Tenosynovitis: Causes, Symptoms & Treatment
Tenosynovitis is an inflammation of the tendon sheath causing pain, swelling, and restricted movement. It most commonly affects the hand, wrist, and foot.
Things worth knowing about "Tenosynovitis"
Tenosynovitis is an inflammation of the tendon sheath causing 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 – the protective sleeve surrounding a tendon that is lined with a lubricating fluid called synovial fluid. This fluid allows the tendon to glide smoothly during movement. When the tendon sheath becomes inflamed, pain, swelling, and reduced mobility can result. Tenosynovitis can occur in an acute or chronic form and may affect various parts of the body, most frequently the hands, wrists, and feet.
Causes
Tenosynovitis can be triggered by several factors:
- Overuse and repetitive movements: Repeated motions in occupational or sporting activities are a leading cause, for example in office workers, musicians, or manual laborers.
- Bacterial infections: Infectious tenosynovitis occurs when bacteria enter the tendon sheath through wounds, punctures, or bite injuries. Common pathogens include Staphylococcus aureus and Streptococcus species.
- Rheumatic diseases: Conditions such as rheumatoid arthritis or psoriatic arthritis can cause tenosynovitis as an associated manifestation.
- Crystal deposits: In gout or pseudogout, crystal deposits within the tendon sheath can trigger inflammation.
- Hormonal changes: Pregnancy and breastfeeding can increase the risk, particularly for De Quervain tenosynovitis affecting the thumb.
Symptoms
The typical symptoms of tenosynovitis include:
- Pain along the affected tendon, worsening with movement
- Swelling and redness over the inflamed tendon sheath
- Warmth in the affected area
- Limited range of motion and stiffness of the affected joint or limb
- A creaking or grating sensation (crepitus) when moving the tendon
- In infectious cases: fever, general malaise, and pronounced local signs of inflammation
Diagnosis
Tenosynovitis is typically diagnosed through:
- Physical examination: The physician palpates the affected area and assesses pain during active and passive movement.
- Ultrasound: Sonography is a quick and accessible method for visualizing fluid accumulation and thickening of the tendon sheath.
- MRI (Magnetic Resonance Imaging): Provides detailed imaging of soft tissue structures and helps evaluate the extent of inflammation.
- Laboratory tests: Blood count, inflammatory markers (CRP, ESR), and infection markers help identify infectious or rheumatic causes.
- Aspiration and fluid analysis: In suspected infections or crystal disease, fluid may be drawn from the tendon sheath and analyzed.
Treatment
Conservative Treatment
In milder cases, non-surgical management is the first-line approach:
- Rest and immobilization: Protecting the affected limb, often with a splint or brace.
- Ice application: Local cold therapy helps reduce pain and swelling.
- Anti-inflammatory medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac reduce inflammation and relieve pain.
- Corticosteroid injection: A local injection of corticosteroid into the tendon sheath can be effective in persistent cases.
- Physiotherapy: Targeted stretching and strengthening exercises help restore function and prevent recurrence.
Treatment of Infectious Tenosynovitis
Bacterial tenosynovitis is a medical emergency requiring immediate treatment:
- Antibiotics: Intravenous antibiotics tailored to the identified pathogen.
- Surgical irrigation: In many cases, operative irrigation and drainage of the tendon sheath are necessary to control the infection and prevent permanent damage.
Surgical Treatment
In chronic or severe cases, surgical release or resection of the thickened tendon sheath may be required to decompress the tendon and restore mobility.
Prevention
To reduce the risk of developing tenosynovitis, the following measures are recommended:
- Take regular breaks during repetitive tasks
- Use ergonomic tools and maintain correct posture at work
- Perform stretching and warm-up exercises before physical activity
- Seek prompt medical care for wounds or injuries near tendons
References
- Langer, M. et al.: Sehnenverletzungen und Sehnenentzündungen. In: Orthopädie und Unfallchirurgie up2date, Thieme Verlag, 2020.
- Kanavel, A.B.: Infections of the Hand. Lea & Febiger, Philadelphia, 1912 (foundational work on infectious flexor tenosynovitis).
- World Health Organization (WHO): Musculoskeletal conditions. Fact Sheet. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
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