Infectious Tenosynovitis Research Articles

Cases of Early Infectious Flexor Tenosynovitis Treated Non-Surgically With Antibiotics, Immobilization, and Elevation.

Early infectious flexor tenosynovitis has been treated with urgent surgery by most surgeons since Bunnell wrote the first textbook of hand surgery in 1945. Some surgeons have good experience with non-surgical management of early presenting disease in some cases. This retrospective chart review included 12 inpatients with early infectious flexor synovitis who received conservative treatment with antibiotics, immobilization, and elevation without surgical drainage. The mean time to resolution of infective symptoms for the 12 patients was 5 days (range: 2-11 days) for those receiving conservative management. Half of them required hand therapy. Eight of the 12 patients had good documentation of a full return of hand function. In some patients with early infectious flexor synovitis, urgent surgery may not be required. We present a brief synopsis of 12 such cases.

Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons.

Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.

Infectious tenosynovitis with bloodstream infection caused by Erysipelothrix rhusiopathiae, a case report on an occupational pathogen

BackgroundErysipelothrix rhusiopathiae is an established animal pathogen, which may cause infections in humans. It is a gram-positive rod and found in the tonsils or the digestive tracts of animals. The bacterium is occupationally related, as usually only people with frequent animal contacts are infected. We report a case of a patient who was admitted with an infectious tenosynovitis with bloodstream infection due to E. rhusiopathiae, and to our knowledge, this is the first report of a tenosynovitis with systemic manifestation associated with this bacterium.Case presentationA 52-year old Norwegian man, who worked with transportation of swine cadavers, was admitted to the local hospital with sepsis and unknown focus of infection. A few days earlier he had an injury to the skin of one of his fingers that later proved to be infected with E. rhusiopathiae. There were no other causes for his symptoms than the infectious tenosynovitis with systemic manifestation. The infection resolved on treatment with antibiotics and surgery. A transoesophageal echocardiogram was performed to exclude endocarditis, which may be associated with this pathogen.ConclusionsThis case report highlights the importance of clinicians being aware of this bacterium, and we describe risk factors for infection, differences in the clinical manifestations of the disease, challenges with diagnosing the bacterium and adverse effects of immunosuppressive drugs. Recommended treatment is appropriate antibiotic therapy and adequate debridement and surgical drainage of the tendon sheath.

The Role of Ultrasound in the Diagnosis of Infectious Tenosynovitis of Hand Mimic Rheumatic Diseases: Two Case Reports

The Role of Ultrasound in the Diagnosis of Infectious Tenosynovitis of Hand Mimic Rheumatic Diseases: Two Case Reports

Role of Diffusion Weighted Imaging in Musculoskeletal Infections: Current Perspectives.

• Abscess in background cellulitis is detected on DWI. • Infectious tenosynovitis shows diffusion restriction as compared to mechanical tenosynovitis. • Pyomyositis with abscess can be differentiated from diabetic myonecrosis on DWI. • Intraosseous abscess is bright on DWI versus devitalized tissue, sequestrum and air. • DWI can be used to differentiate spine infection from simple Modic changes.

FRI0299 Fast Infusion of TOCILIZUMAB in Rheumatoid Arthritis is Well Tolerated

BackgroundTocilizumab (TCZ) is administered by IV infusions over 1 hour. Reduction of infusion time will optimize the utilization of hospital resources and be of benefit for patients. However, the treatment...

AB0611 Recurrent Cutaneous Ulcers and Interstitial Lung Disease in Dermatomyositis with Positive Anti-P155/140 Autoantibodies: an Atypical Case

BackgroundAnti-P155/140 autoantibodies (anti-TIF1) have been reported to be associated with malignancy1; whereas melanoma differentiation-associated gene 5 (MDA5) has been identified as a DM specified autoantigen that appears to be targeted...

Modifications to simplify intrathecal irrigation for pyogenic flexor tenosynovitis.

Dear Sir, We describe two modifications to simplify cannulation and passage of fine feeding catheter through flexor sheath for closed irrigation of infective flexor tenosynovitis. Cannulating the flexor sheath and controlled passage of fine feeding catheter through the retinacular system can be difficult due to its pliability, often requiring multiple attempts and causing additional trauma to flexor tendons. Conventionally, irrigation solution is pumped out through the tip of the catheter and intrathecal lavage is dependent on the pressure jet and continuous flow [2]. The potential drawbacks of the latter are incomplete evacuation of infected material and tedious dressings. Other authors have described single and multiple fenestrations along catheter in human and veterinary patients [1, 4]. The advantage of side fenestration is the delivery of irrigation solution to sanctuaries such as the sub-chiasms and intertendinous interfaces. Based on the above techniques, we have modified the closed irrigation technique in two ways to ease cannulation and intrathecal lavage. In all cases, the flexor sheath is visualized and accessed through hemi-Brunner incision centered over A4/5 or A3/4, and a palmar crease incision centered on the A1. The first modification introduces an intraluminal 24-gauge wire to stiffen the tube for cannulation at either A3/4 or A4/5 and retrograde passage to the A1 window (Fig. 1). The second modification involves fenestrating the catheter along its middle portion to increase turbulence of intrathecal flow. During irrigation, the catheter is drawn back and forth, while an assistant flushes the tube after clamping its tip. The end point is the evacuation of clear fluid from the A1 window. Fig. 1 Middle segment of a feeding catheter is marked (black arrows) and fenestrated with a no. 11 blade. Intraluminal 24-gauge wire to increase stiffness of catheter to ease cannulation and manipulation of catheter We believe that the combination of mechanical lavage and fluid flow through the fenestrations increases direct clearance of intrathecal material as opposed to indirect methods that rely on continuous flow (Fig. 2). The catheter is removed after irrigation and postoperative irrigation is not practiced due to the lack of perceived benefits [3]. Fig. 2 Left to right. Direct irrigation—tip of catheter clamped to facilitate intrathecal flow of irrigation fluid (blue arrows), and oscillating motion (thick black arrows) to promote mechanical lavage. Indirect irrigation—flexor sheath is ...

Infectious Tenosynovitis in a Patient with Dermatopolymyositis and Vasculitis

Flexor tendon sheath infection calls for appropriate antimicrobial and surgical therapy to overcome complications such as deep abscesses, septic arthritis, and osteomyelitis. A 33-year-old woman with dermatopolymyositis and vasculitis for 1 year was diagnosed by typical rash (heliotrope rash, Gottron’s sign), symmetric proximal muscle weakness, elevated serum skeletal muscle enzymes, electromyographic abnormalities, and interstitial lung disease. She started intravenous (IV) methylprednisolone …

Pyogenic tenosynovitis of the flexor hallucis longus in a healthy 11-year-old boy: a case report and review of the literature

Pyogenic tenosynovitis of the flexor hallucis longus (FHL) is a rare condition in young healthy patients. We report the case of a healthy 11-year-old boy who presented with a history of fever and painful swelling below the medial malleolus of the left ankle. Imaging and laboratory findings suggested infectious tenosynovitis of the FHL. Methicillin-sensitive Staphylococcus aureus was isolated on culture following surgery. Antibiotherapy was initiated and continued until inflammatory markers returned to normal. Six months post-surgery, he resumed sport activities and inflammatory markers remained within normal limits. We review also the literature and discuss the clinical characteristics of this condition.

Hazards of steroid injection: Suppurative extensor tendon rupture

ABSTRACTLocal steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain's tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.

Hazards of steroid injection: Suppurative extensor tendon rupture

Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain's tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.

AN UNCOMMON CAUSE FOR A COMMON COMPLAINT

Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.

Infectious tenosynovitis and osteomyelitis caused by Mycobacterium nonchromogenicum

Infections due to Mycobacterium terrae complex are rare. We report a severe case of chronic tenosynovitis and osteomyelitis of the hand caused by Mycobacterium nonchromogenicum requiring second ray finger amputation.

Gouty flexor tenosynovitis of the hand mimicking atypical mycobacterial infection

A 50-year-old Japanese fish dealer presented with painful and swollen fingers. Infectious flexor tenosynovitis with Mycobacterium marinum was suspected. Range of motion was restored after tenosynovectomy and after ofloxacin and clarithromycin were administered. Two years after the operation, the patient presented again with acute inflammation in the same fingers. Histopathological examination revealed gouty tenosynovitis. The preconception that mycobacterial infection occurs often in fish dealers caused us to miss the correct diagnosis of gouty tenosynovitis.

Acute nonspecific flexor tenosynovitis in the digits

Eight patients, aged 53 to 86 years (average, 63 years), with typical symptoms of acute infectious digital flexor tenosynovitis after excessive use of the hand were treated. No bacterial or crystal association was proven. In the two patients treated earliest, antibiotics were administered because of leucocytosis and a positive C-reactive protein (CRP) test result, but there was no improvement with this treatment. Surgical treatment relieved the symptoms in both these patients. In the other six patients, hand elevation and rest, as well as treatment with anti-inflammatory agents, resulted in complete resolution of the symptoms. Considering that the structure of the digital flexor tendon and the tendon sheath is similar to that of the synovial joint, the author suggests that the nonspecific tenosynovitis in this series could have been caused by overload on a flexor tendon system that had degenerated with age.

Infectious Tenosynovitis

Infectious tenosynovitis is treated similarly to infectious arthritis. The principles of treatment include an early diagnosis and immediate therapy. Therapy should include use of systemic and local antimicrobials and sheath lavage and drainage. Fibrosis and adhesions can be minimized with passive range of motion exercises, intrathecal hyaluronate, and phenylbutazone therapy. Restrictive fibrosis may be treated successfully by annular ligament resection.

Acute inflammatory response to cowpox virus infection of the chorioallantoic membrane of the chick embryo

The chick embryo chorioallantoic membrane was used to study the acute inflammatory response in the absence of contributions from the immune system. In preliminary experiments, lesions of wild-type cowpox virus strain Brighton (CPV-BR) and a 38K gene deletion mutant of CPV-BR (CPV-BR.Dl) were compared with vaccinia virus (strains WR and Copenhagen), fowlpox virus, laryngotracheitis virus, and infectious tenosynovitis virus, and were ranked for degree of induced inflammation. The maximal and minimal inflammatory responses were observed with CPV-BR.D1 and CPV-BR viruses, respectively. CPV-BR.Dl lacks a 38K gene which encodes an anti-inflammatory 38-kDa protein that has homology to SERPINs. The kinetics and character of the inflammatory response were examined further in the wild-type CPV-BR and mutant CPV-BR.Dl infections using cell counts, electron microscopy, and assays for inflammatory cell activation. CPV-BR virus infection rapidly spread through the ectoderm, uniformly infecting all cells with the production of large amounts of virions and viral-induced cytopathic effect, but evoking little or no inflammatory response until 144 hr p.i. The CPV-BR.D1 infection, on the other hand, was rapidly contained by a dexamethasone-sensitive inflammatory response mainly of activated heterophils which was advanced by 36 hr p.i. Both infections resulted in disseminated disease with similar numbers of liver lesions and only a slight difference in the LD 50, with the CPV-BR.D1 values being higher than that for CPV-BR virus. In this model, the acute inflammatory response alone is unable to prevent disseminated disease and associated mortality.

Infectious tenosynovitis in broilers and broiler breeders in Egypt.

Two infectious tenosynovitis-producing viruses were isolated from tendon sheaths and synovial fluids of 59 broilers and 15 broiler breeders obtained from different flocks in Egypt during June to October 1983. The viruses grew well on the chorioallantoic membrane of developing chicken embryos, produced small localized white pock lesions with oedematous swellings at the inoculation sites and death of most of the embryos 72 to 96 hours post-inoculation. They also induced cytopathic effect in chicken embryo rough, Vero and MS cell lines. The viruses were neutralized by reovirus S1133 antiserum, both in tissue culture and on the chorioallantoic membrane. Inoculation of the viruses into 2-day-old broiler chicks via the foot pad, intramuscular and oral routes reproduced the disease with the development of characteristic clinical, pathological and serological responses. The infection was transmitted to in-contact control chicks. This is the first report of the disease and of the isolation and identification of the causative virus in Eqypt.

Infectious Tenosynovitis in Young Turkeys

Two viruses serologically related to the tenosynovitis virus of chickens were isolated from two flocks of turkeys experiencing outbreaks of tenosynovitis. Both viruses produced a tenosynovitis when injected into the foot pad of young turkeys. Staphylococcus aureus was not isolated from either flock, nor was there any evidence of Mycoplasma synoviae antibody in either flock.