Tenosynovitis

Disease Description (Causes and Pathophysiology, Main Symptoms)

• Definition: Tenosynovitis is a condition in which inflammation develops in the tendon sheath (synovial membrane), the membrane surrounding a tendon.
• Pathophysiology: Repetitive overuse or trauma causes microscopic tears and an inflammatory response within the tendon sheath, resulting in synovial fluid secretion and swelling. This interferes with the gliding of the tendon, causing pain and restricted movement. In infectious cases (e.g., caused by Staphylococcus or Mycobacterium tuberculosis), purulent inflammation and systemic symptoms may occur. Chronic tenosynovitis may develop due to systemic diseases such as rheumatoid arthritis or gout.
• Main symptoms: Pain, swelling, tenderness, restricted joint movement, and reduced muscle strength in the affected area (e.g., wrist, fingers, shoulder, or heel). In severe cases, pain at rest, redness and warmth (in infectious cases), or tendon rupture may occur.

Treatment Methods

• Conservative treatment (first-line):
  • Stop overuse and rest; reduce the load on the tendon by immobilizing it with a brace (splint) or taping.
  • Control pain and inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Promote functional recovery with local cold compresses and physical therapy (ultrasound, stretching, and strengthening exercises).
• Injection treatment:
  • Local corticosteroid injection: Effective for relieving inflammation, but repeated injections require caution because of the risk of tendon weakening.
  • If infection is suspected, corticosteroids are contraindicated, and antibiotics may be considered.
• In infectious cases:
  • Administer appropriate antibiotics (oral or intravenous); drainage and surgical debridement may be necessary.
• Surgical treatment:
  • In stenosing cases (e.g., persistent pain caused by stenosis or trigger finger) or recurrent/chronic cases that have failed conservative treatment, pathological tendon sheath incision and release (decompression) or scar-removal surgery may be performed.
• Lifestyle management and precautions:
  • Reduce repetitive use of the wrists and fingers and improve the ergonomics of work posture and equipment.
  • Prevent recurrence through stretching and muscle-strengthening exercises.
  • Avoid strenuous activity after corticosteroid injections during treatment.
• Complications:
  • If untreated, tendon rupture, chronic adhesions (restricted movement), spread of infection (in infectious cases), and postoperative scarring or reduced movement may occur.
• Prognosis:
  • Most cases improve with conservative treatment, but recurrence or chronic progression may occur depending on the cause (infection, rheumatoid disease, repetitive overuse, etc.). If left untreated, the risk of tendon rupture increases.

Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

• Items to bring:
  • List of currently used medications (including prescriptions and over-the-counter medications)
  • Medical history (especially rheumatoid disease, gout, diabetes, immunosuppressive treatment, etc.)
  • Records of when symptoms began and their progression (when they worsen), as well as aggravating and relieving factors
  • Occupation and weekly activities (whether the wrists or fingers are used repetitively), and whether there has been any recent accident or trauma
  • Whether there are symptoms suggesting infection, such as fever, redness, or pus
  • Previous test results (X-ray, ultrasound, blood tests, etc.) or photographs (showing the state of swelling and redness)
• Points to tell the doctor in advance during the outpatient visit:
  • Any recent corticosteroid injections and whether you are taking anticoagulants
  • Whether you are breastfeeding or pregnant (particularly in cases of wrist tenosynovitis)
• Examples of symptom records to present during the consultation:
  • Location of the pain (precisely), timing (at rest or during movement), intensity (pain score), and extent of restricted movement

General Example Questions to Ask the Doctor

• What are the side effects of this medication (e.g., an NSAID or local corticosteroid)? How long should I take it, and what precautions should I follow?
• When can I expect the pain to improve? When can I return to daily activities and work?
• What lifestyle habits and exercises can help reduce recurrence?
• If I receive corticosteroid injections, how often can I receive them? What are the long-term risks?
• If an infection is suspected, what additional tests are needed, and is hospitalization necessary?

Examples of Condition-Specific Questions

• How can we determine whether my symptoms are due to infectious tenosynovitis or noninfectious (mechanical or inflammatory) tenosynovitis? (For example, based on fever, blood tests, ultrasound/joint ultrasound findings, and whether a culture is needed.)
• Is this a specific form such as trigger finger or de Quervain tenosynovitis, what is the likelihood of improvement with a corticosteroid injection, and what are the criteria for requiring surgical treatment?