What is Tenosynovitis

Tenosynovitis is inflammation of a tendon and the sleeve of tissue that covers the tendon (tendon sheath). A tendon is a cord of tissue that connects muscle to bone. Normally, a tendon slides smoothly inside its tendon sheath.

Tenosynovitis limits movement of the tendon and surrounding tissues, which may cause pain and stiffness.

Tenosynovitis can affect any tendon and tendon sheath. Commonly affected areas include tendons in the:

• Shoulder.
• Arm.
• Hand.
• Hip.
• Leg.
• Foot.

What are the causes?

The main cause of this condition is wear and tear over time that results in slight tears in the tendon. Other possible causes include:

• A sudden injury to the tendon or tendon sheath.
• A disease that causes inflammation in the body.
• An infection that spreads to the tendon and tendon sheath from a skin wound.
• An infection in another part of the body that spreads to the tendon and tendon sheath through the blood.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Having rheumatoid arthritis, gout, or diabetes.
• Using IV drugs.
• Doing physical activities that can cause tendon overuse and stress.
• Having gonorrhea.

What are the signs or symptoms?

Symptoms of this condition depend on the cause. Symptoms may include:

• Pain with movement.
• Pain and tenderness when pressing on the tendon and tendon sheath.
• Swelling.
• Stiffness.

If tenosynovitis is caused by an infection, symptoms may also include:

• Fever.
• Redness.
• Warmth.

How is this diagnosed?

This condition may be diagnosed based on your medical history and a physical exam. You also may have:

• Blood tests.
• Imaging tests, such as:
  • MRI.
  • Ultrasound.
• A sample of fluid removed from inside the tendon sheath to be checked in a lab.

How is this treated?

Treatment for this condition depends on the cause. If tenosynovitis is not caused by an infection, treatment may include:

• Resting the tendon.
• Keeping the tendon in place for periods of time (immobilization) in a splint, brace, or sling.
• NSAIDs to reduce pain and swelling.
• A shot (injection) of medicine to help reduce pain and swelling (steroid).
• Icing or applying heat to the affected area.
• Physical therapy.
• Surgery to release the tendon in the sheath or to repair damage to the tendon or tendon sheath. Surgery may be done if other treatments do not help relieve symptoms.

If tenosynovitis is caused by infection, treatment may include antibiotic medicine given through an IV. In some cases, surgery may be needed to drain fluid from the tendon sheath or to remove the tendon sheath.

Follow these instructions at home:

If you have a splint, brace, or sling:

• Wear the splint, brace, or sling as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint, brace, or sling if your fingers or toes tingle, become numb, or turn cold and blue.
• Do not let your splint or brace get wet if it is not waterproof.
  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers.
  • If your splint, brace, or sling is not waterproof, cover it with a watertight covering when you take a bath or a shower.
• Keep the splint, brace, or sling clean.

Managing pain, stiffness, and swelling

• If directed, apply ice to the affected area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move the fingers or toes of the affected limb often, if this applies. This can help to prevent stiffness and lessen swelling.
• If directed, raise (elevate) the affected area above the level of your heart while you are sitting or lying down.
• If directed, apply heat to the affected area as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a splint or brace on any part of your arm or leg.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Rest the affected area as told by your health care provider.
• Avoid using the affected area while you are having symptoms of tenosynovitis.
• If physical therapy was prescribed, do exercises as told by your health care provider.

Safety

• Do not use the injured limb to support your body weight until your health care provider says that you can.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms are not improving or are getting worse.
• You have a fever and more of any of the following symptoms:
  • Pain.
  • Redness.
  • Warmth.
  • Swelling.

Get help right away if:

• Your fingers or toes become numb or turn blue.