Idiopathic Tenosynovitis

1. Diagnosis

The main symptom is pain in areas where severe friction occurs. In almost all cases, there is tenderness in the area with marked friction, and occasionally a friction sound similar to a trigger sound may be observed. In addition, when a stress test is performed in which the affected tendon is stretched, the patient complains of pain that is startlingly severe.

If the patient's medical history and characteristic physical examination findings are observed, and there are no abnormal bone findings on plain radiographs,

most cases can be diagnosed as stenosing tenosynovitis.

Tenosynovitis due to rheumatoid arthritis, or suppurative or tuberculous tenosynovitis, is often diagnosed after a tissue biopsy or culture test.

2. Treatment

1. Simple observation

As described above, the affected pulley is very likely to stretch on its own over time, and the symptoms may disappear. Therefore, if there is only tenderness, or if the crepitus (sound of hair rubbing together) is not severe and the patient is not very uncomfortable, observation alone may be performed after educating the patient to avoid activities that cause pain in the area.

After observing in this way for several months, many patients usually show improvement to the point that it does not interfere with daily life.

2. Administration of anti-inflammatory analgesics

For patients who cannot get sufficient rest for the hand, nonsteroidal anti-inflammatory analgesics may be administered to relieve symptoms. However, sufficient rest for the hand is a better treatment. If hand use or exercise continues while taking medication, good treatment results are difficult to expect. If medication is difficult to take due to digestive problems, etc., an anti-inflammatory pain-relief cream may be used instead of oral administration.

3. Local steroid injection

Injecting steroid into the tendon sheath together with a local anesthetic has a good short-term therapeutic effect. Long-term prognosis of 6 months or more varies by author, but more than half are reported to be good. However, repeated injections in the same area multiple times may cause complications such as skin discoloration and atrophy, infection, and tendon rupture, so caution is needed.

4. Surgical treatment

If the effect of steroid injection is unsatisfactory or symptoms persist for a long period of 9–12 months or more, or in cases such as cooks or tennis players who have no choice but to overuse their hands, surgical treatment may be performed. Anesthesia is generally local anesthesia, but depending on the patient's condition, brachial plexus block or general anesthesia may also be used.

5. Surgical complications

Although rare, complications immediately after surgery may occur. Complications may include bacterial infection, digital nerve injury, complex regional pain syndrome, finger stiffness, finger flexion contracture, bowstringing of the tendon, pain at the surgical site, and more. Recurrence has also been reported in some cases.

So far, we have explained idiopathic tenosynovitis.

In the next part, we will look at idiopathic tenosynovitis by location.

Source: National Health Information Portal, Korea Disease Control and Prevention Agency