Tenosynovitis

Causes divide into infectious, inflammatory, and overuse. Disseminated gonococcal infection classically produces the triad of migratory polyarthralgia, tenosynovitis, and pustular or vesiculopustular skin lesions, most often in a sexually active young adult and especially in patients with terminal complement (C5-C9) deficiency; it is treated with ceftriaxone plus empiric chlamydia coverage. Pyogenic flexor tenosynovitis of a finger, usually from Staphylococcus aureus or Streptococcus after a penetrating injury, is recognized by Kanavel's four cardinal signs — fusiform swelling of the digit, the finger held in slight flexion, tenderness along the flexor sheath, and pain on passive extension — and requires urgent surgical drainage to prevent tendon necrosis. Non-infectious forms include de Quervain tenosynovitis of the abductor pollicis longus and extensor pollicis brevis, common in new mothers and diagnosed by the Finkelstein test; stenosing tenosynovitis, or trigger finger, associated with diabetes; and tenosynovitis in rheumatoid arthritis, which may precede joint erosion. Fluoroquinolones are associated with tendinopathy and rupture.