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Upper Extremity Tenosynovitis

What is upper extremity tenosynovitis?

Upper extremity tenosynovitis is a condition affecting the tendons of an upper extremity (limb). It also affects the lining of the sheath around the tendon (synovium). Tendons are cords of tissue that connect muscles to the bones. 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. This may cause pain and tenderness when moving the affected upper and lower arm, hand, wrist, finger, or thumb. This condition usually affects women, athletes, and people of middle age or older. With treatment, such as medicines, a splint, rehabilitation, or surgery, you may be able to resume your normal daily activities.

What causes upper extremity tenosynovitis?

The exact cause of most upper extremity tenosynovitis remains unknown. The following are possible causes or conditions that may increase your risk of getting upper extremity tenosynovitis:

  • Calcium deposits: Calcium may be deposited in the tendons due to decreased oxygen and poor blood supply. These deposits may cause irritation and swelling of the tendon and its covering.
  • Impingement: Incorrect arm or hand movements, or weak flexor muscles may cause the tendon to become trapped. This may also happen in people who overtrain or have a sudden change in arm or hand activity.
  • Infections: Germs, such as bacteria or fungi, may often cause upper extremity tenosynovitis. The infections may result from wounds, bites, or intravenous (IV) drug abuse.
  • Tendon overuse: Upper extremity tenosynovitis may also be caused by frequent, repeated movements of your upper extremity. Jobs that may cause this condition include piano playing, cutting meat, sewing, or dentistry.
  • Trauma: Skin injuries or a direct blow to the extremity may damage the tendon and cause scar tissue to be formed. This scar tissue can make the tendon thick and unable to stretch or move very well.
  • Weak immune system: The immune system is the part of your body that fights infection. A problem with the immune system sometimes makes your body weak and unable to fight infections. If you have a wound infection, you may be more likely to develop upper extremity tenosynovitis.
  • Other diseases: These diseases may include diabetes, rheumatoid arthritis, gout, or problems with the thyroid gland.

What are the types of upper extremity tenosynovitis?

The following are different types of upper extremity tenosynovitis:

  • de Quervain disease: This is also called tenosynovitis of the wrist or washerwoman's sprain. It usually affects the tendons that control the thumb. Knitting, sewing, typing, and piano playing may cause this condition. Lifting small children and playing sports, such as wrestling or bowling, may make this condition worse. Ask your caregiver for more information about de Quervain disease.
  • Infectious tenosynovitis: This may be an acute or chronic (long-term) condition.
    • Acute: This is usually caused by an acute bacterial infection of the tendon coverings. The infections are often caused by trauma or may have spread from other parts of the body through the blood, such as active pulmonary tuberculosis (TB).
    • Chronic: This condition happens when you have a long-term mycobacterial (germ) or fungal infection. It is often a result of a wound infection coming into contact with contaminated water in swimming pools or fish tanks.
  • Trigger finger: A trigger finger is also called digital stenosing tenosynovitis. This occurs when the tendons that help bend the fingers and thumb get stuck in a bent position. Your thumb or ring finger straightens with a snap, just like a trigger being pulled and released.

What are the signs and symptoms of upper extremity tenosynovitis?

There is usually pain, redness, or swelling in your affected arm, hand, wrist, finger, or thumb. The pain usually occurs when you move them 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 any of the following:

  • Clicking, locking, or snapping of fingers.
  • Grating sound or feeling when the hand is touched or rubbed.
  • Nodule (bump) may be present or your fingers may look like sausages.
  • Joint pain or tenderness.
  • Stiffening of fingers or thumb.
  • Weakness, pain, swelling, and limited movement of the affected part.

How is upper extremity tenosynovitis diagnosed?

You may need any 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.

How is upper extremity tenosynovitis treated?

Treatment will depend on your symptoms and the length of time you have had them. Your caregiver may want you to limit movement of your affected upper extremity to decrease stress on the tendon. This may help prevent further damage, decrease pain, and promote tendon healing. You may also have one or more of the following:

  • Immobilization: Immobilization 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 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 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.

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. 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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