Inflammation of the tendon sheath

Alternative names 
Tenosynovitis

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

Causes, incidence, and risk factors

The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis refers to inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from injury, overuse, strain, or infection. The wrists, hands, and feet are areas that are commonly affected, although it may occur with any tendon sheath.

Note: A laceration to the hands or wrists that results in infection that causes tenosynovitis may be an emergency that requires surgery.

Symptoms

     
  • Difficulty moving a joint  
  • Pain and tenderness around a joint, especially the hand, wrist, foot, and ankle  
  • Pain on movement of a joint  
  • Joint swelling in the affected area

Fever, swelling, and redness may indicate an infection, especially if a puncture or laceration 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 to which it is attached to see whether you experience pain.

Treatment

The goal of treatment is to relieve pain and reduce inflammation.

Rest or immobilization of the affected tendons is essential for recovery. You may want to use a splint or a removable brace to help immobolize the tendons. Applying heat or cold to the affected area should help reduce the pain and inflammation.

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

For tenosynovitis caused by infection, your health care provider will prescribe antibiotics. In some severe cases, surgery may be needed to release the pus around the tendon.

After recovery, use strengthening exercises involving the muscles surrounding the affected tendon to help prevent recurrence of the injury.

Expectations (prognosis)

The probable outcome is full recovery with treatment. However, if the condition is caused by overuse and the offending activity is not stopped, tenosynovitis is likely to recur. In chronic conditions, the tendon may be damaged and recovery may be delayed or incomplete.

Complications

If tenosynovitis is left untreated, the tendon may become permanently restricted or it may rupture.

Infection in the tendon may spread to other places in the body, which could have serious consequences.

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 an extremity may help prevent tenosynovitis.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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