Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. Symptoms of tenosynovitis include pain, swelling and difficulty moving the particular joint where the inflammation occurs. When the condition causes the finger to "stick" in a flexed position, this is called "stenosing" tenosynovitis, commonly known as "trigger finger". This condition often presents with comorbid tendinitis.
Causes of tenosynovitis are unknown. Repeated use of hand tools can precede the condition, as well as arthritis or injury. Tenosynovitis sometimes runs in families and is generally seen more often in males than in females. The causes for children are even less well known and have a recurrence rate of less than 1-5% after treatment.
Tenosynovitis is also linked to infectious arthritis caused by bacteria such as Neisseria gonorrhoeae.
Magnetic resonance images of fingers: psoriatic arthritis with dactylitis due to flexor tenosynovitis. Shown are T1 weighted axial (a) precontrast and (b) postcontrast magnetic resonance images of the fingers from a patient with psoriatic arthritis exhibiting flexor tenosynovitis at the second finger with enhancement and thickening of the tendon sheath (large arrow). Synovitis is seen in the fourth proximal interphalangeal joint (small arrow).
A physical examination shows swelling over the involved tendon. The health care provider may touch or stretch the tendon or have you move the muscle to which it is attached to see whether you experience pain.
Treatments for tenosynovitis depend on the severity of the inflammation and location. Mild tenosynovitis causing small scale swelling can be treated with non-steroidal anti-inflammatory drugs (NSAIDs) such as Naproxen, ibuprofen or diclofenac (marketed as Voltaren and other trade names), taken to reduce inflammation and as an analgesic. Resting the affected tendons is essential for recovery; a brace is often recommended. Physical or occupational therapy may also be beneficial in reducing symptoms.
More acute cases are treated with cortisone (steroid) injections, then a course of paracetamol and ibuprofen for pain. Outpatient surgery can be used to enlarge the synovium. The sprained tendon or limb is splinted for a week or so.