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Tendinitis and Tenosynovitis

by Joseph J. Biundo, MD

Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath).

  • Tendons are painful, particularly when moved, and sometimes swollen.

  • The diagnosis is usually based on symptoms and results of a physical examination.

  • Using a splint, applying heat or cold, and taking nonsteroidal anti-inflammatory drugs can help.

Tendons are fibrous cords of tough tissue that connect muscles to bones. Some tendons are surrounded by tendon sheaths.

Tendinitis usually occurs during middle or older age, as the tendons weaken and become more susceptible to injury and inflammation. (Weakening of the tendon, called tendinopathy, usually results from many small tears that occur over time. Affected tendons may gradually or suddenly tear completely.) Tendinitis also occurs in younger people who exercise vigorously (who may develop rotator cuff tendinitis—see see Rotator Cuff Tendinitis and Rotator Cuff Injury/Subacromial Bursitis) and in people who do repetitive tasks.

Certain tendons are particularly susceptible to inflammation.

  • Tendons of the shoulder (rotator cuff): Inflammation of these tendons is the most common cause of shoulder pain ( Rotator Cuff Injury/Subacromial Bursitis).

  • The two tendons that extend the thumb away from the hand: Inflammation of these tendons is called de Quervain syndrome (see De Quervain Syndrome).

  • The flexor tendons that clench the fingers: Inflammation causes these tendons to get caught in their sheaths, resulting in a popping feeling (trigger finger—see see Figure: Trigger Finger).

  • The tendon above the biceps muscle in the upper arm (bicipital tendon): Pain can occur when the elbow is bent or the arm is elevated or rotated.

  • Achilles tendon in the heel: Pain occurs at the back of the heel (see Achilles Tendinitis).

  • A tendon that runs over the side of the knee (popliteus tendon): Pain occurs on the outer part of the knee.

  • Tendons near the hip bone (trochanter): Because bursae may also be affected, the term trochanteric bursitis is often used to include inflammation of these tendons.

Certain joint diseases, such as rheumatoid arthritis, systemic sclerosis, gout, diabetes, and reactive arthritis (previously called Reiter syndrome), can cause tenosynovitis. In people with gonorrhea, especially women, gonococcal bacteria can cause tenosynovitis, usually affecting the tissues of the shoulders, wrists, fingers, hips, ankles, or feet.

Symptoms

The inflamed tendons are usually painful when moved or when pressed. Moving the joints near the tendon, even a little, may cause pain, depending on how severe the tendinitis is. Occasionally, the tendons or their sheaths swell and feel warm.

If tendinitis lasts a long time, calcium may become deposited. The area around the shoulder joint is often affected. In addition to being painful, the shoulder may feel stiff and weak. It may snap or catch when moved.

Diagnosis

Doctors can usually diagnose tendinitis based on the symptoms and results of a physical examination. Sometimes magnetic resonance imaging (MRI) or ultrasonography is helpful.

Treatment

Rest, immobilization with a splint or cast, and application of heat or cold—whichever works—are often helpful. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for 7 to 10 days can reduce the pain and inflammation.

Sometimes corticosteroids (such as betamethasone, methylprednisolone, or triamcinolone) and anesthetics (such as lidocaine) are injected into the tendon sheath. Rarely, the injection causes pain hours later because the corticosteroid temporarily forms crystals inside the joint or sheath. This pain lasts less than 24 hours and can be treated with cold compresses and pain relievers.

Other drugs may be used, depending on the cause. For example, if gout is the cause, indomethacin or colchicine may be used.

After inflammation is controlled, exercises to increase the range of motion should be done several times a day.

Chronic, persistent tendinitis, as can occur in rheumatoid arthritis, may have to be treated surgically to remove inflamed tissues, and physical therapy may be needed after surgery. Surgery is occasionally needed to remove calcium deposits from areas of long-standing tendinitis, such as the area around the shoulder joint.

De Quervain Syndrome

(Washerwoman’s Sprain)

De Quervain syndrome (washerwoman’s sprain) is swelling and inflammation of the tendons or tendon sheaths that move the thumb outward.

De Quervain syndrome usually occurs after repetitive use, particularly wringing, of the wrist. It often develops in new mothers, probably because they repeatedly pick up their baby by stretching out their arms and using only their wrists. It can also develop with rheumatoid arthritis.

The main symptom is aching pain on the thumb side of the wrist and at the base of the thumb, which becomes worse with movement. The area at the base of the thumb near the wrist is also tender.

Doctors diagnose this disorder when they detect tenderness over the two tendons on the thumb side of the wrist, usually accompanied by swelling. To detect tenderness, doctors ask people to bend their thumb into their palm and wrap their fingers over the thumb. Then people are asked to bend their wrist away from the thumb. People are likely to have De Quervain syndrome if this movement causes pain at the same side of the wrist as the thumb.

New mothers may be able to avoid this disorder if they use their entire arm and hold their wrists straight when they lift their baby.

Movements that cause pain should be avoided. Rest, warm soaks, and nonsteroidal anti-inflammatory drugs (NSAIDs) may help people with mild symptoms. People with more severe symptoms usually feel better after treatment with a corticosteroid injection and a thumb splint. Sometimes one or two more injections, separated by several weeks, are needed. If these methods do not relieve symptoms, people may need surgery.

Rotator Cuff Tendinitis

Tendinitis may develop in the tendons of the muscles that help move, rotate, and hold the shoulder in place (rotator cuff).

Rotator cuff tendinitis ( Rotator Cuff Injury/Subacromial Bursitis) is the most common cause of shoulder pain. It causes pain when the arm is raised (particularly between 40 and 120°) or when people dress. People often have pain during the night, especially when they lie on the affected arm.

Symptoms may occur suddenly and be severe, especially after physical activity, or they may develop more slowly and be milder.

Range-of-motion exercises, nonsteroidal anti-inflammatory drugs (NSAIDs), and sometimes a corticosteroid injection can be used for treatment.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • INDOCIN
  • KENALOG
  • MEDROL
  • XYLOCAINE
  • COLCRYS
  • CELESTONE SOLUSPAN, DIPROLENE, LUXIQ