What Is It, de Quervain’s Tenosynovitis, Diagnosis, Treatment, and More
Author:Anna Hernández Castillo, MD
What is tenosynovitis?
Tenosynovitis refers to the inflammation of the tendons and the synovial sheath that surrounds them. Tendons are fibrous cords made up of connective tissue that connect muscle to bone. The tendon sheath is a protective membrane filled with synovial fluid that covers tendons and lubricates them, allowing them to glide smoothly and freely.Inflammation of the tendon sheath can cause pain, swelling, and tenderness along the extent of the sheath, as well as worsening pain with movement. When continued inflammation causes the thickening of the tendon sheath, it can restrict tendon movement and cause contractures, or locking of the joint. Most often, tenosynovitis affects longer tendons, such as those of the hands, wrists, and feet. However, tenosynovitis can affect any tendon that is covered by a tendon sheath.
What are the causes of tenosynovitis?
Tenosynovitis is most often caused by repetitive movements performed with the hand and wrist, such as typing or grasping tools. Other risk factors that can contribute to the development of tenosynovitis include pregnancy, being biologically female, and being over 40 years old. Other causes of tenosynovitis include inflammatory systemic disorders such as rheumatoid arthritis, psoriatic arthritis, and gout. Tenosynovitis may also occur in individuals with metabolic conditions such as diabetes.
Less frequently, tenosynovitis may result from infections of the tendon sheath, which causes infectious tenosynovitis. These infections typically affect the tendons of the hand, especially the flexor tendons in the fingers. Common causes of infectious tenosynovitis include penetrating injuries—such as an animal bite or a contaminated wound—or infection spreading from nearby tissues or the bloodstream.
Finally, some cases of tenosynovitis are idiopathic, meaning that the cause is unknown.
Is tenosynovitis serious?
Most cases of tenosynovitis are fairly mild and can be managed with rest, modification of the repetitive movement, and medications aimed at reducing inflammation. However, if left untreated, chronic tenosynovitis can lead to limited range of motion, joint contractures, and deformities (a long term outcome). Infectious tenosynovitis, on the other hand, is often an aggressive condition that requires early detection and treatment to prevent tissue damage and the spread of infection. If not treated, severe infectious tenosynovitis can lead to the amputation of the affected area.
What is the difference between tendonitis and tenosynovitis?
Tendonitis (also known as tendinitis) refers to the inflammation of a tendon or a group of tendons. Tenosynovitis, on the other hand, refers to the inflammation of the tendon and its synovial sheath. Any tendon of the body can become inflamed, but only those surrounded by a tendon sheath can develop tenosynovitis.
What is de Quervain’s tenosynovitis?
De Quervain’s tenosynovitis (also known as de Quervain’s tendinopathy) is a type of tenosynovitis that affects some of the tendons on the wrist below the thumb, also known as the first dorsal compartment of the wrist. This area is part of a fibrous tunnel that separates the extensor tendons of the fingers as they branch into the hand. The specific tendons affected by de Quervain’s tenosynovitis are the abductor pollicis longus (APL) and extensor pollicis brevis (EPL), which are responsible for moving the thumb away from the rest of the hand. Repetitive movements involving the thumb, such as texting, typing, and certain hobbies, can lead to the thickening of the tendon sheath and overlying connective tissue. Common signs and symptoms of de Quervain’s tenosynovitis include pain and swelling near the base of the thumb, as well as a clicking sound when moving the thumb.
How do you diagnose tenosynovitis?
Tenosynovitis can be diagnosed clinically through physical examination. Common signs and symptoms of tenosynovitis include pain, swelling, limited range of motion, difficulty gripping things, and worsening of pain with certain movements. In some cases, a popping or clicking noise can be heard when moving the affected tendon. In individuals with wrist pain, specific maneuvers, known as Finkelstein’s and Eichhoff’s maneuvers, may be assessed to determine the presence of de Quervain’s tenosynovitis. Infectious tenosynovitis can present clinically with Kanavel’s classic signs, which include swelling of the affected finger, tenderness over the course of the tendon sheath, pain upon passive extension, and resting flexed posture of the finger. When infectious tenosynovitis is suspected, analysis of the synovial fluid within the tendon sheath and blood tests looking for markers of infection can be performed.After physical examination, imaging techniques such as ultrasound or magnetic resonance imaging (MRI) can be performed to confirm diagnosis or detect underlying conditions.
How do you treat tenosynovitis?
Treatment of tenosynovitis will vary depending on the severity and the cause. Most cases of non-infectious tenosynovitis can be managed with rest, immobilization of the affected area, and nonsteroidal anti-inflammatory drug (NSAID) treatment, such as naproxen or ibuprofen. If NSAIDs fail to relieve the pain, a corticosteroid injection can be used to reduce inflammation. Surgical intervention may be considered if symptoms persist after several months of adequate medical treatment. It’s important to treat de Quervain’s tenosynovitis, as it can permanently limit range of motion or—in severe cases—cause the tendon sheath to burst. When the initial pain has resolved, physical therapy is often recommended to strengthen the muscles and prevent similar injuries in the future. Additionally, if tenosynovitis is a result of a systemic disorder, such as rheumatoid arthritis or gout, treatment may also include medications to treat the underlying disorder.Infectious tenosynovitis is a medical emergency that should be treated with broad-spectrum antibiotics, as well as surgical drainage, which consists of irrigation of the tendon sheath. More severe cases may require surgical removal of damaged tissues.
What are the most important facts to know about tenosynovitis?
Tenosynovitis refers to the inflammation of the tendon and the surrounding tendon sheath. Most often, tenosynovitis affects longer tendons, such as those of the hands, wrists, and feet. However, tenosynovitis can affect any tendon that is covered by a tendon sheath. Tenosynovitis can occur as a result of repetitive movement, infections, or associated conditions (such as diabetes, rheumatoid arthritis, and gout). Common signs of tenosynovitis include pain that is worsened by activity, swelling of the affected area, and limited range of motion. Diagnosis of tenosynovitis is established clinically through physical examination, although certain imaging techniques can be useful to detect additional signs of inflammation. Mild cases of non-infectious tenosynovitis are generally managed with rest, immobilization, and pain medication. More severe cases may require a corticosteroid injection or surgical intervention. Infectious tenosynovitis is a medical emergency that often requires treatment with antibiotics and surgery.
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Resources for research and reference
Adams, J. E. & Habbu, R. (2015). Tendinopathies of the Hand and Wrist. The Journal of the American Academy of Orthopaedic Surgeons, 23(12): 741–750. DOI: 10.5435/JAAOS-D-14-00216
Jenson, Mak (2018). De Quervain’s Tenosynovitis: Effective Diagnosis and Evidence-Based Treatment, Work-related Musculoskeletal Disorders, Orhan Korhan, IntechOpen, DOI: 10.5772/intechopen.82029
Giladi, A. M., Malay, S., & Chung, K. C. (2015). A systematic review of the management of acute pyogenic flexor tenosynovitis. The Journal of Hand Surgery, European volume, 40(7): 720–728. DOI: 10.1177/1753193415570248
Vuillemin, V., Guerini, H., Bard, H., & Morvan, G. (2012). Stenosing tenosynovitis. Journal of Ultrasound, 15(1): 20–28. DOI: 10.1016/j.jus.2012.02.002