Tendinitis
Dr. med. Mira Seidel is a freelance writer for the medical team.
More about the experts All content is checked by medical journalists.Tendonitis (tendovaginitis, peritendinitis, tendosynovitis) is inflammation of the tendon sheaths. Usually the forearm, hand and wrist are affected. There are two special forms of tendonitis: tendovaginitis stenosans and tendovaginitis stenosans de Quervain. You can find out everything you need to know about the causes, symptoms, diagnosis and treatment of tendinitis here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M65
Tendonitis: description
A tendon sheath (vagina synovialis, vagina tendinis) is a sheath-like structure around a tendon that protects it and reduces friction with adjacent tissue such as ligaments and bones. To do this, it is filled with synovial fluid (synovial fluid).
Tendonitis itself must be distinguished from tendinitis.
Tendonitis can in principle occur on any real tendon sheath. A tendon sheath is particularly often inflamed on some parts of the body: the hand, forearm and foot. Known forms of tendinitis in the hand are Schnappfinger and de Quervain's tendovaginitis.
Tendonitis: snap finger
If the symptoms occur on the flexor side of the fingers, it may be a snap finger. You can read more about this in the article Schnappfinger.
Tendonitis: de Quervain's tendovaginitis
De Quervain's tendovaginitis should be considered if the thumb is painful. You can read more about this in the article Tendovaginitis de Quervain.
Tendonitis: symptoms
The tendinitis often begins insidiously. The main symptom is pain over the affected tendon sheath (e.g. pain in the wrist). These are particularly pronounced when the joint is actively or passively moved, more precisely the affected tendon. A swelling and reddening can usually be seen over the joint. Morning stiffness and a feeling of tension are also described. In so-called tendovaginitis crepitans, when you move the joint, you may feel rubbing.
Tendonitis: causes and risk factors
Tendonitis is very rarely caused by bacteria (septic tendovaginitis). Instead, tendovaginitis is usually a non-bacterial inflammation, caused by overload and poor posture. The inflammatory reaction causes the tendon and tendon sheath to swell to such an extent that the fine film of fluid in the tendon sheath is no longer sufficient for smooth tendon movement. Sometimes the tendon even gets stuck in its tendon sheath.
This increases the inflammation and creates additional pain. The surfaces of the tendon and tendon sheath can change as a result of the inflammatory reaction, which creates a palpable and audible rubbing when moving. Doctors call this disease tendovaginitis crepitans.
Tendonitis: hand
On the flexor tendons of the fingers, small nodules can form in the tendon so that it can no longer slide smoothly. Then one speaks of a tendovaginitis stenosans (also snap finger or quick finger). This mostly affects the thumb. The flexor tendons of the other fingers can also become inflamed. In addition, this form of tendinitis can also develop in connection with inflammatory diseases from the rheumatic group.
A variant of the tendovaginitis stenosans is the tendovaginitis stenosans de Quervain. Here the tendinitis is localized in the first extensor tendon compartment of the hand. There are a total of six such compartments in which the extensor tendons are guided to the wrist and fingers. The tendon fans are formed by a strong ligament, the so-called retinaculum extensorum.
Tendonitis: wrist
Sometimes a tendon sheath is inflamed at the transition between hand and arm (wrist). The cause is usually an acute or chronic overload or incorrect loading of the tendons running here. If the tendinitis is due to too much work with the computer mouse, for example, the doctor speaks of the "mouse arm". Local bruises on the tendons can also cause a tendon sheath to become inflamed (and sometimes the tendon itself). The flexion of the hand is particularly stressed in sports such as climbing, gymnastics, rowing or table tennis.
Tendonitis: arm
You can feel it not only on the wrist itself when a tendon sheath becomes infected. Arm complaints can also occur, more precisely a pulling in the forearm. Intensive practice with musical instruments such as guitar, violin or piano can also be the reason if a tendon sheath becomes infected in the wrist and forearm area.
Elbow pain often speaks for the so-called tennis elbow, caused by constant overload and microtraumas that lead to tears in the tendons. However, a tennis elbow is an inflammation of the tendon attachments of the muscles of the forearm and therefore not an inflammation of the tendon sheaths. Arm pain caused by tendinitis is in most cases localized in the forearm.
Tendonitis: foot
Very often, but not always, it is the upper extremities on which a tendon sheath becomes inflamed. Foot pain can also indicate tendovaginitis. It often develops in active people, either through direct trauma or chronic ankle instability. The following sports in particular favor tendovaginitis: foot and basketball, hockey and ballet. Tendonitis on the foot can also occur in skiers. The posterior tibial muscle (M. tibialis posterior) or the short fibula muscle (M. fibularis brevis) can be affected.
Tendonitis: examinations and diagnosis
If you suspect tendinitis, it is best to consult a general practitioner or an orthopedic specialist. Tendovaginitis can usually be diagnosed without any problems based on the medical history and physical examination. In order to record your medical history, your doctor will talk to you in detail about your symptoms. He may ask the following questions:
- Have you recently been doing unusually strenuous manual work such as gardening or moving?
- What is your profession? Do you work a lot on a computer keyboard?
- With which movements does the pain occur?
- How long has the pain existed?
- Will Anti-Inflammatory Drugs Help You?
The symptoms described can occur not only with tendinitis, but also with other diseases - such as osteoarthritis of the thumb saddle joint (rhizarthrosis).The doctor must rule out such diseases before he can diagnose “tendinitis”.
Tendonitis: imaging studies
Imaging procedures are usually not necessary and are only used in exceptional cases. In order to rule out bone changes, x-rays can be made in two planes. In addition, the tendon can be visualized with the help of ultrasound. Tendons can also be visualized using magnetic resonance imaging (MRI).
Tendonitis: treatment
Tendovaginitis therapy is usually conservative. It is important to avoid the cause of the tendinitis (such as overload, incorrect loading) if possible. If the tendinitis is due to frequent work on the computer keyboard, for example, a special palm rest in front of the keyboard can be useful: Place your wrists on it while typing so that they are not bent upwards - this relieves the tendons.
Tendonitis: Conservative Therapy
To avoid movements that aggravate the tendinitis and worsen the pain, the hand or foot can be immobilized with a splint. The immobilization should only be done for a short time, however, as the tendon can otherwise stick to the tendon sheath.
Local cooling, electrotherapy and transverse friction massages can also be used for tendinitis. Physiotherapy exercises for strengthening and stretching can have a positive effect on muscles and tendons. Chronic stress can also be corrected through physical or manual therapy.
Sometimes anti-inflammatory pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs), are used. These include ibuprofen and diclofenac, for example. They can be taken as a tablet. Anti-inflammatory ointments can also be helpful.
If necessary (for example in the case of repeated painful tendinitis), the doctor can give targeted cortisone injections. They are anti-inflammatory and usually help, but shouldn't be given as often as you like. Repeated cortisone injections can damage the tendon tissue.
Inflamed tendon sheath: home remedies
Various home remedies can help relieve the inflammation and pain of tendonitis. Examples:
- Cold, damp compresses soaked in vinegar water (1 tablespoon of vinegar to 1 glass of water) can cool the painful areas.
- Toppers with horseradish, healing clay or quark also help.
- An ointment with propolis (bee resin) has an anti-inflammatory effect.
Tendonitis: surgery
If pain and tendovaginitis recur despite intensive conservative therapy, surgery can be considered. It can be done on an outpatient basis and is usually carried out under local anesthesia (if necessary also under general anesthesia). Depending on the type of anesthesia, you can leave the clinic immediately after the procedure (local anesthesia) or after a few hours (general anesthesia).
During tendon sheath surgery, the ligament covering the tendons is cut. The roof of the tendon canal is also split and possibly inflamed and thickened tendon sliding tissue is removed. The surgeon must be careful not to injure adjacent nerves and vessels. Finally, the wound is sutured and bandaged.
Tendonitis: follow-up treatment
After the operation, you should start with light movement exercises immediately to avoid adhesions. The sutures are removed about ten days after the procedure. The scar will still be tender on pressure for the first few weeks. Over time, however, the pain subsides and the surgical scar becomes less sensitive. Depending on the job, you can resume your work after one to three weeks.
Tendonitis: complication
As with any operation, complications can arise during tendon sheath surgery, for example if nerves were accidentally injured. It also rarely happens that a nerve grows together in the scar tissue. If pain and abnormal sensations recur after a symptom-free interval, another operation may be necessary.
As a further complication, the surgical wound can become inflamed. Then should be treated with an antibiotic.
Tendonitis: disease course and prognosis
The tendinitis often has a protracted course. It is important that the joint is spared right at the onset of the symptoms in order to prevent the acute inflammation from becoming chronic. The prognosis of tendinitis is good as long as the triggering movements are avoided as far as possible and no other diseases such as rheumatism or joint inflammation are present.
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