Tendons are tough fibrous structures that connect the muscles to the bone and aid in movement of the joint. The tendons that pass across certain joints like shoulder, wrist and ankle joints are enclosed in double layered sheath called tendon sheaths. These tendon sheaths aids in smooth movement of the tendon and reduces risk of tendon damage from friction or pressure over the bone. Tenosynovitis is a condition in which these tendon sheaths get inflamed.
The tendon sheaths are lined with specialized tissue, synovial membrane which secretes a lubricating substance (Synovial fluid). This normally enables the inner and outer layers of a tendon sheath to glide over each other, allowing the tendon to move freely.
In tenosynovitis, inflammation of the tendon sheath prevents this free movement, but any attempted movement tends to be painful and limited.
- Repetitive micro trauma
- Example like – repetitive usage of mouse and keyboard,
- Repetitive usage of wrist and thumb during household works
- Repetitive use of particular group of muscles. Example: Racquet sports, badminton players
- An acute injury.
- Infection spreading from a nearby part of the body, such as infection of the finger pulp, or carried in the blood stream.
- An inflammatory disease involving the synovial membrane, such as rheumatoid arthritis.
Tenosynovitis is recognized as an occupational disease.
Farmers harvesting sugar cane can have severe tenosynovitis affecting the tendons that extend the wrist. It is otherwise called as “cane cutters disease.” Dhobis, Housewives who repeatedly twist wet clothes are at risk of developing tenosynovitis of tendons at base of thumb or wrist also called as Dequervain’s Disease.
- Swelling over the affected tendon and joint.
- Restricted movement
- Pain on making particular movement, such as moving up and down the wrist or ankle or moving the joint at the base of the thumb.
- The will be swelling along the line of the tendon or, in some long standing cases, the formation of fibrous nodule that can sometimes be seen or felt.
- A warm feeling over the affected tendon.
- Grating sensation in the region of the tendon on movement (crepitus).
- Details of patient’s lifestyle,
- Work place – computer, Keyboard, mouse etc
- Unaccustomed exercises
- History of Rheumatoid arthritis or any joint problems
The diagnosis usually made clinically by examining the affected part.
The doctor may note that
- Movement is limited and painful
- The tendon sheaths are visibly swollen.
- The overlying skin is red and warm to touch
With long standing tenosynovitis an x ray may reveal calcium deposits in the tendon and its sheath.
The discomfort of severe tenosynovitis may be relieved by cold compresses, while chronic inflammation may respond to heat.
Most cases of tenosynovitis resolve with rest. Initially rest to particular tendon and joint can be achieved by applying braces. In severe cases, resting the affected part in a splint or plaster cast for a short period may aid in recovery but, once the acute phase, has passed, the affected part should be exercise several times a day to prevent the formation of scar tissue that may later cause trouble some stiffness.
- Analgesics (pain killing) drugs and
- Non-steroidal anti-inflammatory drugs (NSAID’s) may also be helpful.
- Injections: if there is no evidence of infection local steroid injection can help to relive pain and aid in early recovery.
- In people with rheumatoid arthritis, general measures to treat their disease, anti-arthritis drugs, will be necessary as well as local treatment.
- Antibiotic treatment will be needed if there are signs of infection.
In case tenosynovitis is not responding physical therapy or medications a minor surgery to cut the tight fibrous tissue can help to relive pain and stiffness.
Most patients recover well from tenosynovitis with rest and treatment.
If a person has had tenosynovitis once, it’s likely to recur, especially if the cause is not addressed. It is therefore important to take measures to avoid recurrence by, for example altering working place.