Tenosynovitis
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Synopsis
Tenosynovitis is characterized by the inflammation of both the tendon and synovial sheath. Typically, the hands and wrists are affected, but tenosynovitis may be found with any joint. The etiology includes infection, trauma, inflammatory disease, and strain / overuse. Less commonly, it may be associated with a medication. Infection can be caused by staphylococci, streptococci, gonococci, Mycobacterium avium, and Mycobacterium tuberculosis. Tenosynovitis has also been reported in association with Vibrio vulnificus infection related to traumatic injury in the setting of saltwater fishing. Infection may occur after a wound, puncture, or bite.Trigger finger, or stenosing flexor tenosynovitis, is one of the most common causes of hand pain in adults, and its pathogenesis is often idiopathic.
Signs and symptoms include joint pain, difficulty moving a joint, a slightly flexed finger at rest, edema, and muscle tenderness. Infectious etiologies will include erythema and fever.
Treatment depends on etiology and includes antibiotics, steroid injection, and possibly surgery.
Related topic: de Quervain disease
Codes
ICD10CM:M65.9 – Synovitis and tenosynovitis, unspecified
SNOMEDCT:
67801009 – Tenosynovitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Osteoarthritis
- Rheumatoid arthritis
- Psoriatic arthritis
- Dactylitis
- Overuse injury (eg, tendonitis)
- Carpal tunnel syndrome
- Trauma / fracture
- Disseminated gonococcal infection
- Sarcoidosis
- Osteomyelitis
- Atypical mycobacterial infection
- Gout
- Pseudogout
- Reactive arthritis
- Rheumatic fever
- Malignancy (particularly primary bone [osteosarcoma, Ewing sarcoma] and soft tissue)
- Cellulitis
- Bursitis
- Compartment syndrome
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:05/06/2019
Last Updated:09/08/2021
Last Updated:09/08/2021
Patient Information for Tenosynovitis Overview
Tenosynovitis occurs when tendons and the lining of the protective sheath that surrounds tendons become inflamed and painful. This most commonly happens in the hand or wrist, but tenosynovitis can be found in other joints.Tenosynovitis can be caused by infection, overuse of the wrist or hand, trauma or injury, or an underlying inflammatory disease.
Who’s At Risk
Overuse of joints, particularly with repetitive motions, can lead to swelling, pain, and inflammation of the overused joint.People with inflammatory diseases may have a greater likelihood of developing tenosynovitis.
People who have suffered a penetrating injury, such as a puncture wound or animal bite, are at risk of infection leading to tenosynovitis.
Signs & Symptoms
Symptoms include swelling, joint pain, muscle tenderness, a joint that is hard to move, or a finger that is difficult to straighten out.If tenosynovitis is caused by infection, fever and redness may be observed.
Self-Care Guidelines
Follow your doctor's instructions to reduce swelling and pain. Applying heat or cold to a joint may help with both inflammation and pain. Ibuprofen may also help.When to Seek Medical Care
If you experience painful, swollen tendons in your hand, wrist, or any joint, contact your health care provider.If you experience painful, swollen tendons that may be related to traumatic injury or puncture, or your puncture wound has been exposed to sea water or raw seafood, or if you have signs of infection (fever, redness, progressive swelling), get medical help immediately.
Treatments
Your doctor will test you for bacterial infection and, if the test is positive, will most likely prescribe antibiotics.Your doctor will advise you if you are on any medications that can interfere with your healing, especially if you have an inflammatory disease.
You will receive instructions on how to care for your condition, and any warning signs or complications to report. Some patients are helped by the use of braces or splints to keep the tendon still. A corticosteroid injection may reduce inflammation in some cases. Physical therapy may stop the condition from coming back.
Tenosynovitis