Management for flexor tenosynovitis (excluding single-digit dactylitis)
If the patient’s presentation is not obviously infective (eg not arising postinjury, not single-digit dactylitis, no purulent discharge or fever) the aetiology is likely to be inflammatory. The clinical course of inflammatory flexor tenosynovitis is not well understood. In idiopathic cases, the condition may resolve spontaneously.
Treat any associated medical condition(s) if present (eg diabetes, inflammatory arthritis). Treating the underlying medical condition(s) may resolve the tenosynovitis.
Management for flexor tenosynovitis often includes watchful waiting and, in many cases, local corticosteroid injection. Splinting is often trialled but may not be effective. Activity modification may be useful for some (if practical).
Local corticosteroid injection may be more effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for relieving pain in flexor tenosynovitis. If available, local corticosteroid injection is the first-line treatment and can be repeated if symptoms recur. Ideally, the corticosteroid should be injected into the tendon sheath; however, given the small space, this is not always possible and injection into the vicinity (eg between the skin and the tendon) can also be effective. If the clinician does not feel confident performing this procedure, injection may be performed under ultrasound guidance. For principles of use and example doses of local corticosteroid injections, see Principles of using local corticosteroid injections for musculoskeletal pain.