TENOSYNOVITIS

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Tenosynovitis is a condition that causes inflammation in the protective sheath surrounding your tendons. This sheath, called the synovial membrane, lubricates and cushions your tendons as they slide during movement. When it gets inflamed, it can be painful and limit your ability to move your joints.

Understanding Tendons and the Synovial Membrane

• Tendons are tough cords that connect muscles to bones, allowing for movement.
• The synovial membrane surrounds tendons like a sleeve, filled with fluid to keep them moving smoothly. Imagine an electrical cord with a rubber coating; the coating protects the inner wires, similar to how the synovial membrane protects your tendons.

It’s important to distinguish between tenosynovitis and tendinitis, another tendon-related condition. While both involve inflammation, they affect different parts of the tendon.

In tenosynovitis, the inflammation occurs in the synovial membrane surrounding the tendon, also known as synovitis. On the other hand, tendinitis involves inflammation within the tendon itself. Tendinitis can manifest as either acute, meaning short-term, or chronic, indicating long-term inflammation.

Stenosing tenosynovitis is a specific type of tenosynovitis characterized by the narrowing, or stenosis, of the passageway through which a tendon moves. Imagine trying to slide your arm through a jacket sleeve that’s too tight because you’re wearing extra layers in winter. That’s similar to the sensation experienced when a tendon struggles to move smoothly through an inflamed area of the body.

Forms of stenosing tenosynovitis

There are various forms of stenosing tenosynovitis

1. Trigger finger: This occurs when the tunnel guiding the tendons in your fingers and thumb becomes inflamed, leading to a sensation of catching or bumping when bending the affected finger.
2. De Quervain’s tendinosis: This painful inflammation affects the tendons of the thumb, often causing discomfort on the back side of the wrist near the thumb.
3. Peroneal tenosynovitis: The peroneal tendons located on the sides of your ankles can experience stenosing tenosynovitis if their surrounding synovial membrane becomes inflamed.
4. Forearm tenosynovitis: The tendons around the forearm, such as the extensor carpi ulnaris, extensor carpi radialis, and extensor digitorum communis, can develop narrowing and inflammation.

Risk factor

Anyone can be affected by tenosynovitis, but certain factors increase the risk.

• Rheumatoid arthritis
• Diabetes
• Hand infections
• Gout
• COPD (Chronic Obstructive Pulmonary Disease)
• Thyroid disease
• Dupuytren’s disease
• Undergoing specific cancer treatments

Given the diverse causes and conditions associated with tenosynovitis, it’s relatively common. More than half of individuals with rheumatoid arthritis and approximately 20% of those with diabetes experience tenosynovitis at some point. If you’re experiencing pain or restricted movement in any part of your body, it’s essential to consult with your healthcare provider for proper evaluation and treatment.

Tenosynovitis typically manifests as pain and can affect tendons connected to muscles responsible for pushing, pulling, or extending your limbs, including both flexor and extensor muscles. It commonly impacts areas such as the hands, wrists, and feet, making movement challenging and causing discomfort.

Symptoms of tenosynovitis

The symptoms of tenosynovitis often include:

1. Pain
2. Swelling around the joint
3. Difficulty moving the affected body part as usual
4. Pain during movement
5. Discoloration along a tendon in a straight line

Causes of tenosynovitis

Various factors can lead to this condition, including:

1. Autoimmune diseases: Conditions like rheumatoid arthritis and gout, where the body’s immune system mistakenly attacks itself, can damage the synovial membrane, leading to tenosynovitis.
2. Overuse: Repeatedly performing the same motion over an extended period can result in overuse syndrome, often involving tenosynovitis.
3. Infections: Common infections can spread to the synovial membrane, causing infectious tenosynovitis.
4. Trauma: Injuries or accidents that damage tendons or the surrounding area can trigger tenosynovitis.

While rest and avoiding the activity that caused the condition are sometimes helpful in managing tenosynovitis, it’s essential to seek proper diagnosis and treatment from a healthcare provider. Leaving tenosynovitis untreated can lead to long-term damage to the tendons, highlighting the importance of timely medical intervention.

Diagnosis and tests

To diagnose this condition, your healthcare provider will conduct a physical examination, assessing your symptoms and range of motion. They may also order blood tests or other lab tests to check for infections.

Imaging tests may be necessary, including:

1. X-rays: These can reveal signs of inflammation and hardened synovial membranes.
2. Magnetic resonance imaging (MRI) provides a comprehensive view of the affected tendon and surrounding area.
3. Ultrasound: Similar to X-rays but focused on soft tissue, it can detect inflammation around the tendon.
4. CT scan: Offers a detailed image of the tendon and surrounding tissue, often more precise than X-rays.

Management and Treatment

Treatment for this condition depends on its cause and severity.

1. Rest and activity modification: Stopping the activity that triggered the condition and giving the affected tendon time to heal.
2. Bracing or splinting: Helps reduce stress on the tendon.
3. Heat or cold therapy: Applied to alleviate pain and inflammation.
4. Steroid injections: Administered to reduce inflammation.
5. Surgery is reserved for cases where conservative treatments fail or when there’s a risk of permanent damage, particularly if caused by infection or severe inflammation.

Medications:

Medications prescribed for tenosynovitis include:

1. Antibiotics: If an infection is the cause.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter options like aspirin or ibuprofen to alleviate pain and inflammation.
3. Corticosteroids: Anti-inflammatory injections provided by a healthcare provider.

Complications

The complications of tenosynovitis treatment may include:

1. Stiffness in the affected area.
2. Deformed tendons.
3. Spread of infection to other parts of the body.
4. Scarring.

Prevention

To reduce the risk of tenosynovitis, avoid overusing tendons and allow adequate recovery time after physical activities. Proper safety equipment and safe workout practices can also prevent strain on tendons.

Outlook/Prognosis

Most individuals recover fully from tenosynovitis within four to six weeks, depending on the underlying cause. Those with infections may face longer recovery times and a higher risk of complications.

Living With tenosynovitis

Follow all instructions from your healthcare provider or surgeon, and be patient as treatments take time to work. Seek medical attention if symptoms worsen or fail to improve after a few weeks.

Sources

1. Webmd “
2. Cleveland Clinic: “De Quervain’s Tendinosis,” “Tendinitis.”
3. Mayo Clinic: “De Quervain’s tenosynovitis,” “Overuse injury: How to prevent training injuries,” “Tendinitis.””