Upper Extremity Tenosynovitis

WHAT YOU SHOULD KNOW:

Upper Extremity Tenosynovitis (Inpatient Care) Care Guide

  • Upper extremity (ek-strem-IH-tee) tenosynovitis (ten-o-sin-o-VEYE-tis) is a condition affecting the tendons, sheath, and synovium of an upper extremity (limb). Tendons are cords of tissue that connect muscles to the bones. The synovium is the lining of the sheath (covering) of the tendons. With upper extremity tenosynovitis, the sheath and the synovium of the flexor (bending) muscles become inflamed (swollen). The tendons may also become thickened and have a hard time moving through the swollen covering. Upper extremity tenosynovitis usually affects women, athletes, and people of middle age or older. It is also common in piano players, typists, meat cutters, tailors, seamstresses, and dentists.

  • You may have pain, redness, and swelling in your upper and lower arm, hand, wrist, fingers, or thumb. This pain usually occurs when moving the affected part up and down, while grasping an object, or making a fist. Over time, the pain may become worse and may be present even at rest. You may also have weakness and limited movement of the affected part. Your caregiver will test your shoulder, arm, hand, wrist, or fingers by moving them in different positions. X-rays, arthrograms, a biopsy, or magnetic resonance imaging (MRI) may be done to look for tendon injuries and other problems. Treatment will depend on your symptoms and the length of time you have had them. With treatment, such as medicines, a splint, rehabilitation, or surgery, you may be able to resume your normal daily activities.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Medicines used to relieve the signs and symptoms of upper extremity tenosynovitis may cause side effects. These include stomach ulcers (sores), nausea (upset stomach), or vomiting (throwing up). You could get an infection or bleed too much with surgery. Sometimes, even after treatment, your arm, hand, fingers, or thumb may not move the way it did before treatment. Rehabilitation may take a long time, and your tenosynovitis may return.

  • If left untreated, upper extremity tenosynovitis may cause further problems with using your arms or hands. You may not be able to do your usual activities. The chances of treating upper extremity tenosynovitis are better when it is diagnosed and treated as early as possible. Completing your rehabilitation program is also very important. Ask your caregiver if you have concerns about your condition, medicines, or care.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Cold and warm compresses:

Ice packs may be put first on your affected part. A warm, wet washcloth or a heating pad (turned on low) may be used next on the affected part. Alternating cold and warm compresses will help decrease the swelling and pain.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may be given the following medicines:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.

  • Steroid medicine: Your caregiver may suggest that you take steroid medicine. Steroid medicine may be injected into the affected tendon, taken by mouth, or given in an IV. This medicine decreases chronic (long-term) pain and swelling. It is important to follow your caregiver's instructions on how to take this medicine. Do not stop taking this medicine until your caregiver tells you to.

Tests:

You may have one or more of the following:

  • Physical exam: Your caregiver may have to move your shoulder, arm, hand, wrist, fingers, or thumb in certain directions. He will check to see if you have any pain, weakness, or movement problems. He may also check your other upper extremity for any pain, weakness, or movement problems.

  • Biopsy and culture test: A biopsy may be done by taking fluids out through a needle. Your caregiver may also do a minor surgical procedure to take a biopsy of one or more tendons. The fluid or the tendon biopsy will then be taken to a lab and tested.

  • Imaging tests: You may be given dye before the pictures are taken in some of these tests. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.

    • Arthrogram: An arthrogram is an x-ray that is taken after dye is injected into your affected joint. This test is used to view the structures of your joint such as muscles, ligaments, tendons and cartilage. The dye helps your caregiver see the structures better. People who are allergic to iodine or shellfish (lobster, crab or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish or have other allergies or medical conditions.

    • Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your upper extremity.

    • Magnetic resonance imaging scan: This is also called an MRI. An MRI uses magnetic waves to take pictures of the shoulder, upper and lower arm, wrist, and hand area. This may help your caregiver decide if you have upper extremity tenosynovitis, or another condition that is affecting your limb.

    • Ultrasound: An ultrasound is a simple test that looks inside of your body. Sound waves are used to show pictures of your organs and tissues on a TV-like screen. Caregivers may also look for fluid near the area of your pain and redness. You may also be able to hear your blood flow during this test.

    • X-rays: You may need x-rays of your upper extremities to check for broken bones or other problems. X-rays of both your painful and non-painful upper extremities may be taken.

Treatment options:

Your treatment may change if your health problem is not being controlled. This is often decided after you have tests. You may have some of the following treatments alone or together.

  • Immobilization: Immobilization (keeping the joint from moving) is an important treatment that allows the tendon and its covering to heal. A splint may be used on the affected part to immobilize it. This helps to decrease pain and prevent the tendons from being damaged further.

  • Irrigation and debridement: This is done by cleansing (washing) an open wound. It is important to clean and remove objects, dirt, pus, or dead tissues from the wound.

  • Medicines: Your caregiver may give you medicines to decrease the pain and swelling in your hand, wrist, or thumb. Other medicines, such as antibiotics or anti-fungals, may be given to fight infections.

  • Surgery: You may need surgery if your symptoms do not go away with other treatments. Surgery may also be done if your pain gets worse or is so severe (bad) that it affects your daily activities.

  • Rehabilitation: This is a program that may include physical and occupational therapy to help your condition heal faster. When the swelling has gone down, you may be given exercises to do. These exercises will bring back the normal range of motion of your upper limb and strengthen your tendons. Your caregiver may also ask you to make changes in your activities to decrease stress on the tendons. These changes may prevent this condition from happening again.

  • Ultrasound therapy: A device that uses ultrasound with heat may be used to massage the swollen or irritated upper extremity. This may help to relieve pain and swelling.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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