Introduction

Tenosynovitis is the inflammation of the synovial sheath, a protective layer surrounding tendons, which are the tissues connecting muscles to bones. This condition commonly affects tendons in the hands, wrists, and feet, leading to symptoms such as pain, swelling, and difficulty moving the affected joint. Causes of tenosynovitis include repetitive movements, overuse, injury, or underlying health conditions like rheumatoid arthritis.¹

Common causes include repetitive movements or overuse, such as in sports or manual labour, which can strain the tendons. Injuries or trauma to the tendon area can also trigger inflammation. Additionally, infections can spread to the synovial membrane, resulting in infectious tenosynovitis. Certain medical conditions, like rheumatoid arthritis and diabetes, are associated with a higher risk of developing tenosynovitis.²

General symptoms

• Pain along the affected tendon

Pain in tenosynovitis is typically localised and worsens with movement or pressure. This condition often presents with swelling, tenderness, and difficulty moving the affected joint..³

• Swelling and tenderness

Swelling and tenderness in tenosynovitis result from inflammation of the tendon and its surrounding sheath, commonly affecting areas such as the hands, wrists, and feet.⁴ This inflammation leads to pain, swelling, redness, and limited movement in the affected region.

• Redness or warmth over the inflamed area

Redness or warmth over the inflamed area can occur due to increased blood flow and immune activity in response to inflammation. However, these symptoms are more commonly associated with infectious tenosynovitis rather than non-infectious forms. In cases of infectious tenosynovitis, symptoms may also include significant pain, swelling, and tenderness along the affected tendon, often requiring prompt medical intervention. If redness and warmth are present, it is important to differentiate between infectious and non-infectious causes to determine the appropriate treatment.⁵

• Stiffness and restricted movement

Stiffness and restricted movement arise from inflammation of the tendon sheath, leading to pain and swelling that hinder joint mobility¹. Without appropriate treatment, this condition can cause permanent limitations in tendon function and joint stiffness.

Specific symptoms based on location

• Hands & Wrists (e.g., De Quervain’s tenosynovitis)

De Quervain's tenosynovitis is a condition characterised by pain and tenderness at the base of the thumb and along the thumb side of the wrist, often exacerbated by movements such as pinching, grasping, or wrist twisting. Additional symptoms may include swelling near the base of the thumb, a catching or snapping sensation during thumb movement, and difficulty moving the thumb and wrist, particularly when performing activities that involve gripping or lifting.⁶ In some cases, a fluid-filled cyst may develop in the affected area. These symptoms result from the inflammation of the sheaths surrounding the abductor pollicis longus and extensor pollicis brevis tendons, leading to pain and restricted movement.

• Feet & Ankles

Tenosynovitis in the feet and ankles often presents with symptoms such as pain, swelling, and limited joint movement. The pain is typically localised along the affected tendon and may worsen with activity. Swelling and tenderness are common, and in some cases, the area may feel warm to the touch. Individuals might also experience stiffness, especially after periods of inactivity. If left untreated, the condition can lead to complications like tendon rupture or chronic pain.⁷

• Shoulders & Elbows (e.g., Tennis elbow-related tenosynovitis)

Tenosynovitis in the shoulder and elbow regions manifests through specific symptoms associated with conditions like rotator cuff tendonitis and lateral epicondylitis (tennis elbow). Rotator cuff tendonitis involves inflammation of the shoulder's capsule and related tendons, leading to pain and restricted movement in the shoulder joint. Lateral epicondylitis, commonly known as tennis elbow, is characterised by pain on the outer side of the elbow and forearm, particularly along the thumb side. This discomfort results from damage to the tendons responsible for extending the wrist away from the palm.⁸ Both conditions may also present with swelling, tenderness, and increased pain during specific movements or activities.

Symptoms of infectious tenosynovitis

Infectious tenosynovitis is a bacterial infection that affects the sheath surrounding a tendon, most commonly in the fingers, hands, or wrists. It typically results from a penetrating injury, such as a puncture wound or bite, allowing bacteria to enter and multiply within the tendon sheath. 

The condition presents with rapid swelling and severe pain along the affected tendon, making movement difficult and often painful. Patients may also experience fever and chills, indicating that the infection is spreading beyond the localised area. If left untreated, the infection can progress, leading to pus formation within the sheath and skin discolouration due to tissue damage. 

In severe cases, complications such as tendon necrosis, abscess formation, or even systemic infection (sepsis) can occur, requiring immediate medical intervention. Prompt diagnosis and treatment with antibiotics, drainage, or sometimes surgery are crucial to preventing permanent damage and restoring function.⁹

When to seek medical help 

If you have tenosynovitis, it is important to seek medical help if symptoms worsen or do not improve with rest and self-care. Persistent or worsening pain along the affected tendon, especially if it interferes with daily activities, may indicate that the condition is progressing. 

Difficulty moving the affected joint, stiffness, or a locking sensation could suggest severe inflammation or tendon damage. Additionally, signs of infection such as fever, excessive swelling, redness, warmth, or pus around the affected area require immediate medical attention, as untreated infections can lead to serious complications like abscess formation, tendon rupture, or even sepsis.¹⁰ 

Early intervention with antibiotics, anti-inflammatory medications, or in some cases, surgical drainage can help prevent permanent damage and restore function to the affected joint.

Summary 

Tenosynovitis is a condition characterised by inflammation of the synovial sheath surrounding tendons, leading to pain, swelling, and restricted movement, commonly affecting the hands, wrists, feet, and other joints. It can result from repetitive movements, injuries, infections, or underlying conditions such as rheumatoid arthritis and diabetes. 

While non-infectious tenosynovitis typically arises from overuse or trauma, infectious tenosynovitis is a serious bacterial infection requiring immediate medical attention. Symptoms vary depending on the affected area but generally include localised pain, tenderness, stiffness, and in severe cases, redness, warmth, and pus formation.

Early recognition and appropriate treatment, including rest, medication, or surgical intervention in severe cases, are crucial to prevent long-term complications like tendon damage or chronic pain. Seeking medical help is essential when symptoms persist, worsen, or show signs of infection, as timely intervention can ensure proper healing and restore joint function.