Tenosynovitis

Overuse of a tendon most commonly results in tendon inflammation or tenosynovitis or tendonitis.

Tendonitis or tendinitis = inflammation of a tendon.
Tenosynovitis means inflammation of the sheath that surrounds the affected tendon.

These conditions can often happen together.

Your tendons are strong tissue that attaches a muscle to a bone. Most are covered by a sheath called the
synovium. This makes an oily fluid which lies between the tendon and the sheath. This helps the tendon move smoothly when it pulls on the bone it is attached to.

Symptoms

People normally describe pain, tenderness and swelling over the affected part of the tendon.
The skin can feel warm around the tendon. The movement of that part of the body near the tendon is reduced.

This can last weeks or months if it goes untreated.

Common areas affected

Wrists and hands are often the areas most affected. Below are some named conditions.

De Quervain tenosynovitis.

The tendons that straighten the thumb are affected. People often find they have pain over the wrist and the base of the thumb. This is made worse by activity, and improves with rest.

Trigger finger.

The ring finger is the most commonly affected finger. The finger normally doesn't straighten easily due to the inflammation.

Achilles tendonitis.

The Achilles tendon is above the heel.

Rotator cuff tendonitis.

The rotator cuff muscles are found at your shoulder. They help to rotate and lift your shoulder. The tendons from these muscles sometimes become inflamed.

Causes

Many cases happen for no obvious reason. Often it is due to overuse of the tendon.

Tenosynovitis around the wrist can be due to:

• lots of computer work - typing,
• using the mouse
• writing too much, or
• working on an assembly line for long periods

If you suffer from arthritis this can often affect your tendon sheaths as well as the joints.

Infection is a rare cause. But, if you have a puncture wound to the skin over the tendon, germs can get in and infect the tendon sheath. Or, infection can spread to the tendon sheath through the blood stream.

Rest. This allows the inflammation to settle. Your physiotherapist, GP or other health care professional may give
you a splint, brace or firm bandage to put over the area. Ice packs or wet ice cube over the affected area may ease the swelling and pain. (See below.)

Anti-inflammatory painkillers are often prescribed, for example ibuprofen. It is best to discuss this with your GP or pharmacist.

Physiotherapy. You may be referred to a physiotherapist if the above treatment does not work or if a splint is recommended.

Steroid injection. Again, if the above treatments do not work then you may be offered a steroid injection to reduce the inflammation.

Surgical release of a tendon is rarely needed.

Ice

• Using a wet ice cube or ice pack over the affected area can be helpful.
• An ice pack or bag of frozen peas wrapped in a tea towel over the area for 10-15 minutes can reduce some pain.
• Gently circle the area with a wet ice cube as the ice cube melts, again no longer than 10 minutes.
• It is very important to watch the skin and prevent any ice burns. Always wrap an ice pack in a tea towel to avoid direct contact with the skin.
• Never leave an ice pack on for more than 30 minutes at a time. Allow the skin to return to normal temperature before you put ice on again.