• Tenosynovitis

    (Synovitis)

    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 tissue. 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, stiffness, or 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. It will be done to look for signs of bacterial infection or other conditions such as rheumatoid arthritis. You may be referred 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:

    Supportive Care

    The tendon will need time to heal. Supportive care may include the following: . A brace or splint may be used to help you rest the joint. Rest may be combined with basic stretching and strengthening exercises.
    • Activities may need to be restricted. Normal activities will be gradually reintroduced.
    • Ice therapy may help decrease pain and swelling. If ice is not helpful, heat therapy may be advised.
    • A brace or splint may be used to help rest the joint.

    Physical Therapy

    A physical therapist will assess the tendon. An exercise program will be created to reduce discomfort and promote recovery. The therapist may also suggest modifications to your workplace to reduce stress to the area.

    Medications

    Several medications are used to treat tenosynovitis. These include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation and pain
    • Topical pain medications, such as creams and patches, that are applied to the skin
    • Corticosteroid injections to reduce swelling
    • Antibiotics to treat 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 Society for Surgery of the Hand http://www.assh.org

    OrthoInfo—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.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. Accessed March 11, 2015.

    De Quervain tendonitis. American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00007. Updated December 2013. Accessed March 11, 2016.

    De Quervain’s tenosynovitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115729/de-Quervain-tenosynovitis. Updated January 20, 2015. Accessed March 11, 2016.

    Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev 2015;(6):CD007402.

    10/26/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115729/de-Quervain-tenosynovitis: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

    Revision Information

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