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Tendinitis and Tenosynovitis

By

Joseph J. Biundo

, MD, Tulane Medical Center

Last full review/revision Feb 2020| Content last modified Feb 2020
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Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath).

  • The cause is not always known.

  • 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.

The cause of tendinitis is often unknown. 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 Rotator Cuff Tendinitis Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath). The cause is not always known. Tendons... read more —see also Rotator Cuff Injury/Subacromial Bursitis Rotator Cuff Injury/Subacromial Bursitis The muscles that help hold the upper arm in the shoulder joint (the rotator cuff muscles) can get pinched (shoulder impingement syndrome), become inflamed (tendinitis), or can tear partially... read more ) and in people who do repetitive tasks.

Certain tendons are particularly susceptible to inflammation:

Certain joint diseases, such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) , systemic sclerosis Systemic Sclerosis Systemic sclerosis is a rare, chronic autoimmune rheumatic disorder characterized by degenerative changes and scarring in the skin, joints, and internal organs and by blood vessel abnormalities... read more Systemic Sclerosis , gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flare-ups ... read more Gout , diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more , and reactive arthritis Reactive Arthritis Reactive arthritis (previously called Reiter syndrome) is a spondyloarthritis causing inflammation of the joints and tendon attachments at the joints, often related to an infection. Joint pain... read more Reactive Arthritis (previously called Reiter syndrome), can increase the risk of tenosynovitis. In people with gonorrhea Symptoms Gonorrhea is a sexually transmitted disease caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, and throat or the membranes that cover the front... read more Symptoms , especially women, gonococcal bacteria can cause tenosynovitis, usually affecting the tissues of the shoulders, wrists, fingers, hips, ankles, or feet.

Symptoms of Tendinitis and Tenosynovitis

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 of Tendinitis and Tenosynovitis

Treatment of Tendinitis and Tenosynovitis

  • Rest or immobilization, heat or cold, followed by exercises

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Sometimes injections of corticosteroids

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.

Chronic, persistent tendinitis can occur in rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) and may have to be treated surgically to remove inflamed tissues. Physical therapy Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more may be needed after surgery, and surgery is occasionally needed to remove calcium deposits or repair the tendon from areas of long-standing tendinitis, such as the area around the shoulder joint. Occasionally, surgery is done to release scars that limit function or to remove part of a bone that is rubbing against a tendon.

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 (see Rotator Cuff Injury/Subacromial Bursitis Rotator Cuff Injury/Subacromial Bursitis The muscles that help hold the upper arm in the shoulder joint (the rotator cuff muscles) can get pinched (shoulder impingement syndrome), become inflamed (tendinitis), or can tear partially... read more ) 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 of rotator cuff tendinitis may occur suddenly and be severe, especially after physical activity, or they may develop more slowly and be milder.

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