Tenosynovitis

The synovium is the lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from:

• Diseases that cause inflammation
• Infection
• Injury
• Overuse
• Strain

The wrists, hands, ankles, and feet are commonly affected because the tendons are long across those joints. But, the condition may occur with any tendon sheath.

An infected cut to the hands or wrists that causes infectious tenosynovitis may be an emergency requiring surgery.

Symptoms may include any of the following:

• Difficulty moving the joint
• Joint swelling in the affected area
• Pain and tenderness around the joint
• Pain when moving the joint
• Redness along the length of the tendon

Fever, swelling, and redness may indicate an infection, especially if a puncture or cut caused these symptoms.

The health care provider will perform a physical examination. The provider may touch or stretch the tendon. You may be asked to move the joint to see if it's painful.

The goal of treatment is to relieve pain and reduce inflammation. Rest or keeping the affected tendons still is essential for recovery.

Your provider may suggest the following:

• Using a splint or removable brace to help keep the tendons from moving to aid healing
• Applying heat or cold to the affected area to help reduce pain and inflammation
• Medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injection to relieve pain and reduce inflammation
• In rare cases, surgery to remove the inflammation around the tendon

Tenosynovitis caused by infection needs to be treated right away. Your provider will prescribe antibiotics either taken by mouth or through your veins. In severe cases, emergency surgery is needed to release the pus around the tendon.

Ask your provider about strengthening exercises that you can do after you recover. These may help prevent the condition from coming back.

Most people fully recover with treatment. If tenosynovitis is caused by overuse and the activity is not stopped, it is likely to come back. If the tendon is damaged, recovery may be slow or the condition may become chronic (ongoing).

If tenosynovitis is not treated, the tendon may become permanently restricted or it may tear (rupture). The affected joint can become stiff.

Infection in the tendon may spread, which could be serious and threaten the affected limb.

Contact your provider for an appointment if you have pain or difficulty straightening a joint or limb. Contact your provider right away if you notice a red streak on your hand, wrist, ankle, or foot. This is a sign of an infection.

Avoiding repetitive movements and overuse of tendons may help prevent tenosynovitis.

Proper lifting or movement can decrease the occurrence.

Use the appropriate wound care techniques to clean cuts on the hand, wrist, ankle, and foot.

Inflammation of the tendon sheath

Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 247.

Hogrefe C, Jones EM. Tendinopathy and bursitis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 103.

Thompson NB. Hand infections. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 79.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.