Tendinitis and Tenosynovitis

– An inflammation of the tendon (tendinitis) and lining of the tendon sheath (tenosynovitis) characterized by pain on movement of the associated joint.

Causes and Incidence

The etiology is often unknown, but individuals are thought to be more susceptible as degenerative changes occur in the vascularity of the tendons, causing a slower response to repetitive microtrauma. Repetitive movements, strain, or excessive, unaccustomed exercise may be causes. Underlying systemic disease (e.g., rheumatoid arthritis, gout, sclerosis, and disseminated gonococcal infections) may also be a cause. Middle-aged and older adults and athletes or individuals with occupations requiring repetitive motion are at greatest risk.

Disease Process

Repetitive microtrauma damages the fibers in the common extensor tendon of the involved joint, causing extravasation of tissue fluid and setting up an inflammatory process. Over time, healing builds fibrous, inelastic tissue and scarring, which often bind the tendon and sheath together, limiting joint motion.

Symptoms

The involved tendons usually show visible swelling; the joint may be tender and hot to the touch; motion of the joint causes pain.

Potential Complications

Rupture of the tendon is a possible complication.

Diagnostic Tests

The diagnosis is based on a history of repetitive motion or underlying disease and physical examination of the joint. Radiology may show calcium deposits in the tendon or tendon sheath.

Treatments

Surgery
Removal of calcium deposits in cases unresponsive to other treatment; release of fibroosseous tunnels associated with de Quervain’s disease; tenosynovectomy for chronic inflammation associated with rheumatoid arthritis.

Drugs
Oral or locally injected corticosteroids to relieve inflammation; analgesics/antiinflammatory drugs to relieve pain.

General
Moist heat compresses to joint; rest of joint with controlled progressive exercise program.