Non-infectious causes

Infectious or purulent tendovaginitis is generally less common than non-infectious forms of tenosynovitis. The main causes include long-term mechanical misuse or overloading, which leads to irritation of the tendon tissue. According to this, it is precisely long-lasting monotonous movement sequences and severe postural defects that cause the tendon sheaths to rub particularly hard against the bone and thus become damaged.

Over time, the abrasion is followed by roughening of the collagen fibers, which can lead to the development of inflammatory processes. For this reason, non-infectious tendovaginitis mainly affects office workers and athletes. In most cases, tendovaginitis occurs at the tendon sheaths of the wrists and ankles, i.e. at those places that have to withstand a high degree of stress. Risk factors are especially unergonomic work equipment (e.g. keyboards) at the desk.

Symptoms

Patients suffering from tendovaginitis generally complain of severe stabbing pain in the area of the affected tendon sheath. In addition, many affected patients report a pressure pain along the course of the tendon, which can also extend into the muscle. In many cases, overheating of the joint and reddening of the areas of skin above the tendon sheath can also be observed.

The occurrence of pain at rest occurs only in very pronounced cases. Pain at rest is rather untypical for tendovaginitis. In the case of long-lasting (chronic) forms of tendovaginitis, nodular thickening, palpable crunching and rubbing of the tendon may also occur. In addition, the pain phenomenon can be triggered by passive stretching of the tendon in the presence of tendosynovitis.

Diagnosis

Since the causes for the development of tendovaginitis can be infectious as well as non-infectious, a comprehensive diagnosis must precede the choice of the appropriate therapy.One of the most important points in the diagnosis of tendovaginitis is the detailed doctor-patient consultation (anamnesis). Already by the patient’s descriptions the treating physician receives a first suspected diagnosis. In addition to the description of the type, intensity and localization of the pain, the information about the professional activity is of great importance.

In addition, the doctor can draw further conclusions about the underlying disease by palpating the affected area. If the findings are unclear, it is then possible to initiate further examinations. Inflammation markers in the blood (especially elevated white blood cells and the so-called CRP value) indicate an inflammatory event.

In addition, the blood should be examined for a special rheumatoid factor. An X-ray or MRI (magnetic resonance imaging) may also be useful in the diagnosis of tendovaginitis. In medical terminology, an inflammation of the tendon sheaths is called tendovaginitis (synonyms: tendovaginitis, peritendinitis, paratendinitis).

In most cases, tendovaginitis manifests itself by severe stabbing pain in the area of the affected tendons. In severe cases even redness and overheating may occur. In principle, tendovaginitis can occur in all tendons of the body, but in everyday clinical practice it has been shown that mainly the ankle joints and wrists are affected.

Among the most frequent causes of tendovaginitis are mechanical overloading or incorrect strain. However, inflammation of the tendon sheaths can also be triggered by bacterial pathogens (especially strepto and staphylococci). In the event of repeated occurrence or long-lasting complaints, other possible causes of pain (so-called differential diagnoses) should be urgently clarified.