Tenosynovitis: inflammation of the sheath that surrounds a tendon

 What is Tenosynovitis?

Tenosynovitis is an inflammation of the sheath that surrounds a tendon. Tenosynovitis can be caused by repetitive motions, direct injury to the tendon or joint, overuse (exercise), poorly fitted equipment (tennis elbow), or fluid build-up around tendons (golfer's elbow). The main symptoms are pain and swelling around the affected tendon.

Tenosynovitis is common in many sports and can be found among athletes, especially swimmers, who perform their sport at a high level and for a long period of time. The pain and swelling can range from mild to severe and depending on the severity, symptoms may not appear until several days after beginning treatment.


Tenosynovitis
Tenosynovitis


Athletes participating in any type of repetitive motions such as swimming often suffer from tenosynovitis due to overuse or through direct trauma by collision with another swimmer or the lane line. Overuse injuries typically occur gradually as tissue fibers are broken down by constant hard stress resulting in inflammation at the site of injury. This causes small tears that put stress on nearby uninjured tissues then become injured due to an overload.

Tenosynovitis in swimmers is a very common injury among age groups and competitive swimmers, especially sprinters who have a higher risk due to the amount of force generated when hitting the water. The pain from overuse or direct trauma is located along the tendon sheath surrounding the affected tendons, which can be felt as sharp pains at certain points along the length of the tendon. In most cases, tenosynovitis gets aggravated during training and tends to calm down within hours after finishing a workout session. 

An athlete may not feel any symptoms during practice but once out of water for extended periods of time, will experience tenderness around one or more tendons where inflammation has built up. This condition only worsens with prolonged activity.


Symptoms

Common symptoms for tenosynovitis are stiffness, soreness, tenderness, and swelling around the wrist, thumb, or elbow. The pain typically becomes worse with active use of the affected area and can subside to a dull ache after several hours. Swelling is usually present but will vary depending on how severe the condition has become. In more serious cases an athlete may be unable to make a fist or hold any type of equipment due to severe pain and limited mobility in the tendons themselves. Also, other symptoms that appear related to the swimmer's shoulder such as bursitis or other conditions may be present, especially if there was direct trauma by collision with another swimmer during practice.  


Diagnosis

After a physical examination has been conducted by the physician, tenosynovitis can be determined by conducting an ultrasound or MRI scan to view tendon sheaths that surround tendons, which are responsible for causing stiffness and pain. Ultrasound scans require direct contact with the skin while exposing the area around affected muscles to high-frequency sound waves. 

These echoes are collected within the body tissues which will allow for visualization of inflamed areas. MRI's do not require any type of injection or x-rays and provide images similar to those produced by ultrasound but better define surrounding structures such as surrounding muscle tissue and ligaments. Still, diagnostic imaging alone cannot determine whether inflammation is present so a physician will perform an active test such as moving your fingers in certain directions or opening and closing your hand to determine pain levels.

Pain is caused by the compression of surrounding tissue which causes swelling along the tendon sheath. Due to this, tenosynovitis can be treated using anti-inflammatory medications that reduce symptoms such as redness, pain, and swelling. If symptoms continue for an extended period of time even after proper treatment has been implemented, surgery may become necessary to remove excess tissue causing inflammation within tendon sheaths. 

Treatment varies depending on the severity of the injury but also depends on how long the athlete has had symptoms. If you suspect you may have tenosynovitis make sure to visit a medical professional who specializes in athletic injuries.  


Prevention 

Stretching before practice and maintaining the correct form when swimming can help reduce the risk for this injury. It is very important to properly warm-up and cools down before and after workouts because these exercises will increase blood flow in muscles which reduces stiffness, soreness and allows tendons to become more pliable when moving during stressful motions. 

This will also help prevent tendon overuse injuries such as tenosynovitis along with other conditions such as swimmer's shoulder and carpal tunnel syndrome. Make sure not to overdo stretching because if performed incorrectly it can lead to tears or ruptures in tendons. Furthermore, avoid repetitive stress on one specific area of the body such as continually using an indoor heated pool year-round since doing this increases risk for certain types of tendinitis such as epicondylitis or tenosynovitis.    



Is tenosynovitis serious?

Depending on the severity of the injury, tenosynovitis can be a very serious condition since it is a type of overuse injury that directly affects tendons. This means that even though there may not be any visible or noticeable signs of damage, stress to the tendon from the activity will bring about symptoms that will need to be treated through proper recovery methods such as applying ice packs, anti-inflammatory medications, and stretching before and after workouts.  

Currently, there are no significant studies linking specific types of strokes with pain resulting from tenosynovitis. Most cases reported in swimmers have been related to breaststroke which requires motion similar to opening and closing one's hand while moving through water. Since different strokes involve varying amounts of a range of motion this might be a reason why tenosynovitis has been most often reported in breaststroke swimmers.

This is another example of how competitive swimming puts athletes at risk for chronic injuries. Unfortunately, with any injury it is best to be proactive and try to prevent them from occurring by properly warming up before your workout, cooling down afterward, and taking a break from the pool if you feel fatigued or pain throughout your body. 


What causes tendon sheath inflammation?

Tendons are vulnerable to overuse injuries such as tendinitis which occurs when they become inflamed due to repetitive stress placed on them during activity that involves quick movements of muscles through small ranges of motion. In swimming, the repeated use of one's arm motions can place stress on tendons that connect muscle to bone along the arms and shoulders. 

The most common type of tendon inflammation is called tenosynovitis, where the condition takes place within the sheath that surrounds a tendon. This can create pressure which decreases blood flow causing pain or numbness along the course of the inflamed tendon.


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Does tenosynovitis require surgery?

Surgery to remove excess tissue may be necessary depending on the severity of the condition and the length of time symptoms have been present. If inflammation within the sheath that surrounds a tendon is not treated it can lead to rupture or tearing. Sometimes removing inflamed tissue is the only way to quickly relieve pain caused by tenosynovitis although this procedure can cause further problems if performed incorrectly. 


How long does it take for tenosynovitis to heal?

The healing process for this type of injury varies based on severity and how long the athlete has had symptoms. It is very important for those with tenosynovitis to follow proper recovery methods such as icing the injured areas, minimizing activity involving movements directly with increasing inflammation (i.e. swimming), taking anti-inflammatories, keeping skin clean and dry, to wear compression bandages if prescribed by the doctor, proper nutrition. 

When an athlete is ready to get back in the water focus on getting a range of motion back through slow movements while increasing intensity over time. Keep in mind that tendons will take longer to heal than muscles. 

When tenosynovitis results from overuse there is rarely a case where it comes about suddenly; instead, it develops gradually which makes noticing symptoms much easier when compared with other types of injuries. Symptoms usually present themselves when athletes continue activity despite feeling pain during the workout or when they experience pain after completing their day's exercise routine due to the build-up of excess stress placed on the tendon. 

Wearing proper support may help to prevent injury due to overuse by reducing stress on tendons during activity. Stretching should be done before and after workouts as well as periodically throughout the day. If you are aware that you have tendon issues it is best to avoid any type of activity like swimming where your body is continuously repeating similar motions for extended periods of time (i.e. more than 10 minutes).

After tenosynovitis has healed, stretching before and after workouts may help reduce the risk of reoccurrence. 

The first aid for this condition includes rest, reduction in activities that exacerbate pain, anti-inflammatory medications, massage therapy, icing the area, wearing compression garments if indicated by the physician.  During tenosynovitis, athletes should gradually get back to activity, over time if pain-free.


How long should the recovery process take? 

Recovering from tendonitis may require patience and commitment to treatment depending on the severity of the condition. Typically recovery period lasts for few months but it can vary based on the type of tenosynovitis (i.e. acute or chronic) and how long the athlete has had symptoms before seeking medical attention. While recovering, focus on flexibility exercises that will help stretch out affected areas (i.e., forearms). If you are trying to recover quickly make sure you do not push yourself too much because this may lead to re-injury which could prolong the recovery process. 

It is important to consult with sports physicians during recovery so they can determine if more aggressive treatment is necessary, physical therapy, or changing activity level. There are different types of tenosynovitis that affect tendons including acute and chronic tenosynovitis. Acute tendonitis will have more sudden onset symptoms due to overuse of body parts leading to inflammation. Chronic inflammatory disease can be longer-lasting but less severe since it is not an overuse injury.

Surgery should only be done if the athlete has pain for more than six months after other treatments have failed or there is a rupture within the tendon sheath. Surgery involves removing the excess tissue from the affected area so athletes may recover in two weeks depending on the severity of the condition. If surgery does not help then retired from the athletic competition (i.e., surgeries should be seen as a last resort).

Surgery is a treatment option but it should only be done in cases where symptoms do not improve after 6 months of conservative treatments. Surgery is also an option if the tendon sheath has ruptured. 


How long does tenosynovitis last? 

It will take few months to recover depending on the severity of the condition. Tendinitis may result in symptoms lasting for six months or longer if not properly treated. 

Acute tenosynovitis should be treated within 6 weeks, chronic tendons are more difficult to treat but symptoms should start subsiding after 3-4 months even though it can last for over a year.

After tenosynovitis is gone, athletes should perform flexibility exercises when trying to prevent further injury.