Management of Infectious Tenosynovitis

Immediate Management and Special Considerations

• The American College of Cardiology recommends promptly referring diabetic patients with infectious tenosynovitis to an interdisciplinary care team, including hand surgery, infectious disease, and endocrinology, as they have a significantly worse prognosis and higher complication rates 1, 5
• In diabetic patients with peripheral arterial disease and suspected hand infection, the American College of Cardiology notes that assessing for concomitant foot involvement is crucial, as PAD plus infection confers nearly 3-fold higher amputation risk 1, 2
• The American Journal of Respiratory and Critical Care Medicine suggests considering broader coverage for unusual organisms based on patient characteristics, such as Neisseria gonorrhoeae in sexually active patients or Pasteurella multocida in patients with animal bites 4
• The Annals of Oncology recommends distinguishing infectious tenosynovitis from inflammatory tenosynovitis of rheumatoid arthritis using clinical features, such as purulent discharge, systemic signs of infection, and acute onset 6
• The Journal of the American College of Radiology notes that ultrasound can help differentiate inflammatory synovitis from infectious fluid collections 8
• The American College of Cardiology advises ensuring optimal glycemic control during treatment, as hyperglycemia impairs wound healing and immune function 3