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Corticosteroids as an Adjunct to Antibiotics and Surgical Drainage for the Treatment of Pyogenic Flexor Tenosynovitis
Reid W. Draeger, MD1; Bikramjit Singh, MD1; Donald K. Bynum, MD1; Laurence E. Dahners, MD1
1 Department of Orthopaedics, Campus Box #7055, Bioinformatics Building, UNC School of Medicine, Chapel Hill, NC 27599-7055. E-mail address for R.W. Draeger: rdraeger@unch.unc.edu. E-mail address for B. Singh: bsingh@unch.unc.edu. E-mail address for D.K. Bynum: dkbhands@med.unc.edu. E-mail address for L.E. Dahners: led@med.unc.edu
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Howard Holderness Distinguished Medical Scholars Program, the Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship, and the Aileen Stock Orthopaedic Research Fund. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Donald H. Lee, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.
Investigation performed at the Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Nov 17;92(16):2653-2662. doi: 10.2106/JBJS.I.01205
A commentary by Donald H. Lee, MD, is available here
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Many similarities exist between pyogenic flexor tenosynovitis and other closed-space infections such as septic arthritis. Previous studies have demonstrated that corticosteroids in conjunction with antibiotics considerably improve treatment outcomes in patients with septic arthritis. Using a chicken model, we investigated whether or not corticosteroids in combination with antibiotics and/or surgical drainage could minimize the loss of range of motion typically associated with pyogenic flexor tenosynovitis.


We inoculated the flexor tendon sheath of the right long toe of broiler chickens with Staphylococcus aureus (American Type Culture Collection 29523 NA) (6 × 109 colony-forming units/mL) and twenty-four hours later administered one of six treatments to groups of fourteen or fifteen chickens. Treatment combinations included systemic or intrasynovial antibiotics, surgical drainage with catheter irrigation or no surgical drainage, and local corticosteroid injections or no corticosteroid injections. Measurements of active digital flexion at the proximal and middle interphalangeal joints were performed before inoculation and treatment and at seven, fourteen, and twenty-eight days after treatment. Flexion measurements were compared between groups as well as with similar measurements in the contralateral, uninfected, control long toe.


At twenty-eight days, two of three groups treated with locally administered corticosteroids and the group treated with intrasynovial antibiotics alone (without surgery) regained significantly more active flexion in comparison with chickens treated with systemic antibiotics and surgical drainage (the current standard of care). Pooled data revealed that the corticosteroid-treated groups regained significantly more active flexion at all post-treatment time points.


Our data support the hypothesis that adding locally administered corticosteroids to the treatment regimen for pyogenic flexor tenosynovitis in a chicken model can significantly decrease loss of motion resulting from the infection. Furthermore, locally administered antibiotics may be effective for the treatment of pyogenic flexor tenosynovitis.

Clinical Relevance: 

Additional clinical studies of the treatment of pyogenic flexor tenosynovitis with locally administered corticosteroids and/or antibiotics are warranted.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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