• Tenosynovitis

    (Synovitis)

    Definition

    Tendons are the cords that connect bones to muscles in the body. They are covered by a sleeve-like tissue called a synovial sheath. Tenosynovitis is an inflammation of this sleeve. 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
    • Joint stiffness
    • Joint swelling
    • Difficulty moving a joint
    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. Tenosynovitis that affects tendons of the fingers can also make the finger stick in a bent position.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done including an assessment of the joint.
    A blood test may also be done. Your doctor will use this to look for signs of bacterial infection or other conditions such as rheumatoid arthritis. Your doctor may refer you to a hand specialist.

    Treatment

    Talk with your doctor about the best treatment plan for you. The goals of treatment is to reduce swelling and pain and to allow the tendon to move freely through the tendon sheath. Treatment options include the following:

    Rest

    Resting the involved joint is often the best treatment for tenosynovitis. A brace or splint may be used to help you rest the joint. Rest may be combined with basic stretching and strengthening exercises.

    Ice and Heat

    Applying ice or heat to the area may decrease pain and swelling. Start with ice, especially soon after the injury. If ice is not helpful try heat.

    Medications

    Several medications are used to treat tenosynovitis. These include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation and pain
    • Topical pain medicines (eg, creams, patches) applied to the skin
    • Corticosteroids—injected into the sheath
    • Antibiotics—if tenosynovitis was caused by a bacterial infection

    Surgery

    Surgery may be used for severe tenosynovitis. The surgery will release the tendon and allow it to move freely within its sheath.

    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 Academy of Orthopaedic Surgeons http://www.orthoinfo.aaos.org/

    American Society for Surgery of the Hand http://www.assh.org/

    CANADIAN RESOURCES

    Association for Repetitive Motion Syndromes http://www.certifiedpst.com/arms/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    De Quervain tendonitis. American Society for Surgery of the Hand website. Available at: http://www.assh.org/Public/HandConditions/Pages/deQuervainsTendonitis.aspx . Accessed January 3, 2012.

    De Quervain tendonitis. Amercian Academy of Orthopedic Surgeons website. Available at: hhttp://orthoinfo.aaos.org/topic.cfm?topic=A00007 . Accessed January 3, 2012.

    De Quervain’s tenosynovitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 13, 2011. Accessed January 3, 2012.

    10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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