What Is Tenosynovitis?

A tendon sheath is a double-layered sleeve-like closed synovial tube that surrounds the tendon. It is a synovial sheath that protects the tendon. It surrounds the tendon in two layers, a cavity between the two layers is the synovial cavity, and there is synovial fluid in the tendon sheath. The inner layer is closely attached to the tendon, and the outer layer is lined inside the tendon fiber sheath, which is combined with the bone surface to fix, protect and lubricate the tendon from friction or compression. Tendons are rubbed excessively here for a long time, which can cause injury inflammation of tendons and tendon sheaths, causing swelling, called tenosynovitis. Without treatment, it may develop into permanent inconvenience.

Basic Information

English name

tenosynovitis

Visiting department

orthopedics

Multiple groups

Radial styloid stenosing tenosynovitis is more common in women over 40 years of age

Common locations

Tendon, tendon sheath

Common causes

Caused by excessive muscle activity, synovial inflammation, cellulose exudate, etc.

Common symptoms

Carpal side swelling, fever, tenderness, joint swelling, restricted movement

Contagious

no

Causes of tenosynovitis

1. Styloid tenosynovitis of the radial styloid process

In the first osteofibrous sheath on the dorsal side of the wrist, two tendons pass through, namely the abductor hallucis longus and brachial extensor tendons. The two tendons pass through the narrow sheath and form a certain angle with the sheath. A metacarpal base and a base of the proximal phalanx of the thumb. When the wrist and thumb are very active, the tendon angle of the tendon increases. Over time, the local synovium became inflammatory, thickened, the tendon became thicker, and the wall of the fibrous sheath was also thickened. Subcutaneous hard nodules appeared at the radial styloid process, making it difficult for the tendon to slide in the sheath, causing symptoms such as pain. Due to endocrine changes in lactating and menopausal women, synovial involvement is likely to cause this disease, which is the main cause of this disease in women. In addition to the above reasons, according to our surgical observations and foreign literature reports, there are many anatomical variations that easily cause the disease. For example, the abdomen of the long palm or short extensor hallucis is too low, and some of the abdomen also enters the sheath tube; there are more vagus tendons in the sheath tube, which significantly increases the number of tendons, some as many as ten; There is also a hard, thick and tough fibrous septum in the first dorsal sheath of the wrist, which makes the original not spacious sheath narrower and tendons are easily incarcerated. These anatomical variations make patients younger, and conservative treatments are difficult to achieve.

2. Myosynovitis

The radial wrist of the proximal dorsal ligament is elongated and the short muscles are located on the deep side. The superficial short extensor hallucis longus and long abductor hallucis form a certain angle to pass in the shallow side. When muscles become overactive, muscles, tendons, and the surrounding fascia and peri-tendon tissues become congested and edema. Synovial fibrous exudation increased, and symptoms such as local redness, swelling, and pain appeared.

Tenosynovitis clinical manifestations

1. Styloid tenosynovitis of the radial styloid process

Also known as de Ouervains disease, it is characterized by wrist radial pain and is closely related to thumb movement. The disease is more common in women over 40 years of age, but it also develops during breastfeeding.

2. Tenosynovitis of flexor tendon stenosis

It usually occurs in the thumb, middle and ring fingers, and the age of onset is generally over 40 years old. In the early stage of the onset, when the finger flexed and stretched, it caused popping and pain, so it was also called "trigger finger". Patients often report inflexible joint movements and joint swelling. In severe cases, the joint is locked in a flexed or straightened position, and the joint cannot be straightened or flexed. This disease is occasionally seen in children with bilateral thumbs in a flexed position and cannot be actively straightened. The lighter can be straightened by massaging the thumb when the child is asleep, and the passive can not be straightened by the passive.

3. Myosynovitis

Also known as gravel myosynovitis. When the activity of the wrist increases, redness, swelling, fever, and local tenderness appear near the back of the wrist. Pressing it can produce twisting sounds or stepping snow sounds.

4. Ulnar carotid extensor tenosynovitis

Is one of the causes of wrist ulnar pain. The ulnar carpi extensor tendon and surrounding sheaths play an important role in supporting the distal radial ulnar joint and the cartilage triangle fiber cartilage complex. Excessive wrist movements can cause lateral ulnar pain due to repeated pulls or sprains, especially when the wrist is stressed.

Tenosynovitis diagnosis

1. Styloid tenosynovitis of the radial styloid process

With the above symptoms, if the thumb flexes during the examination, and the other four fingers hold the thumb, the pain of the wrist ulnar deviation becomes worse, that is, Finkelsteins is positive, the diagnosis can be made.

2. Finger flexor tendon stenosis tenosynovitis

The above symptoms exist, and there is obvious tenderness at the beginning of the distal sheath of the palm, where most patients can touch the nodule.

3. Ulnar carotid extensor tenosynovitis

With the above symptoms, when the ulnar cartilage is resisted from being straightened during the examination, the ulnar carpal tendon compression along the ulnar side can induce severe pain on the ulnar side and it can be diagnosed.

Tenosynovitis treatment

1. Styloid tenosynovitis of the radial styloid process

For initial diagnosis or mild symptoms, braking, physical therapy or local closed conservative treatment can be used. If the symptoms of non-surgical treatment are not obvious or recurrent, surgical treatment can be used.

2. Finger flexor tendon stenosis tenosynovitis

(1) Physical therapy or local closed treatment is most effective at the beginning of the lesion ;

(2) Severe or recurrent lesions The author can use surgical treatment. The thickened narrow ring is removed during surgery. The range of resection should be observed during operation. The flexion tendon is not blocked by the sheath when the finger is flexed and extended.

3. Myosynovitis

Wrist braking, local hot compress, local physical therapy or local closure if necessary, most symptoms can disappear; if long-term recurrence, the tendon and synovial tissue become thicker, local bulge can be considered surgical treatment, thickened synovial membrane and Fascia.

4. Ulnar carotid extensor tenosynovitis

In the early stage, braking or partial closure is needed, and in the later stage, synovectomy or partial sheath resection is performed. Similarly, similar symptoms can occur in the radial flexor carpi flexor and ulnar carpi flexor, often caused by the corresponding tenosynovitis. If recurrent, patients may also consider surgery.

Tenosynovitis prevention

Pay attention to maintaining correct posture during work, avoid excessive strain on joints, and take regular breaks.

1. When doing household chores such as laundry, cooking, knitting sweaters, cleaning, etc., pay attention to the correct posture of fingers and wrists, do not excessively bend or stretch back; do not carry heavy objects; do not use excessive force on fingers, wrists.

2. Continuous working time should not be too long. After work, rub your fingers and wrists, and soak your hands with hot water.

3. It is best to use warm water when washing clothes in winter, and also to wear cotton gloves when snowing, to prevent cold in the hands.

4. For long-term desk office staff, the correct working posture should be adopted, as far as possible to balance their hands, the wrist can touch the real thing, do not hang.

5. Do 360-degree rotation of the wrist joint; or relax the fist with the palm of your hand firmly, do a few more back and forth or back pressure your fingers or palm a few times, you can effectively alleviate the sore hands.

6. When you feel tired of your joints, you can take a hot bath to relax your tight muscles, or apply a hot compress on the sore part. Often using computers is susceptible to tenosynovitis.