Tenosynovitis (flexor, hand)

This is a cause of stiffness and pain in the hand, tending to affect one or more digits (1).

It is due to inflammation of the tendon sheaths, which can be detected by examination as a thickening in the palm. There may be tenderness and swelling which may extend proximal to the wrist and over the proximal phalanges. Active flexion of the affected finger may be reduced whilst passive flexion is preserved.

This condition should not be confused with Dupuytren's contracture where there is also a thickening in the palm, but where there is not normally any pain.

Hand tenosynovitis can be due to either infective or non-infective reasons such as idiopathic, overuse, and autoimmune reasons (2):

• overuse
  • repeated movements can lead to synovial sheath inflammation that results in strain injury or overuse syndrome to the synovial sheath
    • due to the repetitive irritation to the synovial sheath tenosynovitis occurs
• autoimmune
  • tenosynovitis is noted in 87% of the patients with rheumatoid arthritis on magnetic resonance imaging (MRI)
  • psoriatic arthritis is also a frequent autoimmune condition that is commonly associated with tenosynovitis
• infective causes can results from direct injury contamination or spread from the infected soft tissues in the vicinity
  • most frequent organisms responsible include Staphylococcus aureus (40% to 75%) followed by methicillin-resistant Staphylococcus aureus MRSA (29%)
  • human bites can lead to the injection of common skin bacteria such as Staphylococcus epidermidis, beta-hemolytic Streptococcus, Pseudomonas aeruginosa, and Eikinella into the tendon sheath
    • Pasturella multocida infection is also noted in animal bites
• idiopathic
  • condition can also be idiopathic without any known causes ascertained for its development

Reference

1. Adams JE, Habbu R. Tendinopathies of the Hand and Wrist. J Am Acad Orthop Surg. 2015 Dec;23(12):741-50.
2. Muthu S, Annamalai S, Kandasamy V. Tenosynovitis of hand: Causes and complications. World J Clin Cases. 2024 Feb 6;12(4):671-676.