Brief overview
- Symptoms: pain, swelling, redness, morning stiffness, feeling of tension, crunching when moving
- Treatment: Immobilization with splint or tight bandage, cooling if necessary, physiotherapy, anti-inflammatory ointments and tablets, cortisone injections, surgery in severe cases
- Cause and risk factors: Inflammation of the tendon sheaths due to overloading or incorrect loading of joints, for example during sport, at work or when playing music; rarely due to injury or infection
- Diagnosis: Based on the symptoms and typical signs of inflammation; rarely X-ray examination
- Prognosis: Usually good if the joint is immobilized; chronic progression possible if untreated
- Prevention: Warm-up exercises, “warm-up games”, joint-friendly techniques and action sequences, use technical aids
What is tendinitis?
It is possible for a tendon sheath to become inflamed, particularly in the event of overuse. Tendovaginitis itself must be distinguished from tendon sheath inflammation (tendinitis).
In principle, tendovaginitis can occur in any tendon sheath. It particularly frequently affects the fingers or wrist, sometimes also the foot. It can also affect the forearm, upper arm, elbow, shoulder, back of the knee, leg, ankle or big toe.
Known special forms of tendinitis in the hand are snapping finger and tendovaginitis de Quervain. In both diseases, tendons are constricted, which is why doctors refer to them as tendovaginitis stenosans (stenosis = constriction).
If the symptoms occur on the inside of the fingers, it may be a case of snap finger. You can read more about this in the article Snap finger.
How does tendinitis manifest itself?
Tendon sheath inflammation often begins insidiously. In general, the five signs of inflammation can be recognized:
- Redness (rubor)
- Swelling (tumor – not in the sense of cancer)
- Pain (dolor)
- Warming (calor)
- Functional impairment (functio laesa)
How does tendon sheath inflammation progress at the respective sites?
The main symptom is pain over the affected tendon sheath (e.g. pain in the wrist). This pain intensifies when the joint, or more precisely the affected tendon, is moved actively or passively. Swelling and redness can usually be seen above the affected joint. Morning stiffness and a feeling of tension are also often described. Some patients feel a crunching sensation when they move the joint. Doctors then speak of tendovaginitis crepitans.
Treatment
Conservative therapy
To avoid movements that aggravate tendonitis and make the pain worse, it often makes sense to immobilize the hand, foot or affected joint with a splint or a tight bandage. However, immobilization should only be short-term, as it is possible that the tendon will otherwise stick to the tendon sheath.
Accordingly, in addition to splints or fixed bandages, so-called stable tapes can be used to immobilize the joint. Doctors will only use a plaster cast in special situations, as the joint should only be immobilized for a short period of time.
Physiotherapy exercises for strengthening and stretching generally have a positive effect on the muscles and tendons. Physical or manual therapy can also correct chronic incorrect strain.
Sometimes doctors use anti-inflammatory painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen and diclofenac, for example. They can be taken as tablets. Anti-inflammatory ointments are also helpful in many cases.
If necessary (e.g. in the case of repeated painful tendinitis), the doctor will administer targeted cortisone injections. They have an anti-inflammatory effect and usually help well, but are not administered as often as required. Repeated cortisone injections may have the undesirable effect of damaging the tendon tissue.
Home remedies: what can you do yourself?
Various home remedies are said to help against the inflammation and pain of tendonitis. Examples:
- Applications with horseradish, healing clay or quark are also said to help.
- An ointment with propolis (bee resin) has an anti-inflammatory effect.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
Surgery
If pain and recurrent tendovaginitis occur despite intensive conservative treatment, doctors often consider surgery. This is often performed on an outpatient basis and is usually performed under local anesthesia (or general anesthesia if required). Depending on the type of anesthesia, patients leave the clinic immediately after the procedure (with local anesthesia) or after a few hours (with general anesthesia).
Aftercare
After the operation, it is advisable to start light movement exercises immediately to avoid adhesions. The stitches are removed about ten days after the operation. The scar will still be painful for the first few weeks. Over time, however, the pain will subside and the surgical scar will become less sensitive. Depending on your activity, you can return to work after about two to three weeks.
Possible complications
As with any operation, complications are possible with tendon sheath surgery, for example if nerves are accidentally injured. It is rare for a nerve to grow into the scar tissue. If pain and discomfort recur after a symptom-free interval, another operation may be necessary.
A further complication is that the surgical wound may become infected. It should then be treated with an antibiotic.
Alternative medicine and homeopathy
- St. John’s wort
- arnica
- Essential oils such as bergamot, lavender, orange, lemon for rubbing in
The remedies are said to have an analgesic, anti-inflammatory and sometimes cooling effect.
Herbal remedies are often effective, even from a scientific point of view. However, conventional painkillers are generally more effective. Talk to your doctor about whether herbal remedies might be a good addition to a therapy.
In the field of homeopathy, there are treatments for tendonitis that are based on dilutions of Acidum fluoricum (“hydrofluoric acid”) or Bryonia (“white turnip”).
The concept of homeopathy is controversial. Its effectiveness cannot be proven according to conventional medical, scientific and evidence-based criteria.
Causes and risk factors
Injuries may also cause the inflammation. Sometimes a rheumatic disease is the trigger for tendovaginitis. Only very rarely are bacteria responsible for the inflammation (septic tendovaginitis).
The inflammatory reaction causes the tendon and tendon sheath to swell so that the fine film of fluid in the tendon sheath is no longer sufficient for smooth tendon movement. Sometimes the tendon even gets stuck in its tendon sheath.
This increases the inflammation and causes additional pain. The surfaces of the tendon and tendon sheath often change as a result of the inflammatory reaction, causing a palpable and audible rubbing sensation during movement (tendovaginitis crepitans).
Fingers
The flexor tendons of the fingers extend into the palm on the inside of the finger and the extensor tendons on the top of the finger extend into the back of the hand. If their tendon sheaths become inflamed, the fingers hurt when moving.
Wrist
Tendon sheaths in the wrist often become inflamed and cause pain. The cause is usually acute or chronic overloading or incorrect loading of the tendons that run here.
Local bruising of the tendons also sometimes causes a tendon sheath to become inflamed (and sometimes the tendon itself). The flexor tendons of the hand are particularly stressed during sports such as climbing, gymnastics, rowing or table tennis. Intensive practice with musical instruments such as the guitar, violin or piano is also often the reason when a tendon sheath becomes inflamed in the wrist area.
A common form is the so-called tendovaginitis stenosans de Quervain. In this case, two tendon sheaths in the wrist below the thumb are inflamed (in the so-called first extensor tendon compartment): That of the short extensor muscle and the short extensor muscle of the thumb. The thumb hurts when moving, especially when gripping.
Pain in the arm
Elbow pain is often a sign of tennis elbow, caused by constant overloading and microtraumas that lead to tears in the tendons. However, tennis elbow is an inflammation of the tendon insertions of the muscles of the forearm and therefore not tendon sheath inflammation. Arm pain caused by tendinitis is more localized to the forearm.
Foot
Tendovaginitis in the foot is less common than in the hand. The foot tendon sheaths are located at the level of the ankle joint. They often become inflamed in people who are active in sports, either due to an injury to the foot or chronic instability in the ankle joint.
Examinations and diagnosis
If you suspect tendovaginitis, it is best to consult a general practitioner or an orthopaedic specialist. Tendovaginitis can usually be easily diagnosed on the basis of the medical history and physical examination. In order to record your medical history, your doctor will talk to you in detail about your symptoms. He or she may ask the following questions:
- Have you recently been doing unusually strenuous work with your hands, such as gardening or moving house?
- What is your occupation? Do you work a lot on a computer keyboard?
- What movements cause the pain?
- How long has the pain been present?
- Do anti-inflammatory medications help you?
Imaging examinations
Imaging procedures are generally not necessary and are only used in exceptional cases. In order to rule out bony changes, it is possible to take X-ray images in two planes. Ultrasound can also be used to visualize the tendon. Magnetic resonance imaging (MRI) also makes tendons visible.
Course of the disease and prognosis
Tendonitis often has a protracted course. It is important to protect the joint from the very beginning of the symptoms in order to prevent the acute inflammation from becoming chronic. However, the prognosis for tendonitis is good as long as the triggering movements are avoided as far as possible and there are no other conditions such as rheumatism or joint inflammation.
Prevention
For sedentary activities, a dynamic office chair may help to avoid strain on the joints and back as well as problems caused by sitting still for too long (e.g. thrombosis).
For many physical activities, there are specific postures or techniques that are easy on the back and joints, as well as appropriate technical aids.
When playing sports and music, it is advisable to warm up muscles, tendons and joints thoroughly to prevent specific problems. This ranges from warm-up and stretching exercises to gradually warming up with musical instruments.
