Infectious Disease Compendium

Tenosynovitis

Diagnosis

Infections of the tendon sheath.

Epidemiologic Risks

Trauma, sex (for some the same thing).

Microbiology

Any penetrating trauma can lead to infection. The nature of the trauma leads to consideration of microbiology. An animal bite is different than a knife. (:Unless the knife was cleaning a cats mouth, I suppose:) S. aureus and streptococci are most common; Candida, nontuberculous mycobacteria and Sporothrix schenckii, after injection from organic material (the rose thorn is a risk, but over rated, for Sporothrix; any woody material has Sporothrix, except Woody Harrelson).

Disseminated N. gonorrhoeae can present as a migratory tenosynovitis.

Empiric Therapy

Depends on what caused the trauma. Acute is usually nafcillin / oxacillin OR cefazolin OR vancomycin PLUS/MINUS third generation cephalosporins OR quinolone. Usually treat with IV for 2 (streptococcal) to 3 (staphylococcal) weeks.

Do not treat with po.

Pearls

Have a very low threshold for surgery, a little inflammation in a tendon sheath can lead to beaucoup problems with movement.

Rants

Treating without debridement is usually destined to failure, disability and a lawsuit.

ICD9 Codes (Soon to be supplanted by ICD10)

Tenosynovitis 727.00; ankle 727.06; elbow 727.09; finger 727.05; foot 727.06; gonococcal 098.51; hand 727.05; hip 727.09; knee 727.09; radial styloid 727.04; shoulder 726.10; spine 720.1; supraspinatus 726.10; toe 727.06; wrist 727.05.