Medical Information

Explore detailed information about a range of joint problems and treatments, including medications, surgery, physiotherapy and rehabilitation. Reading this will help you understand more about your own condition. There is also a glossary with explanations of many medical terms used in orthopaedics. You can find out even more by following the links page to other related websites, journals or professional medical associations.

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Tendonitis and Tenosynovitis

Tendonitis means inflammation of a tendon. Tenosynovitis means inflammation of a tendon sheath – the synovium. These two conditions often occur together.

What are tendons?
Tendons attach muscles to bones and allow the muscles to move the bones. For example, the tendons that you can see behind the knee come from the hamstring muscles in the thigh and move the knee. Some tendons are covered by a sheath called the synovium. Between the synovium and the tendon is a tiny amount of ‘oily’ fluid. This helps the tendon to move freely and pull on the bone it is attached to.

What are the symptoms of tendonitis and tenosynovitis?
Pain, tenderness and swelling of the affected area of tendon are typical. The overlying skin may be warm. Any tendon of the body may be affected. However, tendons over the wrist, hand, shoulder ankle are most commonly affected. The inflammation may last just a few days. Sometimes it can last weeks or months if not treated.

Common tendonitis conditions include:
• Hand and wrist: Trigger finger / trigger thumb De Quervains syndrome
• Elbow Tennis elbow Golfers elbow
• Shoulder Rotator cuff tendonitis Biceps tendonitis
• Hip Adductor strain / Adductor tendonitis
• Knee Runners knee Illeo-tibial tract syndrome Patellar tendonitis Quadriceps tendonitis
• Ankle Achilles tendonitis Posterior tibialis tendonitis

What is the cause of tendonitis and tenosynovitis?
• Overuse – of a tendon is the common cause. These conditions commonly occur around the wrist and overuse by lots of writing (writers cramp), typing, golf, tennis or running etc.
• Arthritis – can sometimes include inflammation of the tendon sheaths or tenosynovitis as well as the joints
• Unknown – many cases seem to occur for no apparent reason
• Infection – between the tendon and its sheath is a rare cause which requires urgent treatment.

What is the treatment?
• Rest – is important to allow the inflammation to settle. Most commonly this involves stopping the repetitive activity which precipitated the condition. This may include reducing or modifying the activity (e.g.: stopping serving or overhead shots in tennis, badminton or squash).

• A splint or support: Sometimes a splint, firm bandage or brace may help (e.g. De Quervains tenosynovitis at the wrist). This enforces the hands and wrist to stay in the same position to allow rest of the affected tendon. For Achilles tendonitis an insole arch support or Orthotic helps support and elevate the ankle and often helps relive Achilles tendonitis.

• Ice packs – over the affected area may ease swelling and pain, especially directly after exercise.

• Anti-inflammatory painkillers – are often prescribed (for example, ibuprofen). These ease pain and reduce the inflammation.

• Physiotherapy – may be advised. This is often helpful in stretching out tightened and contracted muscles in Achilles Tendonitis or Patellar tendonitis. Specific targeted muscle strengthening is essential in Rotator Cuff Tendonitis of the shoulder.

• A steroid injection – into the site of inflammation may be given if the above measures do not work. Steroids work by reducing local inflammation. It is usually effective, particularly in the short term. This is often used in the shoulder, wrist or hand. Steroid injection may cause degeneration of the tendon and possible tendon rupture and so is usually avoided in Patellar tendonitis and particularly Achilles tendonitis.

• Surgical release of a tendon – Most cases of tendonitis can generally be helped by the non-operative measures. However it is not uncommon that the symptoms persist and surgical intervention is required.

Common Surgical procedures include:

• Hand and wrist: Trigger finger / trigger thumb – Percutaneous Release
De Quervains syndrome – Surgical release
• Elbow Tennis elbow – Common extensor release
• Shoulder Rotator cuff tendonitis – Arthroscopic Subacromial decompression
• Knee Patellar tendonitis – Arthroscopic Decompression
• Ankle Achilles tendonitis – Surgical decompression

The following may help prevent a recurrence once the condition has settled.
• Avoid repetitive motion and overuse of the affected area. This may be very difficult if your job involves repetitive movements. If it is a recurring problem then you should discuss this with your employer. A change of duties may be required.
• Exercises to strengthen the muscles around the affected tendon may help prevent a recurrence. It may be best to seek advice from a physiotherapist to find the best exercises to use.

Consultant Orthopaedic Surgeon

Editor: David P Johnson MD.
St Mary’s Hospital. Clifton Bristol. BS8 1JU.
Web site:
© OrthopaedicsOpinionOnline 2011

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