Tenosynovitis and Tendinitis

Tenosynovitis and tendonitis, although two separate conditions, will usually occur simultaneously. These are conditions that affect tendons and the sheaths that cover them. Tendons consist of a bundle of dense, sinewy, fibrous fibers that allow the muscles to be attached to bones. The covering of these tendons are called “synovial sheaths”. They are lubricated sheaths (synovial fluid) that allow the tendons to move freely, and without friction within them.

When any form of external trauma, or a specific systemic invasion targets a particular tendon or its sheath, an inflammatory process occurs causing a build up of fluid, resulting in swelling and pain. There can be varying degrees of pain, from tenderness to severe.  The degree of pain will determine the individual’s ability to function. Severe pain can cause partial to complete inability to move the affected area. Sites most often affected are the shoulder capsule, elbow, hip, hamstrings and Achilles tendons. The inflammatory process may also cause the deposition of calcium within the sheath and tendon, resulting in a chronic problem. The calcium deposit will be confirmed on x-ray, diagnosing the condition of tendinitis.

The causes although unknown, can usually be traced to certain systemic diseases occurring in the body, or to certain external conditions, such as sports activities, or a direct trauma impacting that particular area of the body. Some systemic diseases, such as rheumatoid arthritis (RA), can attack a particular area of the body, causing an inflammation of the tendon sheath or to the tendon itself, and most probably to the tendon and its covering sheath. Gout is another systemic disease that can be a causative factor, and there are yet several others that the condition can be traced too.

There are many physical activities that can be causative triggers for tenosynovitis, and, or tendinitis, such as:

1. Occupational, with such jobs that require repetitive motions. Examples are:
   1. Punch press operators requiring the use of one leg to activate the press. This can impact the hip and or the Achilles tendon.
       
2. Carpenters, roofers, construction workers, and basically anyone engaged in a job requiring repeated use of the arms, which constantly repeat the same motions.
    
3. Jobs requiring the use of a computer or typewriter for hours at a time can also impact the nerves and tendons of the wrist.
2. Athletic activities. This includes the professional athlete as well the individual who engages in occasional sports, such as the weekend athlete. Many sports will be included as possible triggers, such as the following and areas that they can trigger:
   1. Running….the Achilles tendon, hip and hamstrings.
   2. Golfing….the hip, shoulder and elbow
   3. Tennis….the elbow, Achilles tendon and hamstrings.
   4. Bowling….the shoulder, elbow, hip and hamstrings.
   5. Bicycling….the Achilles tendon and hip.
   6. Rowing….the shoulder, elbow and hip.
   7. Skiing….the shoulder, hip, hamstrings and Achilles tendon.
   8. Baseball….the shoulder, elbow and Achilles tendon.
   9. Basketball….the shoulder, elbow, hip, hamstrings and Achilles tendon.
   10. Football….the shoulder, hip, elbow, hamstrings and Achilles tendon.

The above are just some of the activities that can result in a tenosynovitis and or tendinitis.

Basically, any or all of our daily activities can be the trigger, if they are constantly repeated, especially in a wrong-full manner. Treatment of tenosynovitis and or tendonitis requires complete rest of the affected part. The application of heat or cold can be very beneficial, and which of these to use is best determined by each individual. In some cases using the heat, followed by cold applications can be helpful. Application of analgesic gels; 3 to 4 times daily following the above heat/cold treatment can also be of benefit.

Once the condition is improved, the individual should gradually return to the occupation or sports that initially caused the flare-up. They also need to correct the trigger that was the cause, so as not to aggravate the affected area again. At this point they should also start controlled exercises that will strengthen the affected tendons and muscles.