From the Guidelines
Tenosynovitis is primarily caused by overuse, repetitive movements, direct trauma, or infections, and its management should focus on reducing morbidity, mortality, and improving quality of life through a multifaceted approach including rest, NSAIDs, physical therapy, and potentially corticosteroid injections. The condition can also result from underlying inflammatory conditions like rheumatoid arthritis or systemic lupus erythematosus 1.
Causes of Tenosynovitis
- Overuse and repetitive movements are common causes, particularly in athletes and individuals with jobs involving repetitive motions 1.
- Direct trauma to the tendon can also lead to tenosynovitis.
- Infections, either bacterial or fungal, can cause infectious tenosynovitis, which requires prompt antibiotic therapy and possibly surgical intervention 1.
- Underlying inflammatory conditions such as rheumatoid arthritis or systemic lupus erythematosus can increase the risk of developing tenosynovitis.
Management of Tenosynovitis
- Rest and activity modification are crucial to reduce stress on the affected tendon, allowing for healing and reducing the risk of further injury 1.
- NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) are recommended for pain and inflammation management 1.
- Ice application for 15-20 minutes several times daily and compression with an elastic bandage can help reduce swelling and pain 1.
- Physical therapy focusing on gentle stretching and strengthening exercises is beneficial once acute pain subsides, promoting tendon healing and preventing future injuries 1.
- For persistent cases, corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) may provide relief, though typically limited to 2-3 injections per year to avoid tendon weakening 1.
- Splinting or bracing the affected area helps immobilize and protect the tendon during healing, reducing the risk of further injury 1.
- Infectious tenosynovitis requires prompt antibiotic therapy, possibly surgical drainage, and hospitalization to prevent serious complications 1.
- In severe or refractory cases, surgical intervention may be necessary to release the tendon sheath (tenosynovectomy), providing relief and promoting healing 1.
Prevention and Recovery
- Recovery typically takes 2-6 weeks for mild cases but may extend to several months for severe or chronic conditions 1.
- Proper ergonomics and technique modification during activities can help prevent recurrence of tenosynovitis 1.
- Education on proper exercise techniques, warm-up routines, and cool-down stretches can also help in preventing overuse injuries leading to tenosynovitis 1.
From the Research
Causes of Tenosynovitis
- Tenosynovitis can occur in patients with rheumatoid arthritis, particularly in the hand 2
- Pyogenic flexor tenosynovitis can be caused by bacterial infections, such as Staphylococcus aureus 3
- De Quervain's tenosynovitis is a specific type of tenosynovitis that affects the tendons on the thumb side of the wrist 4
- Idiopathic hand flexor tenosynovitis can also occur, with no underlying cause or condition 5
Management of Tenosynovitis
- Nonsurgical management of tenosynovitis can include corticosteroid injections, which can provide successful, long-term relief from synovitis and prevent tendon ruptures 2, 4, 5
- Surgical approaches, such as tenosynovectomy, can be used to treat tenosynovitis that cannot be controlled by nonsurgical means 2
- Antibiotics and surgical drainage may be necessary to treat pyogenic flexor tenosynovitis, with locally administered corticosteroids potentially decreasing loss of motion resulting from the infection 3, 6
- Treatment of De Quervain's tenosynovitis with methylprednisolone acetate injection can rapidly control signs and symptoms, with minimal adverse reactions 4