Tenosynovitis is inflammation of the protective sheath (the synovial membrane) that surrounds your tendons. It can be painful and make it hard to move your joints like you usually can.

1. Dr. Jitendra Patel

2. Introduction
• Tenosynovitis is inflammation of the
protective sheath (the synovial membrane)
that surrounds your tendons. It can be painful
and make it hard to move your joints like you
usually can. Your tendons are cords that
connect your muscles to your bones.

3. Tendonitis: Tendon
Tenosynovitis: Tendon + Synovium
1) Mesenchymal syndrome: multiple
area of inflammation & tenosynovitis
Terminology:

4. Sleep
Size discrepancy
Repetitive motion

5. 1) Pain at the wrist (specific comp),
exacerbated by wrist movement.
2) Tenderness on examination.
3) Grip strength decreased.
4) Complete pain relieve by a small
amount of LA agent injection in to
the compartment.

6. 1) Conservative: for the first occurrence:
 Modification of activities & avoiding heavy loading
 Steroid injection (into the involve sheath)
 Splinting (short term pain Mx)
 Elastic bands (esp. Tennis elbow)
 NSAID
2) Surgical:
 Synovial sheath decompression
 Size reduction
 Tendon rerouting through another compartment
 Postoperative splinting for 2 weeks & elevation
Triamcinolone 3-4 mg
No systemic or minimal local SE
No more than 2 injection into the same
area
If the first injection failed to resolve the
symptoms, there is no indication for the
second injection (consider surgery)
Avoid high dose:
1) Soft tissue atrophy
2) Skin pigment disturbance

10. Notta node:
Pathological
thickening of FPL at
MCPJ

11. Rx:
1) Conservative: monitoring
up to 6 month of age.
2) Spontaneous resolve
(some cases)
3) Surgical:
 FPL tendon release
through transverse
incision at MCPJ
 A1 pulley released
 No tendon size
reduction is
attempted.

12. 1st Ext. comp
EPB
APL
There is a high degree of
anatomical variation in the
position of & no. of APL
( abductor pollicis longus )
tendon, it is common to
find separation of APL &
EPB ( extensor pollicis
brevis) tendon by a septum.

14. Finklestein test
Performed in steps:
1. Ulnar deviation of the wrist
2. Passive adduction of CMCJ
3. Passive flexion of MCPJ
3

15. 1st compartment
surgical release

16. 1) Conservative:
 Modification of activities & avoiding heavy loading
 Steroid injection (into the involve sheath)
 Splinting (wrist in mild extension)
2) Surgical:
 Second dorsal compartment synovial sheath
decompression
 Postoperative splinting for 2 weeks (wrist in moderate
extension) & elevation

19. ECU tendonitis

21. ECU (Extensor Carpi Ulnaris) tendonitis

22. FCU tendonitis
Sharp curve over ridge of
Trapezium

24. Causes of pain in this site:
1) Undetected scaphoid
fracture
2) Basilar joint arthritis
3) Ganglion cyst

25. Treatment:
1) Conservative
2) Surgical (synovial
sheath release)
Palmar cutaneous branch of median nerve
Runs along flexor carpi radialis

26. Degenerative arthritis &
bone spur formation ??

27. Dx
Rx: often resolve with time.
1) Conservative: including
elastic band at the border
of the proximal and
middle third of the
muscle.
2) Surgical:
 weakening & tearing
of ECRB origin.
 ECRB origin &
periosteum excised
(if replaced by
granulation tissue as
a result of chronic or
recurrent
inflammation).
ECRB
Power grip reduced

28. Radial nerve compression may coexist

29. Not limited to Tennis players

30. Surgical:
1) tearing & weakening of ECRB origin
2) Excision: granulation tissue.

31. Pronator-flexor
mass origin

32. Dx
Rx:
1) Conservative
2) Surgical:
 weakening & tearing
of PT-flexor mass
origin.
 Origin & periosteum
excised (if replaced
by granulation tissue
as a result of chronic
or recurrent
inflammation).
 Ulnar nerve
protected.
Cubital tunnel
syndrome