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Tenosynovitis – Causes, Symptoms and Treatment

Tenosynovitis is an inflammation of the tendon sheath that causes pain, swelling, and restricted movement. It most commonly affects the hand, wrist, and foot.

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Things worth knowing about "Tenosynovitis"

Tenosynovitis is an inflammation of the tendon sheath that causes pain, swelling, and restricted movement. It most commonly affects the hand, wrist, and foot.

What is Tenosynovitis?

Tenosynovitis is an inflammation of the tendon sheath – a thin, fluid-filled sleeve that surrounds tendons and allows them to glide smoothly during movement. When this sheath becomes inflamed, it swells and produces excess fluid, resulting in pain, stiffness, and reduced range of motion. The condition most commonly affects the tendons of the hand, wrist, forearm, and foot.

Causes

Tenosynovitis can be triggered by a variety of factors:

Overuse and repetitive strain: Repetitive movements in work or leisure activities (e.g., typing, manual labour, sports) can overload the tendon sheaths.
Infections: Bacteria, and less commonly viruses or fungi, can enter the tendon sheath through wounds or via the bloodstream, causing infective tenosynovitis.
Systemic conditions: Rheumatoid arthritis, gout, or diabetes mellitus increase the risk of developing tenosynovitis.
Injuries: Direct trauma or sprains can damage the tendon sheath.
Age-related changes: As people age, the resilience of tendons and their surrounding sheaths decreases.

Symptoms

The typical symptoms of tenosynovitis include:

Pain along the affected tendon, especially during movement
Swelling and warmth over the affected area
Restricted movement of the affected joint or finger
Creaking or grating sensation during movement (known as crepitus)
In infective tenosynovitis: redness, fever, and general malaise

Diagnosis

Diagnosis is primarily made through a clinical examination, during which the healthcare provider assesses the area for swelling, tenderness, and range of motion. Additional diagnostic methods include:

Ultrasound: Imaging of the tendon sheath to detect fluid accumulation and signs of inflammation
MRI (Magnetic Resonance Imaging): Used in unclear cases or when deeper structural damage is suspected
Blood tests: To identify systemic causes (e.g., rheumatoid factor, inflammatory markers, full blood count)
Aspiration: In suspected infective tenosynovitis, fluid from the sheath may be collected and tested microbiologically

Treatment

Conservative Treatment

In most cases, tenosynovitis can be successfully managed without surgery:

Rest and immobilisation: Protecting the affected area, sometimes with a splint or orthosis
Ice therapy: Applying cold packs to reduce swelling and pain
Anti-inflammatory medications (NSAIDs): Such as ibuprofen or diclofenac, available as tablets or topical gels
Corticosteroid injections: A local cortisone injection into the tendon sheath can quickly reduce inflammation in persistent cases
Physiotherapy: Targeted exercises to strengthen and mobilise the area once the acute inflammation has resolved

Treatment of Infective Tenosynovitis

Bacterial tenosynovitis requires immediate treatment as it can spread rapidly. Management involves antibiotics, and in severe cases, surgical irrigation and drainage of the tendon sheath.

Surgical Treatment

If conservative measures are insufficient or chronic changes have developed, a surgical procedure may be necessary. This typically involves releasing the thickened sheath or removing adhesions.

Prevention

Tenosynovitis can be prevented or reduced in risk by:

Taking regular breaks during repetitive tasks
Designing an ergonomic work environment
Warming up properly before physical activity
Strengthening the muscles around the affected joints

References

Flexor Tendon Sheath Infections (Pyogenic Tenosynovitis) – StatPearls, National Library of Medicine (NCBI/PubMed), 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482382/
Abrams, R.A., Botte, M.J.: Hand infections: treatment recommendations for specific types. Journal of the American Academy of Orthopaedic Surgeons, 1996; 4(4): 219-230.
World Health Organization (WHO): Musculoskeletal conditions. Fact Sheet, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

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