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Flexor/extensor tenosynovitis

What is tenosynovitis? The tenosynovium can be imagined as the sleeve through which the tendon runs. If you think of your arm moving through a thin shirt sleeve, then that is the normal scenario for a tendon. If the sleeve becomes inflamed, then it would be the equivalent of the arm moving inside a thick woolly jumper. Theoretically almost any tendon in the hand can be affected by the condition, though in my practice I see more commonly tenosynovits affecting the flexor tendons in the fingers, flexor carpi radlalis and extensor carpi ulnaris.

Inflammation affecting the tendons in the hand and wrist can be associated with a recognised inflammatory condition such as rheumatoid arthritis. In many cases the condition is not associated with any generalised disease. Overuse, such as 'painting all weekend' is a much commoner cause. In the acute stage it can be extremely painful and the area affected will be swollen and movement of the tendon can produce a sensation of crackling or creaking (crepitus). Treatment consists of rest, elevation, ice, anti-inflammatory drugs, splintage and physiotherapy.

The chronic condition is much more difficult to both assess and treat. Frequently there is no obvious reason for the development of the swelling, though there is always a tendency to blame something! The chronic inflammation can cause conditions such as carpal tunnel syndrome and trigger finger. The main treatment for the more chronic situation is physiotherapy. If that fails then a hydrocortisone injection cna be very effective. The last resort is surgery and usually I only go down that path after investigations have been performed, e.g. a MRI scan or ultrasound scan.