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Tenosynovitis

Definition

Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone).

Alternative Names

Inflammation of the tendon sheath

Causes, incidence, and risk factors

The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from:

  • Diseases that cause inflammation
  • Infection
  • Injury
  • Overuse
  • Strain

The wrists, hands, and feet are commonly affected. However, the condition may occur with any tendon sheath.

Note: An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery.

Symptoms

  • Difficulty moving a joint
  • Joint swelling in the affected area
  • Pain and tenderness around a joint, especially the hand, wrist, foot, or ankle
  • Pain when moving a joint
  • Redness along the length of the tendon

Fever, swelling, and redness may indicate an infection, especially if a puncture or cut caused these symptoms.

Signs and tests

A physical examination shows swelling over the involved tendon. The health care provider may touch or stretch the tendon, or have you move the muscle where it is attached to see whether you experience pain.

Treatment

The goal of treatment is to relieve pain and reduce inflammation. Rest or keeping the affected tendons still is essential for recovery.

You may want to use a splint or a removable brace to help keep the tendons still. Applying heat or cold to the affected area should help reduce the pain and inflammation.

Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can relieve pain and reduce inflammation. Local injections of corticosteroids may be useful as well. Some patients need surgery to remove the inflammation surrounding the tendon, but this is not common.

Tenosynovitis caused by infection needs immediate treatment. Your health care provider will prescribe antibiotics. In some severe cases, surgery may be needed to release the pus around the tendon.

If there is no infection, a steroid injection may be used to decrease inflammation along the tendon sheath.

After you have recovered, do strengthening exercises using the muscles around the affected tendon to help prevent the injury from coming back.

Expectations (prognosis)

Most people fully recover with treatment. However, if the condition is caused by overuse and the activity is not stopped, tenosynovitis is likely to come back. In chronic conditions, the tendon may be damaged and recovery may be slow or incomplete.

Antibiotics are necessary for tenosynovitis caused by infection. Without prompt treatment, permanent stiffness or pain may occur.

Complications

If tenosynovitis is not treated, the tendon may become permanently restricted or it may tear (rupture). The affected joint can become stiff.

Infection in the tendon may spread to other places in the body, which could be serious and threaten the affected limb.

Calling your health care provider

Call for an appointment with your health care provider if you have pain or difficulty straightening a joint or extremity. If you suspect infection, contact your health care provider immediately.

Prevention

Avoiding repetitive movements and overuse of tendons may help prevent tenosynovitis.

Use the appropriate wound care techniques to clean cuts to the hand, wrist, and feet.

References

Geiderman JM, Katz D. General principles of orthopedic injuries. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 46.

Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 115.

Netscher D, Murphy K, Fiore II NA. Hand surgery.In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL,eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 70.


Review Date: 8/11/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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