Definition & Overview
Tendons are tough fibrous connective tissues made of collagen that connects the muscles to the bone or other structures, such as the eyes. However, despite their toughness, tendons are also prone to damage due to overuse, bacterial infections, and injury. Tenosynovitis is one of the most common forms of tendon problems and is characterized by the inflammation of the protective sheath (synovium) surrounding the tendon.
Tendons are located all over the body particularly in areas with joints such as the hands and feet. Since these areas are two of the most commonly used parts of the body, it’s only natural that they become more prone to damage due to injuries or diseases.
In general, an injury to the tendon is referred to as tendinopathy. However, this can be categorized into more specific forms, such as tenosynovitis, tendonitis, and tendinosis.
While tenosynovitis refers to the inflammation of the synovium, tendonitis is the inflammation of the tendon itself. Tendinosis, meanwhile, is the deterioration of the tendon without displaying any signs of inflammation. Despite the differences, rarely would the conditions occur without a certain cause. In most cases, the conditions are a result of an injury or small injuries that gradually degrade the tendon sheath and tendon itself. Therefore, many doctors simply refer to separate conditions as tendinopathy.
One of the most common forms of tenosynovitis is De Quervain’s tenosynovitis, named after Swiss surgeon Fritz de Quervain, who was the first to publish cases wrist problems.
Cause of Condition
Tenosynovitis can affect anybody, but studies have shown that those who are active in sports and other activities that require repetitive movements, such as typing, writing, or swinging a golf club, are more prone to developing the condition.
However, in some cases, the exact cause may not be so apparent. Although rare, inflammation of the sheath can also be a result of an infection that could be caused by a minute injury, such as a small puncture to the outer layer of the skin that became infected. There have also been reported cases of tenosynovitis that was caused by an infection that spread from other parts of the body. A good example is an infection caused by a sexually transmitted disease (STD) that has spread throughout the body and affected the tendon sheath.
Other than sports injuries, repetitive movements, or infections, tenosynovitis can also occur in people with certain diseases, like arthritis, gout, diabetes, and scleroderma.
The most common areas affected by tenosynovitis are the wrists, hands, and feet, but it can also occur on the elbows, knees, or shoulders. Pain and inflammation that limit the range of motion of the affected area are the most common signs. In some cases, the tendon has a reddish color that is visible through the skin. If the condition is a result of an infection, fever could also be present.
Who to See and Types of Treatment Available
Tenosynovitis usually does not require diagnosis and treatment by a specialist. A family doctor should be able to diagnose the condition simply by visually inspecting the affected area. In fact, rarely would specialized equipment, such as x-rays or ultrasound devices be required. However, if the doctor suspects that the condition may have been caused by an infection, the patient will be required to undergo a blood test to determine the cause and origin of the infection. If blood test results are inconclusive, imaging tests, such as an x-ray or MRI will be conducted.
In most cases, patients can fully recover from tenosynovitis with simple rest and pain medications when required. It’s imperative that the affected area receives as much rest as possible. If the problem affects the hands or wrist, placing a splint can help prevent the body part from moving.
In severe cases, steroidal injections may be prescribed to control the pain. Physiotherapy may also be recommended to aid in the healing process.
If an infection is present, antibiotics will be prescribed. Other medications may also be needed depending on the type of infection.
Rarely would surgery be required to treat tenosynovitis. However, should this be recommended, the objective of the surgical procedure would be to release the tendon.
Tenosynovitis can be prevented by avoiding repetitive movements. Unfortunately, this would be difficult to accomplish if performing those movements is work related. If you determine that your work is causing multiple episodes of the condition, it would be best to discuss your situation with your employer.
Another way to reduce the chances of experiencing the condition is to strengthen the muscles around the affected tendon through certain exercises. To learn what these exercises are, it would be best to consult a physiotherapist as some exercises can worsen the condition. In fact, prolonged exercises, such as running, may also result in tenosynovitis or damage to the tendon itself.
Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier; 2013:chap 117.
Wolfe SW. Tendinopathy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier Churchill-Livingston; 2010:chap 62.