Introduction

“Doc, my wrist hurts so badly I can’t write, drive or do anything with my hand.”

Are you a hairstylist or one who does a lot of typing and writing, or even one who plays golf or tennis, and this sounds like your experience? You may just be dealing with Tenosynovitis or Repetitive Strain Injuries (RSIs). 

In this article, I will be looking at what Tenosynovitis and Repetitive Strain Injuries (RSIs) are, what causes both conditions, how they can be identified and treated to prevent complications.

Join me as we go on this journey together.

What is tenosynovitis?

Tenosynovitis refers to inflammation of the tendon sheath - the protective membrane surrounding a tendon. The causes vary; however, inflammation and thickening are seen in all types. As a result of the overuse of the hand, this sheath may become inflamed and result in severe pain.^1,4

Tenosynovitis is a common clinical condition that occurs as a result of inflammation and is capable of affecting any tendon in the body, but is more common at the wrist, ankle, and hand. In 87% of the patients with rheumatoid arthritis, tenosynovitis has been identified with magnetic resonance imaging (MRI), and this shows there is a very strong connection between them.⁴

Stenosing tenosynovitis occurs generally in about 1.7% to 2.6% of the general population and increases to about 10% to 20% in people with diabetes mellitus. Infectious tenosynovitis accounts for about 2.5% to 9.4% of concomitant hand infections. An average of 55% of people with rheumatoid arthritis may have symptoms in 3.1 tendons.⁴

Types of tenosynovitis

Tenosynovitis can be:^1,4

• Idiopathic or stenosing Tenosynovitis, e.g., trigger thumb or finger and Quervain tenosynovitis
• Autoimmune Tenosynovitis e.g., Rheumatoid arthritis
• Infectious Tenosynovitis, e.g., the organism that is most commonly responsible is Staphylococcus aureus (40% to 75%), followed by methicillin-resistant Staphylococcus aureus MRSA (29%). Chronic infection from atypical microorganisms like mycobacteria and gonococci may also occur
• Noninfectious, inflammatory Tenosynovitis

What are repetitive strain injuries (RSIs)?

Repetitive strain injuries (RSIs) are chronic musculoskeletal conditions caused by prolonged, repetitive, or awkward movements. They primarily affect the muscles, tendons, and nerves of the neck, shoulders, forearms, wrists, and hands, resulting in pain, weakness, or impaired function.² It usually will get better on its own without any interventions. About 5-10% of the general population will usually complain of some discomfort/ strain in the hand.

What are the types of RSIs?

Examples of RSIs include:⁵

• Carpal tunnel syndrome
• Tendonitis
• Bursitis

What are the symptoms of tenosynovitis and RSIs?

Symptoms of tenosynovitis differ based on the probable cause of the condition. Some symptoms you will see in tenosynovitis include:^3,4

• Pain and redness around the affected area
• Crackling sound on the movement of the joint (crepitus)
• Swelling and inflammation
• Difficulty moving the joint
• Stiffness, weakness, or numbness

RSIs symptoms are usually gradual in onset and they include:⁵

• Burning, throbbing or aching pain
• Muscle cramps
• Weakness and stiffness
• Swelling
• Feelings of pins and needles, numbness and/or tingling sensations

What areas are commonly affected by tenosynovitis and RSIs?

The parts of the body commonly affected by tenosynovitis include:

• Hands and wrists (e.g., De Quervain’s tenosynovitis)
• Shoulders and elbows (e.g., tennis elbow, golfer’s elbow)
• Knees and ankles (e.g., Achilles tenosynovitis)

whereas, RSIs commonly affect the:⁵

• Hands and fingers
• Wrists and forearms
• Elbows
• shoulders

What are the causes and risk factors of tenosynovitis and RSIs?

The risk factors of tenosynovitis and RSIs include:^1,2,5

• Repetitive motions such as typing, writing, assembly line work, and some sports
• Age
• Poor posture and ergonomics
• Lack of proper rest and recovery
• Regular use of handheld power tools
• Some health conditions include rheumatoid arthritis, thyroid disease, diabetes, and gout.

How do you diagnose tenosynovitis and RSIs?

The diagnosis of tenosynovitis and RSIs can be:^4,5

• A good medical history and physical examination - This can help with identifying the probable cause, and to know the possible course of management that will be best
• Some laboratory tests, e.g., high white blood counts and blood cultures, will help in diagnosing infectious tenosynovitis. Specific blood markers may also be required if autoimmune tenosynovitis is suspected
• Imaging tests such as X-rays, ultrasound, and MRI can be used to confirm the presence of tenosynovitis. However, they may not always be required

Other conditions that may present similarly to tenosynovitis and RSIs include:⁴

• Cellulitis
• Osteoarthritis
• Gout/pseudogout
• Rheumatoid arthritis
• Psoriatic arthritis
• Injuries to the bone or tendon may also present as stenosing tenosynovitis. 
• Dupuytren contractures may also mimic the stenosing tenosynovitis
• Compression of nerves

What complications can occur as a result of tenosynovitis and RSIs?

Tenosynovitis can get complicated, resulting in:^1,4

• Necrosis (death)
• Rupture of the tendon
• Scar tissues (adhesion)
• A need for amputation of the affected part 

How do you treat and manage tenosynovitis and RSIs?

Treatment of tenosynovitis differs based on the cause. It may be conservative care, physical therapy, medical or surgical therapy.⁴

Conservative treatments

• Rest and modification of activities such as typing, and the use of smartphones
• Application of Ice and heat therapy on the affected area
• Use of Anti-inflammatory medications (NSAIDs), e.g Ibuprofen
• Splinting or bracing of the affected tendon

Physical therapy

• Stretching and strengthening exercises
• Ergonomic adjustments at work

Medical/surgical interventions

• Use of corticosteroid injections, e.g in autoimmune tenosynovitis
• Disease-modifying antirheumatic drugs (DMARDs) such as glucocorticoids are useful in noninfectious tenosynovitis, especially when NSAIDS  are not effective.
• Use of antibiotics in infectious tenosynovitis
• Surgery, e.g., debridement and adhesiolysis, can be done in severe or persistent cases.

For RMIs, treatment may not be required most of the time. However, if required, the following can be done:⁵

• Physiotherapy
• Rest from activities that trigger your symptoms. Avoid resting the affected part for too long to prevent reduced flexibility and weakness of the affected part
• Cold and heat therapies may help with symptoms
• Use of painkillers like paracetamol and ibuprofen may help. Avoid taking them regularly without a prescription
• Raising the injured part up on a pillow will help reduce swelling
• Steroids and surgeries may also be required in severe cases

How do you prevent tenosynovitis and RSIs?

These conditions can be prevented  in the following ways:^4,5

• Proper ergonomics at work and home
• Regular breaks and stretching exercises
• Strengthening muscles to support tendons
• Using proper techniques in repetitive tasks

Conclusion

Early detection of tenosynovitis and RSIs through good history and proper physical examination will help to initiate proper care early so as to avoid complications. Laboratory investigations, radiographs, ultrasound scans and MRI will help in diagnosis also. The first line of management of non-infectious tenosynovitis remains conservative therapy with NSAIDs and splinting. However, in cases of resistance, individuals may require DMARDs, steroid injections, and/or surgery.

Summary 

Do you have severe pain in your wrists, hands, fingers and ankles after writing, typing or making repeated movements for a long time?  You might be having Tenosynovitis and Repetitive Strain Injuries (RSIs). 

Tenosynovitis is the inflammation of the tendon’s protective covering, resulting in pain, stiffness, and swelling, which commonly affects the wrist, fingers, hand, and ankle; whereas, RSIs happen when a movement is repeated for a long time, causing pain, muscle weakness, and swelling in the hand, wrist, shoulder and elbow. It may cause similar symptoms to tenosynovitis but is also known to cause tingling and burning sensations.

People at risk of these conditions include: those who play golf and tennis, those who type or write for long hours, and people with diabetes, arthritis, and thyroid problems.

With thorough history, examination and tests like X-rays, blood tests, ultrasound, and MRI, diagnosis can be made and treatment commenced early so as to prevent complications.

Treatment can be conservative ( rest), the use of cold and heat therapy, painkillers or steroids and surgery in severe conditions.

Tenosynovitis and RSIs can be prevented with proper ergonomic care and posture.