Orthopaedics & Rheumatology _ Synovitis and Tenosyvitis

Question 1

What is synovitis?

Answer 1

• Inflammation of the synovial lining of a joint; can be seen in gout, rheumatoid arthritis, lupus, and other inflammatory conditions

Question 2

What is tenosynovitis?

Answer 2

Inflammation of the fluid-filled sheath, the synovium, surrounding a tendon

Question 3

What are the Kanavel signs for tenosynovitis in a digit?

Answer 3

• STEP
  
  • S ymmetric swelling
  • T enderness limited to the flexor sheath
  • E xtension painful
  • P osture flexed

Question 4

What is the mechanism of injury for many cases of septic tenosynovitis?

Answer 4

• Penetrating trauma or puncture wound, often from dog bite

Question 5

If you suspect a septic tenosynovitis, what should you do?

Answer 5

• Parenteral antibiotics with coverage for Staphylococcus and Streptococcus and
• reevaluate in 12 hours
• oral antibiotics for 7-14 days, total

Question 6

If a patient with tenosynovitis does not respond to initial antibiotics, or if infection is purulent, what is the next step?

Answer 6

• Urgent evaluation for surgical drainage