What is Tenosynovitis?
An overload which is related to the continuous repetition of a movement may cause inflammation of the tissue surrounding the tendon. The result is tenosynovitis (inflammation of the sheath surrounding the tendon). Tenosynovitis affects mainly people who work with the computer daily. Athletes, dependents, bartenders, hairdressers and warehouse staff can also develop this injury.
The tendon sheath encloses and protects the tendons, especially in the area where they extend directly through the bone or bony prominences due to the excessive friction that occurs in these areas. Through the joint fluid (synovial fluid) inside, the tendon sheaths facilitate the movement of the tendon. Overuse of certain tendons lead o inflammation of the tendon sheath. The most common is inflammation that occurs in the wrist. However, tenosynovitis can occur in any tendon which is covered by this sheath.
Tenosynovitis is an injury that can occur due to different causes such as:
- Most tenosynovitis occur due to prolonged repetition of monotonous movements and / or a permanent incorrect position such as improper working position by inappropriate table, computer mouse that favors poor posture or poor keyboard tight
- Repeated uniform movements (for example, working with the computer, weight training or rowing practice)
- Strong overload for practicing sports such as tennis, gymnastics or climbing. Musicians (for example, guitarists, violinists or pianists) are also prone to suffer from this injury by repetition of movements during the study
- Inflammatory rheumatic disease can lead to inflammation of the tendon sheath (tenosynovitis)
- Tenosynovitis may be the result of an infection with chlamydia, mycoplasma or gonococcus
The characteristic symptoms of tenosynovitis are as follows:
- Severe stabbing pain.
- Cracking in the affected joint with the movement.
- Inflammation, redness and temperature increase of the affected area.
Typically, a treatment with analgesic and anti-inflammatory drugs is sufficient in tenosynovitis to resolve this lesion. It is advisable to apply heat or cold and immobilize the joint. To avoid the general malaise caused by tenosynovitis, it is also very positive to avoid the daily tasks that have caused it. In these cases, there are many possibilities for healing. However, a tenosynovitis that is not detected or treated early can become chronic. This means that because of repeated stress, the injury will recur (known as one of the repetitive strain injuries). In some risk groups, including those who work daily in front of the computer, tenosynovitis is considered a professional disease.
Tenosynovitis or inflammation of the tendon sheath is an inflammation of the tissue that lines the tendon. In principle, all pods of any tendon can become inflamed (on the hand, foot, forearm or elbow). However, the area that is most often affected by this injury is the wrist. There is a special form of tenosynovitis that only affects the thumb. This form is called stenosing tenosynovitis or de quervain’s tenosynovitis.
Tenosynovitis is recognized as a professional disease. Among the professional groups most affected by tenosynovitis are the following:
- People who work daily with the computer (especially the transcriptionists)
- Musicians (pianists or guitarists)
- Masseurs and physiotherapists
What Causes Tenosynovitis?
The causes of inflammation of the tendon sheath (tenosynovitis) are often monotonous repetitive movements or poor permanent posture. When someone performs the same movement many times or when he or she adopts an unsuitable position permanently, excessive friction of the tendon with the bone occurs. Therefore, the tendon sheath will wear out over time. Its walls are damaged and small lesions can lead to inflammation of the sheath.
The following factors contribute to excessive friction and to inflammation of the tendon sheath:
An improper working position, such as poor position on the table, computer mouse or keyboard
Repeated uniform movements (for example, working with the computer, weight training or rowing practice)
Strong overload for practicing sports such as tennis, gymnastics or climbing
Musicians (for example, guitarists, violinists or pianists) are also prone to this injury by repetition of movements during the study
Inflammatory diseases of the joints and infections are among the possible causes of tenosynovitis. However, These are not very frequent. Trigger infections can be chlamydia, mycoplasma, or gonococcus. The latter is also known as the pathogen of gonorrhea (gonorrhea).
Symptoms of Tenosynovitis
Symptoms caused by tenosynovitis resemble those of other inflammatory diseases such as carpal tunnel syndrome. The characteristic symptoms of tendon sheath inflammation are as follows:
- Severe stabbing pain.
- Cracking in the affected joint that is with the movement.
- Inflammation of the affected area may become red and warm
- Nodular thickening may be a symptom of chronic tendon sheath inflammation
- Tendon of the thumb is affected
How is Tenosynovitis Diagnosed?
Usually, the diagnosis of tenosynovitis is based on the following parts:
The clinical history (anamnesis): If anti-inflammatories relieve the discomfort and if there is any inflammatory disease of the joints or basic bacterial infection, It is important to provide information about the professional activity that is performed.
Physical exploration: By palpating the affected area, it is checked if the pressure causes pain or if the joint produces a creaking when it moves.
Other tests: If this is not sufficient to confirm the diagnosis of tendon sheath inflammation, other tests or examinations will be necessary. An X-ray and a blood test can be used to try to detect inflammatory biomarkers and rheumatoid factors to know if there is a tenosynovitis. High levels of uric acid may support the diagnosis.
How To Treat Tenosynovitis?
Normally, treatment of tenosynovitis is a conservative (non-surgical) therapy that works against the trigger of inflammation. In this treatment, drugs can be prescribed or establish home remedies such as applying a source of heat or cold to relieve the symptoms of tenosynovitis. In addition, adopting healthy habits can also help improve inflammation of the tendon sheath.
Before the symptoms of a tenosinovitis, it is recommended to cool the affected area because this can improve the inflammation. The use of a source of heat or external cold can be helpful against pain, either in motion or at rest, when the tendon sheath is inflamed. Non-steroidal antirheumatic drugs are used for treatment with tenosynovitis drugs. These drugs do not contain cortisone and act as anti-inflammatories and analgesics.
In addition, there are preparations of cortisone and special creams for the treatment of inflammation of the tendon sheath that can counteract inflammation. If the inflammation of the tendon sheath causes acute pain, there is the option of administering local anesthesia. This injectable is given near the nerve that causes the pain (nerve block).
If inflammation of the tendon sheath is caused by an infection, it is important for the treatment to determine the pathogen which cause tenosynovitis. When the inflammation of the tendon sheath has a particularly painful outcome and conservative treatment does not achieve the desired results, a surgical intervention will be performed. The surgeon divides the point at which the tendon sheath is narrowed and thus the area tension disappears.
Tenosynovitis may have a fairly long evolution. However, the prognosis is good, unless there are other associated diseases such as rheumatism or arthritis.
A tenosynovitis that is detected and treated too late can lead to various complications in a late development. In these cases, symptoms and chronic discomfort can be manifested. In this case, it is referred to a repetitive strain injury (RSI). This term refers to symptoms caused by efforts and activities that are performed regularly and repeatedly.
In other cases, stenosing tenosynovitis can give rise to inflammation of the sheaths of the tendons of the hand (particularly of the sheaths of the flexor tendons).
How To Prevent Tenosynovitis?
The inflammation of the tendon sheath (tenosynovitis) can be prevented with simple measures. Since tenosynovitis is due to repetition of movements or to an inadequate permanent posture (poor computer habits, exercise with weights or repeated movements during the study of an instrument), the following preventive measures are recommended:
- Perform frequent breaks when performing activities with monotonous movements (for example, in professions such as musicians, masseurs or physiotherapists)
- Place a pad in front of the computer keyboard and make sure the keyboard is not tilted. These two measures relax the wrist because they make it stay straight
- If possible, make changes to the usual movements