Surgical therapy
If the conservative treatment options are not sufficient, the step to surgery may be useful. This is especially so if there are constrictions and sources of friction due to the individual anatomical conditions or due to the inflammation-related damage to the tissue. Such nodular adhesions are often the result of prolonged disease progressions.
During surgery, the tendon sheath in question can be split, or adjacent connective tissue structures can be loosened.This dissolves constrictions and removes inflamed tissue so that the affected tendon can function again without irritation. Depending on the affected joint, these operations can also be performed under local or regional anesthesia and are therefore also possible on an outpatient basis. Although the operation is always an invasive procedure, it can lead to freedom from symptoms for a large proportion of patients.
Therapy of infectious tendosynovitis
There are two forms of tendosynovitis due to an infectious event. On the one hand, an inflammation can occur after a bacterial infection, on the other hand, the pathogens can also have reached the tendon directly, for example through stab, bite or cut injuries. Since there is a clear cause of the inflammation in this case, antibiotic treatment of the trigger is the main focus.
Infectious tendosynovitis is usually noticed by a much faster progression of the symptoms. The antibiotic treatment should be administered as soon as possible, because if it is started too late or if the treatment does not take effect directly, the bacteria can spread via the blood vessel and lymphatic system. In the worst case, this can lead to widespread centres of inflammation and even blood poisoning (sepsis).
Therefore, if the inflammation continues to spread despite antibiotic therapy, there must be no hesitation in proceeding with surgery if necessary. Purulent tendon sheaths are an emergency that must be operated on immediately and should not be taken lightly under any circumstances. In contrast to the above-mentioned operation after chronic irritation, the main aim here is to remove the infected tissue.
