What Is Tenosynovitis?
Tendons are anatomical bridges between muscle and bone. Tendons consist of longitudinally arranged collagen fibres.
Tenosynovitis is inflammation of the tendon and its surrounding membrane. Tendinitis is used for inflammation of the tendon, while the term tendinosis refers to chronic degeneration of the tendon without inflammation. The term tendinopathy is also used as a general term.
Tenosynovitis is most common in middle-aged to old age. Decrease in tendon vascularity with aging, repetitive microtrauma or overload, stretching, excessive exercise pose a risk.
The risk increases in some concomitant diseases: RA-Systemic sclerosis, gout, reactive arthritis, diabetes mellitus, amyloidosis, extremely high cholesterol levels, disseminated gonococcal infection.
Tenosynovitis and bursitis are inflammations that occur especially in the shoulder, elbow, knee, hip, wrist and ankle. These inflammations, which often occur over a long period of time, are caused by different causes and in some cases may occur suddenly.
Overstraining the joints and making wrong movements are effective in the sudden development of the problem. Repetitive activities for professional reasons, carrying heavy loads and similar situations can damage the joints.
If there is a delay in diagnosing the problem, cases may progress and become permanent.
Muscles are attached to bones at points called tendons. The outer part of tendons is covered by a synovial sheath that prevents wear and tear against friction and facilitates movement.
Inflammation in this sheath is called “tenosynovitis.” Tenosynovitis is commonly seen in the shoulder, elbow, ankle, and thumb joints.
What Are The Risk Factors In The Development Of Tenosynovitis?
- Inflammatory diseases: rheumatoid arthritis, gout
- Infectious conditions
- Strain/tension injury
Where Are The Most Common Regions?
How Is Tenosynovitis Diagnosed?
History is important in the diagnosis. The following conditions should be questioned in the history:
- Working in a job that requires repetitive movement
- History of trauma
- Whether there are complaints of night sweating, fever, cough, phlegm, etc.
- Whether there is a problem with other joints
- Rash, skin problems etc.
- Excessive water drinking, frequent trips to the toilet, night urination
- Family history of diabetes, history of inflammatory diseases
Again, The Patient's Complaints And Findings Should Be Asked In Detail:
- Pain and tenderness
- Difficulty of movement in the joint, limitation of movement due to pain
- Loss of strength due to pain
- Joint swelling
- Redness along the tendon
- Fever, sweating, rash, etc. signs of infection
- Difficulty in handling and carrying objects
In physical examination, we use swelling in the affected tendon area, pain on touching or stretching the tendon and some specific tests (e.g. Finkelstein test in Dequervain’s tenosynthitis).
After the patient’s history and examination, various tests are performed according to the diagnosis. These tests are as follows:
- Complete blood count, sedimentation, C reactive protein, glucose, rheumatoid factor, urea, liver enzymes, etc.
- Fluid aspiration and microbiological examination if there is swelling
- Radiography Direct radiographic examination
- Ultrasonographic evaluation
Which Diseases Can Be Considered In Differential Diagnosis?
- Inflammatory diseases
- Fractures and other traumatic events
- Heterotopic ossification
What Is Done In Treatment?
Firstly, it is aimed to reduce pain and eliminate inflammation. For this purpose, treatment is selected by evaluating the clinical findings of the patient. Treatment methods include the following:
- Rest or avoidance of use of the affected tendon
- Splint use
- Hot-cold applications
- NSAID use
- Local injections (corticosteroid, ozone, prp, prolotherapy etc.)
- Surgical removal of inflamed tissue
- If there is infection, emergency treatment: surgical removal of inflammation around the tendon, removal of dead tissue, antibiotic treatment for the infectious agent
- Tendon stretching exercises after recovery
What Can Be Done To Prevent The Development Of Tenosynovitis?
It is important to avoid repetitive movements that place a load on the tendon and to avoid overuse of the tendons, to prevent tendon shortening and muscle weakness by performing regular stretching and strengthening exercises, as these conditions are often caused by misuse and overload.
What Is Bursitis?
Bursae are closed synovial sacs filled with fluid. They can be superficial/deep located. They are located between two soft tissues and facilitate the sliding of these soft tissues (tendon, bone, skin) on each other by reducing friction. There are more than 150 bursae in our body. Bursitis here means enlargement, growth.
The joints and bones in the body are filled with fluid sacs called bursae. These fluid sacs prevent the bone ends from rubbing against each other. Inflammation of the bursa fluid sacs is called “bursitis” and occurs especially in areas such as hips, elbows and shoulders.
In addition, bursitis is also common in areas with frequently moving joints such as the ankle, knee and heel.
Can You Talk About The Causes Of Bursitis?
Bursitis may be acute traumatic/haemorrhagic, chronic aseptic (microtraumatic or inflammatory) or septic (with infectious agent). It is important to distinguish whether there is infection or not, sometimes this distinction may be difficult.
In acute traumatic/hemorrhagic bursitis, bleeding into the bursa occurs with direct impact. It may occur in any bursa. In patients with coagulation disorders, it may occur without trauma in anticoagulant areas.
How Is Bursitis Diagnosed?
A good history and physical examination are important. Tests are helpful in making a diagnosis. Imaging modalities are usually not helpful, but may need to be ordered according to the patient’s findings, such as history of trauma. Swelling is usually not an important factor.
There is pain when there is inflammation/infection in the bursa. Swelling is noticeable in some bursae: achilles, olecranon, prepatellar. The most common bursitis are: prepatellar, olecranon, trochanteric, retrocalcaneal bursitis. These bursitis occur in the anterior part of the knee, posterior part of the elbow, lateral part of the hip and posterior part of the ankle.
These areas can be easily exposed to trauma and pressure. In women who frequently clean, swelling develops in the anterior knee due to pressure on the knee on hard ground, and it is called prepatellar bursitis (servant’s knee).
Which Diseases Should Be Considered In Differential Diagnosis?
- Tendon and ligament injuries
- Nerve problems,
What Kind Of A Path Is Followed From Bursitis Treatment?
Firstly, it is aimed to reduce swelling and pain with non-surgical treatments (ice, activity modification, use of painkillers (NSAIDs). Antibiotic treatment is performed in septic bursitis. In some bursitis, injections are used.
In patients who do not respond to these treatments, surgical treatment can be performed. Surgical treatments such as open bursectomy, arthroscopic excision of the bursa, partial removal of the affected bone part can be applied.
What Are The Causes Of Tenosynovitis And Bursitis?
The causes of tenosynovitis and bursitis are not known for certain, but factors such as overstrain and use play a role in both problems. In addition to excessive exercise, injury and repetitive movements, diseases such as rheumatoid arthritis, viral infections and diabetes are also effective in tenosynovitis.
In bursitis, similarly, compulsive and repetitive movements are involved. The main causes are constantly bending in the same direction, moving in a way that causes injury, working at a desk job, doing sports activities such as tennis and straining the body too much.
In addition to these; some rare cases of bursitis can be caused by factors such as blood and kidney problems, advanced age and fibre tear.
In addition, it is known that the following conditions can cause tenosynovitis and bursitis:
- Continuous standing due to occupation
- Wearing the wrong shoes
- Carrying heavy weights and doing physical activities
- Excessive load on shoulders and wrists
- Psoriatic arthritis
- Trigger finger
- Micro traumas
- Gonorrhoea and tuberculosis
- Septic arthritis
- Reactive arthritis
What Are The Symptoms Of Tenosynovitis And Bursitis?
In both problems, the symptoms vary from person to person. At this stage, especially the shape and severity of the symptoms are quite different depending on the problem area. In general, reduced mobility, difficulty walking and pain during movement are among the common symptoms. In addition, swelling and heat increase in the problem area is also an important finding.
Other symptoms are as follows:
- Pain with tendon and joint movement
- Increased fluid and inflammation in the area
- Creaking sound during joint movement
How Are Tenosynovitis And Bursitis Treated?
In cases of tenosynovitis and bursitis, a clear understanding of the problem area is required for the correct treatment. For this, the patient’s history is first listened to and the findings are evaluated.
In some cases, imaging techniques such as blood tests, MRI and X-rays can be used in addition to physical examination.
After the source of the problem is understood, appropriate treatment planning is made, and at this stage, the course of treatment is adjusted according to the patient’s complaints, the severity of the disease and the region.
The inflammation in tenosynovitis causes local pain, and painkillers can be used to relieve or alleviate this pain. Medications used with the recommendation of a doctor may also be antibiotics that reduce the infection in the area.
In some cases, the use of cortisone may be necessary to improve local damage. The medication process should be applied under the control of a doctor.
In addition to drug treatment, physical therapy can be applied to strengthen the muscles in the area and relieve pain. In this treatment, appropriate movements are made to the area.
These movements are prepared according to the patient’s pain level, problem area, and age. Most problems are treated with regular physical therapy.
Resting the area is one of the most important steps in treatment. Over-stressing the area can increase the level of inflammation and lead to irreversible problems, such as tendon rupture.
Therefore, it is appropriate for the patient to rest and, if necessary, to receive splint support. Healing is observed in most cases by protecting the area from pressure and load.
Application of cold ice to the area where swelling and inflammation are observed reduces the swelling in the area. For this, 15-minute ice applications can be made 2-3 times a day in support of treatment.
In advanced cases where other treatments do not work, surgical intervention may be resorted to as a last resort. However, it is also important to do regular exercise and not to tire the area after surgery, as in other cases.
In addition, surgery is not required in many cases due to early diagnosis and regular exercise. Therefore, it is extremely important to consult a specialist doctor immediately and apply the recommendations in case of a problem.
The things to be considered to prevent tenosynovitis and bursitis are as follows:
- Problems may occur in various regions in those who exercise regularly. In order to prevent these, attention should be paid to warm-up movements before and after exercise.
- Performing exercise movements faster than they should also cause problems in different regions. It is important to apply these movements slowly and without rushing.
- During exercise, it is necessary not to strain the body too much and allow the muscles to rest. The joints and tendons should be given short rest periods between movements.
- It is also an important risk factor to suddenly start exercising again after a long break. In such cases, the intensity of exercise should be increased gradually over time. In addition, keeping the exercise length short at first also helps to prevent risks.
- The use of the right sports equipment and equipment minimises the risks that may occur. Wearing shoes suitable for the ground is one of the most important factors and prevents wrist injuries.
- Staying in the same position all the time is a major risk factor. Standing for a long time can put pressure on the ankles and sitting for a long time can put pressure on the hips. Using a keyboard for a long time is also dangerous for the shoulders. In such cases, it is important to take short breaks between movements. Standing up and walking once in a while for those who are sitting and sitting once in a while for those who are standing relaxes the areas and prevents overexertion. For repetitive movements, it is therefore necessary to change position at regular intervals and allow the area to rest.