What is Tenosynovitis?

Tendinitis is when something -- injury, illness, repeated motion -- inflames one of your tendons, the cords of tissue that hold muscle to bone. When it also irritates the sleeve of tissue, or sheath, around the tendon, you have tenosynovitis.

What Are the Symptoms?

The inflamed tendon may be painful and swollen. You may notice it more when you use it, especially if a repeated motion like swinging a hammer or a tennis racquet caused it.

When the tendon sheath gets swollen, fluid can build up and make your symptoms worse. You may feel swelling and in some cases see it, too. The area can get so tender that it hurts even to touch it.

It might happen anywhere you have muscles and tendons, but it’s more likely in your:

• Shoulder
• Upper arm
• Forearm (biceps)
• Hands and fingers
Knee
• Achilles (thick, ropey tissue that runs from calf muscle to heel)

If you have these symptoms in your thumb, then you probably have a specific type called De Quervain’s tenosynovitis. It results from an inflamed tendon at the base of your thumb. You might feel:

And you’re more likely to get it when you’re pregnant, though doctors aren’t sure why.

Causes and Risk Factors

It isn’t always clear what causes tenosynovitis (or tendinitis), though it usually starts in middle age. Repeated motions like jumping, throwing, or running might be to blame, or it might happen if you do something sudden like lifting an unusually heavy load. New movements, especially over your head, like painting the ceiling, also could play a role.

Arthritis and inflammatory diseases that wear down your joints may cause problems in surrounding tendons and tissues. This can sometimes lead to the long-term, or chronic, form of tenosynovitis. Serious cases can form cysts that tear or break tendons, change the shape of your hand, and make it hard to use.

Certain medicines like fluoroquinolone antibiotics (Cipro, Noroxin) and statins, which treat high cholesterol, also might raise your risk for tendon damage that leads to tenosynovitis.

How Is Tenosynovitis Diagnosed?

The doctor can usually diagnose you from your symptoms and a physical exam. They might push on affected areas or ask you to make specific motions and see if they hurt.

Let them know how the area feels. Does it tingle? Burn? Does it get better when you rest? Be sure to tell them about any new increase in work or exercise patterns.

If all this isn’t enough to diagnose you, the doctor might take pictures of the area with an MRI or ultrasound machine to confirm or to rule out other causes.

How Is Tenosnynovitis Treated?

Rest is usually the first treatment. The quicker you start, the better it will work. Where possible, try to stop the things that cause your symptoms. You might even need a splint or brace to keep that part of your body from moving.

When it flares up, ice the inflamed area for 20 minutes at a time. Heat might be more useful for chronic tendinitis. Talk to your doctor if you’re unsure.

Over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) can also help. Your doctor might suggest larger than standard doses depending on your level of pain and swelling or if you have conditions like rheumatoid arthritis. In some cases, they might inject a corticosteroid to reduce inflammation.

Once swelling and pain are down, you should start to slowly and gently increase your range of motion. If your tenosynovitis is severe, your doctor or physical therapist might give you a set of exercises to help with this. You may need to do them several times a day.

In rare cases, you might need surgery to repair a tendon or remove hard bits of calcium that can build up and cause tendon problems.

Tips to Prevent Tenosynovitis

Tenosynovitis typically starts with tendinitis. Though it isn’t always clear what causes either one, there are some things you can do that might lower your risk.

Take breaks. Try not to stay in the same position for too long. For example, if work keeps you still for hours on end, take breaks and move around every 30 minutes or so if you can. Don’t do the same thing over and over without a break. Whether it’s typing, throwing a baseball, or playing piano scales, mix up your movements to stay balanced and to give your body a chance to rest.

Learn how to lift. Take care when you lift things. Use a firm but not overly tight grip when it’s unusually heavy, and avoid lifting with just one arm or only one side of your body.

Move the right way. Learn the right way to do the physical movements for all your sports and activities. Whether you lift weights, shoot free throws, or play the cello, there are proper techniques that can prevent injury. Trainers, teachers, coaches, and physical therapists can help you learn proper form. If you notice that some movement causes pain, stop and ask questions.

Warm up before you exercise. About 5 to 10 minutes of light jogging or jumping jacks should be enough.

Living With Tenosynovitis

It’s important to rest as soon as you notice symptoms. If you don’t, you could rupture a tendon or its sheath, which can be hard to repair. If your symptoms are very painful, won’t go away, or stop you from living your life normally for more than a few days, see your doctor. They might notice an underlying condition that you can treat. They’ll give you the right mix of rest, medication, and physical therapy to get you on the road to recovery.

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