A Family Doctor's Tale - TENDONSYNOVITIS

DOC I HAVE A PAINFUL TENDON

Tenosynovitis is fairly common more in women than in men. One of the most common tenosynovitis is tennis or golf elbow due to strain of the tendon at the elbow region. 
The other common tenosynovitis are trigger finger at the palm of the hand and De Quarvain's Disease which affects the tendons of the wrist. 
In most cases a single injection of lignocaine and hydrocortisone will clear the  inflammation and swelling of the tendon sheath. Recurrence however is common. Patients are advised to avoid pressure on their tendon sheaths and strain on their tendons. 
Very rarely is there any need to go for surgery

Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.


It can occur together with tendinitis(inflammation of the tendons).


It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).


The cause of Tenosynovitis is unknown.

Some possible causes are:
1.Injury or trauma to the tendon


2.Repetitive usage of finger and wrist joints 


3.Arthritis of the joints may predispose to tenosynovitis


4.Systemic diseases such as multiple sclerosis , amyloidosis, rheumatoid arthritis


5.Tenosynovitis occurs in families, and is generally seen more often in males than in females


Symptoms:
1.Pain on movement of the tendon


2.Swelling of part of the tendon affected


3.Stenosis of the tendon sheath may be present


4.Stiffness of the tendon - inability to stretch


5.Pain is felt most beneath the bone of involved joints


Signs:

1.swelling over the involved tendon


2.Passive stretching of the tendon is painful.


3.There may be local tenderness of the inflamed tendon.


4.The tendons sheaths are usually swollen and thickened


5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)


6.There may be crepitation over the tendon as it moves across the sheaths



Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.


Conservative treatment:

1.rest of the tendon


2.Cold or ice may help reduce inflammation


3.Splints over the hand, wrist and elbow may help to rest the tendons


4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain


5.Muscle relaxant to relax muscles


6.Injection of local anesthetic and long acting steroid into the affected sheath or tendon nodule may help to reduce inflammation


7.Surgery :

Surgical opening of the synovial sheath may be necessary for tendon release.


Prognosis is usually good although recurrence may occur after cortisone injection.


Surgery usually give excellent results.