From the Guidelines
A thorough tendon exam for tenosynovitis involves a combination of visual inspection, physical examination techniques, and specific provocative tests to assess for inflammation of the tendon sheath. The exam should begin with a visual inspection of the affected area to look for signs of swelling, redness, or visible nodules along the tendon sheath. Palpation of the tendon and surrounding tissues is also crucial to assess for tenderness, thickening, or crepitus (a grating sensation) 1.
The physical examination should include:
- Active and passive range-of-motion testing to evaluate for pain or restriction
- Specific provocative tests based on the location, such as Finkelstein's test for de Quervain's tenosynovitis of the wrist or Bunnel-Littler test for trigger finger
- Assessment for crepitus by placing fingers over the tendon while the patient moves the joint
- Comparison of findings with the unaffected side to identify asymmetry
- Noting functional limitations and pain severity using a standardized scale
These examination techniques help identify inflammation of the tendon sheath by detecting characteristic findings such as pain with movement, localized tenderness along the tendon course, and possible triggering or locking of the tendon 1. The exam should be thorough but gentle to avoid exacerbating symptoms while gathering sufficient information to distinguish tenosynovitis from other musculoskeletal conditions.
It is essential to note that the diagnosis of tenosynovitis is primarily clinical, and imaging studies such as plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear 1. However, the primary focus of the examination should be on identifying the characteristic signs and symptoms of tenosynovitis, rather than relying solely on imaging studies.
In terms of treatment, rest, icing, and eccentric strengthening exercises are recommended, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief 1. However, the focus of the question is on the examination techniques, and the treatment options should be considered separately.
Overall, a thorough and gentle examination is essential to diagnose tenosynovitis and distinguish it from other musculoskeletal conditions, and should include a combination of visual inspection, physical examination techniques, and specific provocative tests.
From the Research
Tendon Exam for Tenosynovitis
A thorough tendon exam for tenosynovitis entails several key components, including:
- Medical history: assessing the patient's symptoms, such as pain, swelling, and limited mobility 2
- Physical examination: evaluating the affected tendon for signs of inflammation, such as redness, warmth, and tenderness 2, 3
- Special tests: performing specific tests, like Finkelstein's test, to diagnose De Quervain's tenosynovitis 3
- Imaging studies: using ultrasound or MRI to confirm the diagnosis and rule out other conditions 2
Diagnostic Techniques
Diagnostic techniques for tenosynovitis may include:
- Finkelstein's test: a physical examination test used to diagnose De Quervain's tenosynovitis 3
- Ultrasound: a non-invasive imaging study used to evaluate tendon inflammation and guide injections 2
- MRI: a non-invasive imaging study used to confirm the diagnosis and rule out other conditions 2
Treatment Options
Treatment options for tenosynovitis may include: