Tenosynovitis is an inflammation of the synovium, or the lining encompassing a tendon sheath. Tenosynovitis is not the same condition as tendonitis, which refers to the inflammation of the tendon itself, although in many cases the two conditions occur simultaneously.
The cause of the inflammation in tenosynovitis is not always known, but common causes include:
- Inflammatory diseases such as rheumatoid arthritis
Tenosynovitis typically affects the hands, wrists and feet because the tendons are long across those joints, though the condition can affect any tendon sheath. Symptoms of tenosynovitis can include:
- Difficulty moving a joint and pain
- Swelling in the area of the affected joint
- Tenderness or pain around a joint
- Redness running along the length of the tendon
The most common type of tenosynovitis is de Quervain’s tenosynovitis, which involves swelling of the sheath of the tendons in the thumb. Patients with de Quervain’s may feel a sticking sensation when moving the thumb and difficulty moving the wrist when trying to grasp objects. The risk factors de Quervain’s can include:
- Age. People between the ages of 30 and 50 are the most likely to develop de Quervain’s tenosynovitis.
- Sex. De Quervain’s tenosynovitis is more common among women than men.
- Pregnancy. De Quervain’s has been associated with pregnancy.
- Being a parent. The movement associated with picking up a child is linked to the development of tenosynovitis.
- Occupations and hobbies. Activities like gardening or playing racket sports that involve repetitive movement may contribute to de Quervain’s tenosynovitis.
- A previous injury. Scar tissue in the wrist area from an earlier injury may restrict movement in the tendons.
To diagnose tenosynovitis, an orthopedist can apply pressure to the tendon to see if it causes pain. For de Quervain’s tenosynovitis in particular, an orthopedist can perform Finkelstein test, which involves having the patient bend the thumb across the palm of the hand while bending the remaining fingers down over the thumb. Then the patient turns their wrist toward the pinky finger, and if this causes pain it is likely due to de Quervain’s.
Treatment Options for Tenosynovitis
The primary treatment goal for tenosynovitis is to reduce pain and inflammation. Applying a heat or cool pack can help with this, as well as resting and keeping the tendons as still as possible. Other treatment options can include:
Physical Therapy. Coupled with rest and activity modification, physical therapy can help lessen the effects of tenosynovitis.
Splint or removable brace. Patients may want to consider a splint or removable brace to help reduce movement.
Pain relievers. Nonsteroidal anti-inflammatory drugs like ibuprofen can help relieve pain and reduce inflammation.
Corticosteroids. Local injections of corticosteroids into the sheath can help to suppress inflammation. This is only an option for patients with tenosynovitis caused by anything other than infection.
Surgery. If an infection causes tenosynovitis, patients may require emergency surgery to drain the pus around the tendon. Surgery to relieve the pressure on tendons may also be considered after conservative treatments have been exhausted in patients with chronically inflamed tendons.
With treatment, most patients fully recover from tenosynovitis within 4 to 6 weeks. If tenosynovitis goes untreated, patients risk having the affected joint becoming stiff and having the tendon become permanently restricted. Avoiding repetitive movements can help to prevent tenosynovitis. Patients should also be sure to appropriately care for any wounds to the hands, wrists and feet.
Studies have shown that physical therapy, including strengthening exer for all forms of tendonitis can help to reduce pain and strengthen the muscles around the damaged tendon to help avoid similar injuries in the future. A physical therapist may recommend strengthening exercises and adjusting daily activities to help avoid aggravating the tendon going forward.