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Tenosynovitis(Synovitis)

Pronounced: ten-o-sin-o-VITE-is

Definition

Tendons are the cords that connect bones to muscles in the body. They are covered by a sleeve-like tissue. Tenosynovitis is an inflammation of this sleeve. It occurs most often in the hand, wrist, or foot.

Tenosynovitis

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Causes

Most cases of tenosynovitis are caused by one of the following:

  • Injury
  • Infection
  • Strain
  • Repetitive motions such as those used for:
    • Computer operation
    • Assembly line work
    • Cash register operation
    • Sports that involve repetitive actions
    • Sewing
    • Playing musical instruments
Risk Factors

Factors that may increase your risk of tenosynovitis include:

  • Repetitive actions with your hand, wrist, or foot during work or play
  • Diseases that cause inflammation such as gout and rheumatoid arthritis
Symptoms

Tenosynovitis may cause:

  • Joint pain
  • Joint stiffness
  • Joint swelling
  • Difficulty moving a joint
  • Redness along the length of the tendon

Tenosynovitis is common in the tendons of the thumb. This is called de Quervain’s tenosynovitis. It causes pain and stiffness in the thumb side of the wrist.

The wrists, hands, and feet are also commonly affected. Tenosynovitis that affects tendons of the fingers can also make the finger stick in a bent position.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. It will include an assessment of the joint.

A blood test may also be done. Your doctor will use this to look for signs of bacterial infection or other conditions such as rheumatoid arthritis. Your doctor may refer you to a hand specialist.

Treatment

Talk with your doctor about the best treatment plan for you. The goal of treatment is to reduce swelling and pain and to allow the tendon to move freely. Treatment options include the following:

Rest

Resting the involved joint is often the best treatment for tenosynovitis. A brace or splint may be used to help you rest the joint. Rest may be combined with basic stretching and strengthening exercises.

Physical Therapy

Your doctor may refer you to a physical therapist. Therapy will help to reduce discomfort and promote recovery through exercise. The therapist may also suggest modifications to your workplace to reduce stress to the area.

Ice and Heat

Applying ice or heat to the area may decrease pain and swelling. Start with ice, especially soon after the injury. If ice is not helpful, try heat.

Medications

Several medications are used to treat tenosynovitis. These include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation and pain
  • Topical pain medicines, such as creams and patches, that are applied to the skin
  • Corticosteroids—injected into the sheath
  • Antibiotics—if tenosynovitis was caused by a bacterial infection
Surgery

Surgery may be used for severe tenosynovitis. The surgery will release the tendon and allow it to move freely.

Prevention

To prevent tenosynovitis, avoid overuse of your tendons. Take the following steps if you have a job or hobby that involves repetitive motions of the hand, wrist, or foot:

  • Adjust your workspace to minimize the strain on your joints
  • Alternate activities when possible
  • Take breaks throughout the day
  • Exercise regularly

RESOURCES:

American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org

American Society for Surgery of the Hand
http://www.assh.org

CANADIAN RESOURCES:

Canadian Orthopaedic Foundation
http://www.canorth.org

Health Canada
http://www.hc-sc.gc.ca

References:

De Quervain syndrome. American Society for Surgery of the Hand website. Available at: http://www.assh.org/Public/HandConditions/Pages/deQuervainsTendonitis.aspx. Published 2012. Accessed February 28, 2014.

De Quervain tendonitis. American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00007. Updated December 2013. Accessed February 28, 2014.

De Quervain’s tenosynovitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 10, 2013. Accessed February 28, 2014.

10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.



Last reviewed February 2014 by Teresa Briedwell, PT, DPT

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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