Overview 

Our joints have dense connective tissues that attach muscle to bone, called tendons. They work hand in hand with a lubricant that is known as the synovial sheath, to bring upon every movement we make. Although our bodies are well designed to keep this mechanism working effortlessly, overusing and injury can cause tendinopathy. Tenosynovitis is the inflammation of the tendon sheath that stems from a range of different reasons, including overuse during physical activities, repetitive motion during manual labour, or other underlying health issues, particularly inflammatory diseases (rheumatoid arthritis).¹ 

Diagnosing the condition requires thorough clinical assessment and imaging techniques, so that the symptoms can be accurately identified to tailor treatment for the patient’s specific form of tenosynovitis. Clinical diagnosis includes recognising key symptoms such as pain and swelling.¹ It is then followed by a physical examination where specific diagnostic manoeuvre tests like Finkelstein’s test will be performed, to confirm or exclude the presence of de Quervain’s tenosynovitis.² In some scenarios, doctors may want to take further steps to analyse and gain a more detailed overview, to characterise tenosynovitis from other musculoskeletal disorders, so utilising imaging techniques for confirmation is ideal.³ 

This highlights the significance of early diagnosis through the paired usage of clinical and imaging methods, which is essential for diagnosis and management, for appropriate tenosynovitis treatment.¹ 

Clinical diagnosis of tenosynovitis

The cause of tenosynovitis can be divided into two subgroups: infective and non-infective.¹ Therefore, when clinicians diagnose tenosynovitis, the first step is to ask about the patient’s medical history in detail. This is important as the treatment will directly depend on the root cause of the tenosynovitis. For example, a doctor would suggest an infectious cause if a patient has had a history of injuries, fevers, ulcers, pus, and pain when straightening and bending the joints.¹ On the other hand, chronic systemic tenosynovitis would be diagnosed if the patient has long-standing arthritis or autoimmune disorders with slow and gradual symptoms.¹

The next stage is a physical examination where the key symptoms of tenosynovitis are evaluated. This is when a doctor will visually check for swelling and redness around the affected tendon, stiffness, difficulty moving the joint, and other irregular sensations.⁴ A variety of motion tests will also be carried out to assess pain levels and movement restrictions. These happen for conditions like stenosing flexor tenosynovitis, more commonly known as trigger finger, which assesses if the affected finger joint locks or clicks when the patient attempts to straighten it.⁵ 

Similarly, Finkelstein’s test is performed to diagnose De Quervain’s tenosynovitis, where pain stems from the base of the thumb when gripping or moving the wrist.² This type of tenosynovitis is more prevalent in women due to hormonal changes and increased wrist and thumb motions from lifting their newborns, which causes swelling over the mother’s wrist. Pregnancy and postpartum are the highest risk factors for this condition, reinforcing the importance of diagnosing the patient holistically. Overall, these clinical assessments help distinguish tenosynovitis from other joint conditions and determine if further imaging is needed for confirmation.¹ 

Imaging techniques for confirmation of tenosynovitis

Before 1895, physicians could only dissect lifeless tissue to learn about the human body.⁶ But the invention of X-rays by Wilhelm Conrad Roentgen marked the beginning of diagnostic imaging for the visual representation of our tissues and organs.⁶ Following that, other techniques, including ultrasounds and magnetic resonance imaging (MRI), were developed in 1956 and 1977, respectively.⁷ This leads us up to today with medical imaging as an essential component for the entire healthcare system to conduct routines, from normal check-ups to diagnosis and treatment for patients without surgery. 

Ultrasound is usually the first-line imaging option for tenosynovitis. It can reveal subtle changes that were not noticeable in a physical exam by capturing real-time pictures, and it is especially useful if the affected area is the hands.⁸ In 15% of cases, ultrasounds are able to detect early signs of tendon damage and swelling, which can alert patients to take precautionary measures before it worsens. In advanced cases, ultrasounds can display fluid buildup around the tendon (sheath cysts) or other joint abnormalities.¹ This makes ultrasound a valuable and non-invasive way to achieve a clear picture of the internal structures of the hand and guide correct therapy for tenosynovitis management.⁸ 

In more serious cases, if the ultrasound is insufficient, MRIs can be used for further evaluation. MRIs can often reveal thickening of the tendons associated with the extensor brevis longus in the toes and the abductor pollicis longus that helps to move the thumb, clinically relevant to de Quervain’s tenosynovitis.¹ In rheumatoid arthritis patients, changes in bone marrow can appear on MRI even before developing tenosynovitis. Additionally, an abscess can be indicated by an increase in fluid collection, which makes it a prized imaging technique for diagnosing more complex cases.¹ Another imaging technique that is less commonly used is computed tomography, but it is still useful in challenging cases. 

Clinical testing and imaging comparison of tenosynovitis

Both clinical and imaging techniques have their strengths and limitations when diagnosing tenosynovitis. Clinical examination is the first step that physicians use to identify typical symptoms, based on physical examinations that assess pain by exacerbating certain movements.² Since the process is performed without the use of special equipment, this straightforward method of diagnosis is inexpensive.⁴ However, this relies on the patient’s self-reported symptoms and clinician experience, whilst also discrediting overlapping symptoms that may belong to other diseases, so in those instances, it notably compromises the accuracy of a diagnosis solely from clinical evaluation. 

Sometimes, clinical assessment is not enough to produce conclusive results. This is where imaging techniques come in handy for assessing the severity of the disease. MRI can offer high-resolution soft tissue imaging and is particularly useful for detecting more subtle irregularities, even in subclinical cases, while ultrasound is a relatively inexpensive option that can give immediate pictures of tendon abnormalities.⁹ Inflammation confirmation is also objective in imaging approaches, making diagnosis more reliable.¹ It can also be used if no improvement has been seen from conservative treatment to guide alternate treatment decisions. 

FAQs

What are some treatment options for tenosynovitis? 

Rest and avoid movements that will worsen the condition immediately. Also, antibiotics will be prescribed to those patients who have infectious tenosynovitis.¹ If the patient’s tenosynovitis is non-infectious, then treatment will be tailored to the cause. In those cases, non-steroidal anti-inflammatory drugs and glucocorticoid injections are used, however, if no improvement is found, surgery may be the next step.¹ 

How long does it take to recover from tenosynovitis?

Symptoms should start to improve by 4 weeks, and some patients reach full recovery by 10 weeks with the appropriate treatment.¹ However, recovery time differs with every individual and can vary depending on the cause and severity of the condition. 

When should I see a doctor for tenosynovitis? 

You should consult a healthcare professional if you are experiencing persistent pain or swelling in the tendon area, have difficulty mobilising your joint, have symptoms that do not improve with rest, or have any signs of infection.¹ 

Summary

Tenosynovitis is a painful condition that causes swelling due to the inflammation of the synovial sheath. Physicians have designed a comprehensive diagnosis plan for the condition through the invention of different clinical tests and modern imaging techniques. Tenosynovitis is usually recognised through a brief consultation with a doctor, where they identify localised pain in the joints and carry out physical examinations to check for swelling and tendon thickening. In some cases, doctors may request further advanced imaging, such as ultrasound and MRI, to provide further detail in deeper structures for a definitive diagnosis. While clinical evaluation is beneficial for early diagnosis, imaging techniques aid in the confirmation of tenosynovitis severity and treatment decisions. The two approaches complement each other to raise diagnostic confidence when clinical findings are unclear, and the combined method ensures a more well-rounded evaluation, leading to more effective and targeted strategies for patients with tenosynovitis.