Tenosynovitis - Diagnosis

Laboratory studies:-Gonococcal cultures from the urethra or cervix, rectum and pharynx are indicated if it is suspected gonococcal tenosynovitis-These cultures are positive in 80% of patientsCBC with differential count, if it is suspected infectious etiologyErythrocyte sedimentation-rate if it is suspected infectious etiologySuppurative synovial-fluid cultures before antibiotics are requiredThese include bacteria-resistant crops acid, anaerobic, aerobic fungiNonsupurative-in synovial fluid cultures or nonbirefringente crystals show birefringenceEvaluate the RF-Abnormal liver tests occur in disseminated gonococcal infections.
Imaging studies.X-rays are less sensitive, if not suspect a retained foreign body or if opaque is necessary to exclude a fracture. MRI is helpful in diagnosing tenosinovitelor.Diagnostic arthrocentesis is indicated if tenosynovitis articular effusion is present because most patients with disseminated gonococcal infection had concomitant septic arthritis. Sterile fluid is common in gonococcal arthritis, cultures are negative in 50% of patients. Most are monoarticulare gonococcal arthritis, 25% are polyarticular. Glucose is normal joint fluid. White blood cells are less than 50, 000, and the Gram stain is positive in 25% of patients.Histological examination. Synovial biopsy showed acute or chronic inflammatory changes. Gram stain may show bacteria. Infection should be suspected in atypical presentations of chronic conditions. These changes help to differentiate the histological inflammatory arthropathy.The differential diagnosis is made with the following conditions: abdominal pain in elderly, rheumatoid arthritis, bursitis, cellulitis, carpal tunnel syndrome, compartment syndrome, endocarditis, Felon, gonorrhea, gout and pseudogout, the hand infections, reactive arthritis, osteoarthritis, subcutaneous abscess.