Overview of flexor tenosynovitis

Figure 1. Key practice points for flexor tenosynovitis. [NB1]
  • Flexor tenosynovitis refers to inflammation of one or more flexor-tendon sheath(s) (usually in the hand), associated with overuse-related trauma, infection (especially after a penetrating injury) or an inflammatory rheumatological condition.
  • Single-digit flexor tenosynovitis presenting as an isolated ‘sausage finger’ (dactylitis) should raise suspicion of a digital infection; urgent surgical referral may be required.
  • Multiple-digit flexor tenosynovitis is usually due to repetitive trauma, diabetes or an inflammatory rheumatological condition.
Note: NB1: This list is a summary guide only; refer to full text.

Flexor tenosynovitis causes pain, swelling and tenderness along one or more digital flexor tendons, and their tendon sheaths, in the hand. It commonly affects multiple digits and may be associated withRay, 2022:

  • noninfective aetiologies
    • inflammatory rheumatological conditions
    • mechanical (overuse-related) trauma
    • idiopathic
  • infective aetiologies (also known as pyogenic or purulent tenosynovitis).

For more detail on these aetiologies, see Multiple-digit flexor tenosynovitis. Key practice points for flexor tenosynovitis lists some key practice points for flexor tenosynovitis.

When a single digit is affected by tenosynovitis, infection must be considered. Single-digit flexor tenosynovitis can present as an isolated ‘sausage finger’ (dactylitis) that resembles a digital infection. Infective flexor tenosynovitis and single-digit dactylitis are surgical emergencies and need urgent referral to a hand surgeon for management.

Note: Infective flexor tenosynovitis and single-digit dactylitis are surgical emergencies and need urgent referral to a hand surgeon.

Trigger finger (also known as stenosing tenosynovitis) is a potential complication of chronic noninfective flexor tenosynovitis, with thickening of the tendon-sheath synovium, narrowing of the synovial canal or nodularity of the flexor tendon that can be associated with clicking, catching or locking of the digit.