Tenosynovitis

What is tenosynovitis?

Tenosynovitis is inflammation of the protective sheath (the synovial membrane) that surrounds your tendons. It can be painful and make it hard to move your joints like you usually can. Tenosynovitis is pronounced “ten-oh-sin-oh-vyt-us”.

Your tendons are cords that connect your muscles to your bones. They let your bones move as you tighten and relax your muscles. Your tendons are surrounded by a synovial membrane. Your synovial membrane is full of fluid. It protects your tendons and helps them move smoothly. Picture an electrical cord. The wires inside the cord do the work, and the rubber or plastic coating keeps them safe. Your synovial membrane is the protective layer that insulates your tendons.

When your synovial membrane is irritated, damaged or infected it can become inflamed. In addition to symptoms from the tenosynovitis itself, this inflammation can lead to other serious issues if you don’t get it treated. You’ll need to rest your affected tendon while it heals. You should make a full recovery in roughly four to six weeks, depending on what’s causing your tenosynovitis.

What is the difference between tenosynovitis and tendinitis?

Tenosynovitis and tendinitis are both conditions that affect your tendons. Both issues are caused by inflammation.

The most important difference is what is inflamed. Tenosynovitis happens when the synovial membrane that encases your tendons is inflamed. This is also known as synovitis.

Tendinitis is inflammation in the tendon itself. Tendinitis can be either acute (short-term) or chronic (long-term).

What is stenosing tenosynovitis?

Stenosing tenosynovitis is a specific kind of tenosynovitis. Stenosis is a medical term for narrowing. Stenosing tenosynovitis happens when the inflammation around a tendon makes it hard for it to move smoothly through a small area of your body that it normally does.

If you’ve ever bundled up in the winter, it’s the same feeling you have when you struggle to fit your arm through your jacket sleeve with extra layers on. You can get your arm through, but it’s harder than usual.

Different kinds of stenosing tenosynovitis include:

• Trigger finger: Trigger finger happens when the tunnel that controls and guides the tendons in your fingers and thumb is inflamed. People with trigger finger often feel a “catch” or bump as they bend their affected finger.
• De Quervain’s tendinosis: De Quervain’s tendinosis is a painful inflammation in the tendons of your thumb. It’s also sometimes known as radial styloid tenosynovitis and presents as pain on the back side of your wrist by your thumb.
• Peroneal tenosynovitis: Your peroneal tendons are on either side of your ankles. They can be affected by stenosing tenosynovitis if their synovial membrane is inflamed.
• Forearm tenosynovitis: The tendons around your forearm (extensor carpi ulnaris, extensor carpi radialis and extensor digitorum communis) can develop stenosing tenosynovitis, as well.

No matter which condition you have, if you’re in pain or can’t move a part of your body as well as you usually can, talk to your healthcare provider.

Who does tenosynovitis affect?

Tenosynovitis can affect anyone. You’re more likely to develop tenosynovitis if you have these conditions:

• Rheumatoid arthritis.
• Diabetes.
• Hand infections.
• Gout.
• COPD.
• Thyroid disease.
• Dupuytren’s disease.
• Undergoing certain cancer treatments.

How common is tenosynovitis?

Because tenosynovitis is caused by so many different issues and conditions, it’s relatively common. However, different groups of people have different risks of developing it.

More than half of people with rheumatoid arthritis develop tenosynovitis. Around 20% of people with diabetes experience it.

How does tenosynovitis affect my body?

Tenosynovitis is usually painful. It can affect tendons connected to any muscle that helps one of your limbs push, pull or extend (your flexor and extensor muscles). You might also have trouble moving the affected part of your body like you usually can. The most common places tenosynovitis affects include your:

• Hands.
• Wrists.
• Feet.

What are the symptoms of tenosynovitis?

The most common symptoms of tenosynovitis include:

• Pain.
• Swelling at a joint.
• Difficulty moving a part of your body like you usually can.
• Pain when moving a part of your body.
• Discoloration in a straight line along a tendon.

What causes tenosynovitis?

Tenosynovitis causes include:

• Autoimmune diseases: Any condition where your body’s defenses attack itself can cause damage to your synovial membrane. Arthritis (like rheumatoid arthritis and gout) and diabetes can cause tenosynovitis.
• Overuse: Repeating one movement or motion constantly over a long period of time can lead to overuse syndrome. The damage from overuse syndrome often includes tenosynovitis.
• Infections: Many common infections can spread to your synovial membrane and lead to infectious tenosynovitis.
• Trauma: Any injury or accident that damages your tendons or the area around them can cause tenosynovitis.

Does tenosynovitis go away on its own?

Not always. Even if rest and taking a break from the activity that caused it are sometimes treatments of tenosynovitis, it’s important that your healthcare provider diagnoses the cause of your pain. If you don’t get tenosynovitis diagnosed and treated properly you can cause long-term damage to your tendons.

How is tenosynovitis diagnosed?

Your healthcare provider will diagnose tenosynovitis with a physical exam. They will check your symptoms and your range of motion (how far you can move a part of your body).

They might also order blood tests or other labs to check for infections.

What tests will be done to diagnose this condition?

After a physical exam, you might need at least one of a few imaging tests:

• X-rays: An X-ray can show if your synovial membrane has hardened and other signs of inflammation.
• Magnetic Resonance Imaging (MRI): Your provider might use an MRI to get a complete picture of your tendon and the area around it.
• Ultrasound: An ultrasound is like an X-ray for soft tissue. Your provider can use it to take pictures of the area around your tendon that will show any inflammation.
• CT scan: A CT scan will give your provider a more detailed picture of your tendon and the surrounding tissue than an X-ray.

How is tenosynovitis treated?

How tenosynovitis is treated depends on what’s causing it. Treatments include:

• Rest and stopping the activity that caused your tenosynovitis.
• Wearing a brace or splint to reduce stress on your tendon.
• Applying heat or cold to the area to reduce pain or inflammation.
• Steroid injections.

Your provider will tell you which specific treatments you’ll need based on how severe your symptoms are.

Tenosynovitis surgery

Surgery for tenosynovitis is usually needed if your tenosynovitis is caused by an infection, if the inflammation is so severe it’s threatening to cause permanent damage or if conservative treatments haven’t worked after a few months (i.e. failed steroid injections).

Your surgeon will make incisions around your affected tendon to reduce pressure on it and perform a debridement (the medical term for cleaning out dead or infected tissue). In some cases of infectious tenosynovitis, the surgeon may make a limited number of incisions and use a catheter to regularly flush your tendon sheath to help clean your finger and clear the infection.

What medications are used to treat tenosynovitis?

Which medications you’ll need depends on the cause of your tenosynovitis. Some medications your provider might prescribe include:

• Antibiotics: If your tenosynovitis is caused by an infection, you’ll need antibiotics.
• NSAIDs: Over-the-counter NSAIDs like aspirin or ibuprofen can reduce pain and inflammation.
• Corticosteroids: Your provider might give you an injection of anti-inflammatory corticosteroids.

Complications of tenosynovitis treatment

Complications of tenosynovitis treatment include:

• Stiffness in the affected body part.
• Deformed tendons.
• Spread of the infection to other parts of your body (if your tenosynovitis is caused by an infection).
• Scarring.

How do I manage my tenosynovitis symptoms?

The best way to manage your tenosynovitis symptoms is to rest your affected tendon. Your body needs time to heal. If your provider prescribes other treatments, make sure you follow them as best you can. This could include:

• Avoiding the activity that caused your overuse syndrome.
• Taking medicines like NSAIDs and antibiotics as often as you should, for as long as your provider recommends.
• Wearing your brace or splint as often as your provider instructs.

Talk to your provider about the best ways to help your synovial membrane heal.

How soon after treatment will I feel better?

How long it takes to feel better depends on what caused your tenosynovitis, and which treatments you needed to reduce the inflammation. Your symptoms should gradually decrease as you start your treatments.

If you have an infection, you should start to feel better after starting antibiotics. Make sure you take the full dose for as long as your provider prescribes, even if you feel better.

How can I reduce my risk of tenosynovitis?

The best way to reduce your risk of tenosynovitis is to avoid overusing your tendons. Give your body time to recover after workouts, sports, jobs or other activities that require you to perform the same movements repeatedly.

You can prevent strain on your body (including your tendons) by wearing proper safety equipment and working out safely.

What can I expect if I have tenosynovitis?

You should expect to make a full recovery from tenosynovitis. If it’s caused by an infection, you face a higher risk of complications and a longer recovery time.

How long does tenosynovitis last?

How long tenosynovitis lasts depends on what caused the inflammation in your synovial membrane. Most people recover in four to six weeks.

Will I need to miss work or school?

If you can do your job or schoolwork without overusing your affected body part, you shouldn’t need to miss work or school. This depends on which part of your body is affected, and how you use it. Typing on a keyboard might be difficult with your wrist in a brace, for example.

Talk to your healthcare provider or surgeon before resuming any physical activities while you’re recovering.

What’s the outlook for tenosynovitis?

The outlook for tenosynovitis is generally positive, depending on the cause. Almost everyone who develops it makes a full recovery and resumes their normal activities. You might need to take a break from the activity that caused you to overuse your tendon, but — once you’ve healed — you should have no long-term effects.

If your tenosynovitis was caused by an infection, your outcome depends on several factors. People who are older, have a history of diabetes, peripheral vascular disease and/or kidney disease have poorer outcomes.

How do I take care of myself?

Make sure you’re following all the instructions from your provider or surgeon. Because the most common treatments for tenosynovitis take time to work, it’s important to be patient and let your body heal.

When should I see my healthcare provider?

Talk to your healthcare provider if your symptoms get worse or aren’t getting better after a few weeks.

When should I go to ER?

Go to the emergency room if you notice any of the following:

• Extreme pain.
• Swelling.
• Discoloration.
• Bleeding at your surgery site.

What questions should I ask my doctor?

• Do I have tenosynovitis or tendinitis?
• How long will I need to rest my tendon?
• What medicines will I need?
• Do I need any additional tests or imaging?
• Will I need surgery?

A note from Cleveland Clinic

Tenosynovitis is painful and can be dangerous if it’s not treated right away. However, most people make a full recovery, and you’ll likely only need conservative treatments like rest to give you body time to heal. Don’t “play through pain” or push your body beyond its limits. If you notice symptoms, talk to your healthcare provider right away.