MANUAL MINORS
Tendinitis refers to the inflammation of a tendon, the structure connecting muscle to bone, while tenosynovitis involves inflammation of both the tendon and its synovial sheath. Both conditions are typically caused by overuse, trauma, or repetitive movements and are commonly seen in areas such as the shoulder, elbow, wrist, knee, and ankle. They are characterised by localised pain, tenderness, and swelling in the affected region, which worsens with movement.
Diagnosis
Diagnosis is based on a clinical history of localised pain that worsens with movement, accompanied by tenderness on palpation of the affected tendon. Physical examination reveals tenderness along the tendon, pain with both active and passive movement, and in some cases, crepitus or swelling (more common in tenosynovitis). X-rays are usually normal, but ultrasound or magnetic resonance imaging (MRI) can reveal tendon and synovial sheath thickening, confirming inflammation.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Bursitis | Inflammation of a bursa (synovial sac), with more diffuse pain not directly related to the tendon. |
Arthritis | Joint pain, stiffness, and crepitus, more localised to the joint rather than the tendons. |
Tendon rupture | Sudden pain with significant loss of function in the affected tendon, possibly with a palpable “gap.” |
Carpal tunnel syndrome | Pain and numbness in the wrist and hand due to nerve compression, not tendon inflammation. |
Emergency Management
Initial emergency management includes resting the affected joint, applying ice to reduce inflammation, and administering analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.
In more severe cases, temporary immobilisation with a splint or elastic bandage may be required to limit movement. Corticosteroid injections are reserved for cases where conservative treatment is insufficient but should be used cautiously.
Definitive Treatment
Definitive treatment for tendinitis and tenosynovitis includes physiotherapy to improve flexibility, strengthen muscles, and correct biomechanics. In chronic or refractory cases, corticosteroid injections can be useful to reduce inflammation.
Activity modification is essential to prevent recurrence, such as avoiding repetitive movements or overuse. In severe cases or when complications like tendon rupture occur, surgical intervention may be necessary. Complete recovery may take several weeks to months, depending on the severity of the condition.
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