Tenosynovitis is a condition where the sheath that surrounds a tendon becomes inflamed. Tendons are strong, fibrous cords that attach muscle to bone and help produce movement. Some tendons, particularly those that curve around joints or pass through narrow spaces, are encased in a protective layer called a synovial sheath. This sheath allows the tendon to glide smoothly by producing a small amount of lubricating fluid. When the sheath becomes irritated or inflamed, it can thicken, swell, and create friction that restricts normal tendon movement. This can lead to pain, stiffness, and impaired function.
Tenosynovitis differs from tendinopathy, which involves changes to the tendon tissue itself. In tenosynovitis, the tendon may be healthy, but the surrounding sheath becomes inflamed and irritated. Recognising this difference is important because it influences both treatment and recovery timeframes.
From a physiotherapy perspective, tenosynovitis is a common and manageable condition when addressed early, especially in people with repetitive strain or biomechanical issues.
Common Locations
Tenosynovitis can affect many areas of the body but is most commonly seen in tendons that pass through confined anatomical spaces or are exposed to repetitive motion. These include:
- Wrist and thumb (De Quervain’s tenosynovitis): Involves the sheaths of the abductor pollicis longus and extensor pollicis brevis, typically due to repetitive thumb use or gripping.
- Achilles tendon: The sheath around the Achilles can become inflamed, often from increased load or poor footwear.
- Tibialis posterior: Runs along the inside of the ankle and plays a key role in supporting the arch. Irritation of its sheath can lead to medial ankle and arch pain.
- Peroneal tendons: Located along the outside of the ankle and commonly affected in people with ankle instability or increased walking or running volume.
- Flexor tendons of the fingers: Often results in “trigger finger”, where the tendon sheath thickens and interferes with smooth finger motion.
Signs and Symptoms
Symptoms of tenosynovitis vary depending on location and severity but typically include:
- Pain along the path of the affected tendon, usually worsened by movement
- Localised swelling or thickening around the tendon
- A feeling of tightness or stiffness, especially after rest
- Crepitus, or a squeaking sensation, during movement
- Tenderness to touch along the tendon sheath
- Reduced strength or range of motion in the associated joint
In some cases, a clicking, catching, or locking sensation may be present, particularly in the fingers or thumb.
Differentiating tenosynovitis from tendinopathy
While both conditions involve tendons, they affect different structures. Tendinopathy involves degeneration within the tendon itself, usually in response to overload. It tends to present with pain that worsens with resistance or loading, and is often more gradual in onset. Tenosynovitis, on the other hand, typically presents with more superficial pain, often accompanied by swelling and creaking. The pain may not always be load-dependent and may be worse with stretch or friction rather than tension.
Causes and Contributing Factors
Tenosynovitis can be caused by a number of factors, often acting in combination:
- Repetitive motion or overuse, such as typing, gripping, or running
- Sudden increases in activity level without adequate conditioning
- Biomechanical factors such as flat feet or poor movement control
- Inappropriate or unsupportive footwear
- Direct trauma or pressure over the tendon sheath
- Inflammatory conditions like rheumatoid arthritis or lupus
- Diabetes, which can affect tissue healing and increase inflammation
- Infection, particularly in the flexor tendons of the hand (a medical emergency)
Prognosis
Most cases of tenosynovitis resolve with conservative treatment within 6 to 8 weeks.
Recovery time may be prolonged in chronic cases, those with underlying inflammatory conditions, or where aggravating activities continue without modification. When addressed early and comprehensively, long-term outcomes are generally very good.
Treatment
Physiotherapy management
Physiotherapy is the primary approach for managing tenosynovitis and should be tailored to the individual. Treatment may include:
- Activity modification to reduce aggravating movements or positions
- Gentle isometric exercises to maintain tendon load tolerance without irritation
- Progressive strengthening and controlled loading, including eccentric exercises as tolerated
- Soft tissue techniques and joint mobilisation to improve movement and reduce stiffness
- Stretching of associated muscles or fascia to reduce mechanical stress
- Footwear assessment and possible referral for orthotics in lower limb cases
- Taping or bracing to support the affected area during activities
- Education to help individuals understand their condition and avoid recurrence
Night Wrap (Topical Anti-Inflammatory Treatment)
The Night Wrap is a topical anti-inflammatory treatment designed to reduce pain and inflammation overnight. It combines two topical medications — Hydrodoid cream and Diclofenac gel — to enhance local absorption of anti-inflammatory agents.
The application involves:
- Applying a small amount of Hydrodoid cream to the painful area
- Applying a larger amount of Diclofenac gel over the top
- Covering the area with plastic wrap (such as Glad Wrap) to create an occlusive dressing
- Leaving the wrap on overnight during sleep (typically 6–8 hours)
This method aims to provide sustained local delivery of anti-inflammatory medication to the affected tendon sheath, potentially reducing morning pain and stiffness. It is particularly useful in reactive phases of tenosynovitis, where inflammation is prominent.
Disclaimer: This is a relatively new treatment option and thus there is currently limited clinical research on the effectiveness or safety of this treatment approach. It should only be used under the guidance of a qualified physiotherapist and pharmacist. Risks may include skin irritation or overexposure to topical NSAIDs, particularly in individuals with sensitive skin or pre-existing health conditions.
Medical management
- Oral non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation
- Corticosteroid injections are sometimes used in persistent cases, particularly in the wrist or thumb, though repeated use is not recommended due to potential tendon weakening
- Antibiotics are essential in any case of suspected septic (infectious) tenosynovitis and require urgent medical attention
Surgical
Surgery is rarely required but may be considered for chronic cases that fail to respond to conservative treatment. Surgical intervention typically involves releasing the sheath or removing inflamed tissue to allow freer tendon movement.