises have been shown to be an effective treatment for tendinopathy, including tenosynovitis, with consistent evidence across systematic reviews 5
• Other treatment options, such as extracorporeal shockwave therapy, low-level laser therapy, and platelet-rich plasma injections, may also be effective, but the evidence is less consistent 5
• Surgical options, such as minimally invasive procedures, may be considered in severe cases, but are generally less effective than conservative treatments 5

Considerations for Treatment

• The use of NSAIDs should be prioritized with dose and duration minimization, and combined with simple principles of protection, rest, ice, compression, elevation (PRICE) 4
• Corticosteroid injections can be effective in the short-term, but may be ineffective or even contraindicated for long-term use 5
• The treatment of tenosynovitis should be individualized, taking into account the specific location and severity of the condition, as well as the patient's overall health and medical history 6