How can tenosynovitis be treated?

Photo of a young man using a smartphone (PantherMedia / Goodluz)

Painful tendon sheath inflammations (tenosynovitis) are particularly common in the hands and feet. Resting the inflamed area for some time usually helps the pain go away. If the symptoms don’t go away, physiotherapy, injections or – if that doesn’t work – surgery can help.

Constantly repeating certain movements or certain types of strain can cause the involved tendons and tendon sheaths to become inflamed. For instance, this can happen in the fingers or wrists if you write on a computer or smartphone a lot. Known as tenosynovitis, this kind of inflammation can lead to swelling too, making it harder to move your fingers. It can also occur in your ankles if you put too much strain on them – for example, by walking long distances without training beforehand.

The inflammation often already clears up after conservative treatment involving immobilization (keeping the affected area still), painkillers and physiotherapy. If the inflammation was caused by a work-related activity, it can be a good idea to make changes in the workplace, such as using an ergonomic mouse for computer work. If you aren’t sure whether making changes would be helpful, you can ask for advice – for instance, from an occupational health specialist.

Which conservative measures can help?

Immobilization and pain relief

It’s important to rest the affected area, and in particular to avoid the movements that led to the inflammation in the first place. To do this, you may have to get a sick note from your doctor and stay home from work. If it isn’t possible to completely avoid a specific movement, you can try to do it less often or with less force. A plaster cast, tight bandage or special orthopedic brace can help as well, for instance by keeping the thumb or wrist still.

Inflammation-reducing painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) can be swallowed or applied to the skin too, particularly if the inflamed area hurts even when it isn't being moved. These medications relieve pain as well as reducing inflammation and swelling. Many people say that cooling the affected area helps, but heat is sometimes applied too. You can try applying cold or heat yourself to see what works for you.

Physiotherapy and massage

Although it’s important to rest the affected part of your body, movement isn’t forbidden. For instance, if the tenosynovitis means you can no longer move your finger or wrist properly, you can try to reduce the symptoms using stretching or mobilization exercises. Massages or other treatments in a physiotherapy practice can help too. Sometimes tenosynovitis is also treated with acupuncture or transcutaneous electrical nerve stimulation (TENS).

Injections with steroids and anesthetics

If tenosynovitis is very persistent, doctors sometimes try to reduce the symptoms using injections. In most cases, a corticosteroid and the anesthetic lidocaine are injected directly into the inflamed area.

When is surgery considered?

Some tendons – for instance, in the fingers and wrists – run through a narrow tunnel made of bones and ligaments. They are protected by tendon sheaths. The swelling in tenosynovitis can make it difficult or even impossible for the tendon to slide through the tendon sheath. The medical term for this is stenosing tenosynovitis.

Conservative treatment approaches such as rest, physiotherapy and painkillers can help here, too. If they don’t provide any relief, the narrow part of the “tunnel” can be operated on. This involves removing or cutting the obstructing tissue to give the tendon more room to move again.

The short procedure is often carried out in an outpatient setting (in other words, you can go home again on the same day), and there's usually no need to make big cuts in the skin. It’s important to rest and protect the affected part of the body until the wound has healed. But that doesn't mean that you aren’t allowed to move it. On the contrary: It’s a good idea to move the affected tendons several times a day – without using too much force, though. After a few weeks, you can move that part of your body normally again without it hurting.

Like all operations, this procedure can have adverse effects such as wound healing problems and infections. Side effects such as abnormal sensations or limited mobility are possible, too.

Labels: M65, Muscles, bones and joints, Tendonitis, Tendosynovitis, Trigger finger