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Tenosynovitis

Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone).

Alternative Names

Inflammation of the tendon sheath

Causes

The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from:

  • Diseases that cause inflammation
  • Infection
  • Injury
  • Overuse

The wrists, hands, and feet are commonly affected, because the tendons are long across those joints. But, the condition may occur with any tendon sheath.

An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery.

Symptoms

Symptoms may include any of the following:

  • Difficulty moving a joint
  • Joint swelling in the affected area
  • Pain and tenderness around a joint, especially in the hand, wrist, foot, or ankle
  • Pain when moving a joint
  • Redness along the length of the tendon

Fever, swelling, and redness may indicate an infection, especially if a puncture or cut caused these symptoms.

Exams and Tests

A physical examination shows swelling over the involved tendon. The health care provider may touch or stretch the tendon, or have you move the muscle where it is attached to see whether you experience pain.

Treatment

The goal of treatment is to relieve pain and reduce inflammation. Rest or keeping the affected tendons still is essential for recovery.

You may want to use a splint or removable brace to help keep the tendons still. Applying heat or cold to the affected area should help reduce pain and inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can relieve pain and reduce inflammation. Local injections of corticosteroids may be useful as well. Some patients need surgery to remove the inflammation surrounding the tendon, but this is not common.

Tenosynovitis caused by infection needs immediate treatment. Your health care provider will prescribe antibiotics. In some severe cases, emergency surgery may be needed to release the pus around the tendon.

If there is no infection, a steroid injection may be used to decrease inflammation along the tendon sheath.

After you have recovered, do strengthening exercises using the muscles around the affected tendon to help prevent the injury from coming back.

Outlook (Prognosis)

Most people fully recover with treatment. If the condition is caused by overuse and the activity is not stopped, tenosynovitis is likely to come back. In chronic conditions, the tendon may be damaged. Recovery may be slow or incomplete.

Antibiotics are needed for tenosynovitis caused by infection. Without prompt treatment, permanent stiffness or pain may occur.

Possible Complications

If tenosynovitis is not treated, the tendon may become permanently restricted or it may tear (rupture). The affected joint can become stiff.

Infection in the tendon may spread to other places in the body, which could be serious and threaten the affected limb.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have pain or difficulty straightening a joint or extremity . Call right away if you notice a red streak on your hand, wrist, or foot. This is a sign of an infection.

Prevention

Avoiding repetitive movements and overuse of tendons may help prevent tenosynovitis.

Use the appropriate wound care techniques to clean cuts to the hand, wrist, and feet.

References

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.

Updated: 9/8/2014

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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