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Infectious tenosynovitis

Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Tenosynovitis refers to inflammation of a tendon and its synovial sheath; this condition occurs most frequently in the hands and wrist but can occur in any joint. Issues related to infectious tenosynovitis will be reviewed here. Noninfectious causes of tenosynovitis can mimic clinical features of infectious tenosynovitis; these disorders are discussed separately. (See "de Quervain tendinopathy" and "Trigger finger (stenosing flexor tenosynovitis)".)


The anatomic placement of tendons, their sheaths, and the adjacent bursae has important implications for the clinical features of tenosynovitis (inflammation of a tendon sheath) (figure 1). (See "Finger and thumb anatomy".)

Extensor and flexor tendon sheaths have two surfaces: an inner visceral layer adherent to the tendon and an outer parietal layer abutting adjacent structures such as bursae and muscles. In their normal states, the visceral and parietal layers abut one another; in the setting of tenosynovitis, the space between the two layers may fill with inflammatory or purulent fluid.

The visceral and parietal layers of most tendons are tightly joined at the ends to produce a closed compartment encased in a tendon sheath. Many tendon sheaths lie in close proximity to adjacent bursae. Therefore, infection in a tendon sheath can spread readily to adjacent bursae as well as other tendon sheaths. For example [1,2]:

Infectious tenosynovitis involving the extensor tendons on the dorsum of the hand can spread via bursae to the volar surface of the hand.

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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  1. Tsai E, Failla JM. Hand infections in the trauma patient. Hand Clin 1999; 15:373.
  2. Small LN, Ross JJ. Suppurative tenosynovitis and septic bursitis. Infect Dis Clin North Am 2005; 19:991.
  3. Young-Afat DA, Dayicioglu D, Oeltjen JC, Garrison AP. Fishing-injury-related flexor tenosynovitis of the hand: a case report and review. Case Rep Orthop 2013; 2013:587176.
  4. Doyle JR. Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg Am 1988; 13:473.
  5. Kour AK, Looi KP, Phone MH, Pho RW. Hand infections in patients with diabetes. Clin Orthop Relat Res 1996; :238.
  6. Baskar S, Mann JS, Thomas AP, Newton P. Plant thorn tenosynovitis. J Clin Rheumatol 2006; 12:137.
  7. Gonzalez MH, Garst J, Nourbash P, et al. Abscesses of the upper extremity from drug abuse by injection. J Hand Surg Am 1993; 18:868.
  8. Mateo L, Rufí G, Nolla JM, Alcaide F. Mycobacterium chelonae tenosynovitis of the hand. Semin Arthritis Rheum 2004; 34:617.
  9. Anim-Appiah D, Bono B, Fleegler E, et al. Mycobacterium avium complex tenosynovitis of the wrist and hand. Arthritis Rheum 2004; 51:140.
  10. Chin KR, Miller BS, Koris MJ. Serous flexor tenosynovitis as an associated finding in meningococcal septic polyarthritis. Am J Orthop (Belle Mead NJ) 2002; 31:88.
  11. Skoll PJ, Hudson DA. Tuberculosis of the upper extremity. Ann Plast Surg 1999; 43:374.
  12. Millerioux S, Rousset M, Canavese F. Pyogenic tenosynovitis of the flexor hallucis longus in a healthy 11-year-old boy: a case report and review of the literature. Eur J Orthop Surg Traumatol 2013; 23 Suppl 2:S311.
  13. Kanavel AB. Infections of the hand: a guide to the surgical treatment of acute and chronic suppurative processes of the fingers, hand, and forearm, Lea and Febiger, Philadelphia 1912.
  14. Pang HN, Teoh LC, Yam AK, et al. Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Am 2007; 89:1742.
  15. Nikkhah D, Rodrigues J, Osman K, Dejager L. Pyogenic flexor tenosynovitis: one year's experience at a UK hand unit and a review of the current literature. Hand Surg 2012; 17:199.
  16. Michon J. [Phlegmon of the tendon sheaths]. Ann Chir 1974; 28:277.
  17. Newman ED, Harrington TM, Torretti D, Bush DC. Suppurative extensor tenosynovitis caused by Staphylococcus aureus. J Hand Surg Am 1989; 14:849.
  18. Kostman JR, Rush P, Reginato AJ. Granulomatous tophaceous gout mimicking tuberculous tenosynovitis: report of two cases. Clin Infect Dis 1995; 21:217.
  19. Bogoch II, Robbins GK. Varicella zoster mimicking infectious tenosynovitis. J Infect 2012; 64:341.
  20. Murphey DK, Septimus EJ, Waagner DC. Catfish-related injury and infection: report of two cases and review of the literature. Clin Infect Dis 1992; 14:689.
  21. Müller CT, Uçkay I, Erba P, et al. Septic Tenosynovitis of the Hand: Factors Predicting Need for Subsequent Débridement. Plast Reconstr Surg 2015; 136:338e.
  22. Giladi AM, Malay S, Chung KC. A systematic review of the management of acute pyogenic flexor tenosynovitis. J Hand Surg Eur Vol 2015; 40:720.
  23. Kabakaş F, Uğurlar M, Turan DB, et al. Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative? Ann Plast Surg 2016; 77:169.