Tenosynovitis

Tenosynovitis is an inflammation of the synovial sheath that surrounds a tendon, often causing pain, swelling, and difficulty moving the affected part. The condition can be aseptic (noninfectious) or septic (infectious) and may be acute or chronic. It most commonly involves the hands and wrists but can affect any area where tendons glide within a sheath. Notable forms include De Quervain's tenosynovitis, which affects the thumb side of the wrist, and trigger finger, a stenosing tenosynovitis that causes finger locking or catching.

Symptoms typically include localized pain and tenderness along the tendon pathway, swelling, and limited movement. In infectious cases, fever and a broader range of symptoms may be present. Diagnosis is based on medical history and physical examination, with imaging such as ultrasound or MRI used to assess the tendon and sheath. Blood tests may help distinguish infection or inflammatory diseases from noninfectious causes.

Treatment depends on the cause. Noninfectious tenosynovitis is usually managed with rest or activity modification, immobilization with a splint, nonsteroidal anti-inflammatory drugs, ice, and physical or occupational therapy. Corticosteroid injections into the tendon sheath can provide relief. If symptoms persist or recur, surgical release of the tendon sheath (tenosynovectomy) may be considered. Infectious tenosynovitis requires prompt antibiotics and often surgical drainage, with surgical release as needed.

Prognosis is generally favorable with appropriate treatment, but recurrence is possible, and delayed management can lead to chronic pain or reduced range of motion. Prevention focuses on proper conditioning, ergonomic adjustments, and gradual increase in activity to avoid repetitive strain.