Introduction

I would like to commence this article by defining what an athlete is, because so often the media paints a picture that an athlete needs to look a certain way or train a certain amount. An athlete in any sport can be classified according to one study by three criterias which are: intent of exercise, volume of exercise in terms of hours per week and finally level of competition. There are however many factors that come into play such as, age of peak sports performance when defining an athlete and its definition is disputed in health and sports literature. In sports science, an athlete is typically considered to be a person regardless of gender or age, with superior physical and psychological conditions that enable them to have athletic excellence. 

Diagram depicting the tendon sheath and tendon.

The above diagram depicts in more detail how the tendons connect bone to muscle with the tendon sheath being filled with lubricating fluid to easily move around.⁴

Now that we have delved into the definition of an athlete, it is important to now define tenosynovitis . Tenosynovitis, otherwise known as an inflamed tendon sheath, occurs when the tendon sheath which protects the tendons are overused. As a result, this reduces the mobility and stability of the bone to muscle connection. A tendon is a strong tissue that connects muscle to bone with some of them being covered with a sheath which helps the tendon move smoothly when it pulls on its respective bone.

There are six tendons in the wrist and five tendons of which will be discussed briefly, as inflammation can occur in any of these. 

• Profundus tendon: runs along the palm side from your wrist to hand and primarily is used to flex the wrist
•  Superficialis tendons: travel through the palm side and are also used to flex the wrist
• Extensor tendons: located predominantly in the finger and also work with the other previous tendons to move the wrist
• Abductor pollicis longus and extensor pollicis brevis: responsible for the thumb movement 

This was just a brief overview of the anatomy of the tendons and location in order to understand that they play an important role in the movement of the wrists, hands and forearms. 

This inflammation most commonly occurs in the hands, arms and fingers from overuse. If the pain stems from the thumb side of the wrist then this condition is called De Quervain’s tenosynovitis. This article will discuss this condition in more detail whilst also looking at the causes, treatment options and the anatomy of the tendons. 

There is an importance in recognising this condition amongst athletes, and by referring to the classification system, an appropriate training plan can be derived. The classification system used in the treatment of elite and professional is as follows:

• Mild: This is where there is swelling in the sheath and no other abnormalities 
• Moderate: A moderate inflammation may cause possible intrinsic changes
• Severe: the tendon can be shaped abnormally due to the inflammation and bowstringing of the ECU distal ( tendon moving out of place ) 

Despite this article being solely about tenosynovitis in athletes, it should be noted that the tendon can be inflamed in non-athletes as well so it is pivotal to look out for any symptoms which will be discussed at a later stage in the article. This article will help you understand the causes, the common symptoms and the preventative strategies for athletes. 

Causes and risk factors

Tenosynovitis can arise due to infectious or noninfectious causes. The most common infection is Staphylococcus Aureus and insect bites which can spread from nearby soft tissue causing the inflammation. 

There are also non infectious causes that include idiopathic, autoimmune and overuse. Tenosynovitis according to one study is strongly associated with the autoimmune condition rheumatoid arthritis.⁸ Another possible cause is repetitive strain injury (RSI) which also includes carpal tunnel syndrome and this is stress related accumulating from repetitive movements such as in racket sports, awkward movement of the ankles and insufficient rest. 

RSI is the most common cause amongst athletes, nevertheless, it may also be caused from a blunt trauma, trigger finger and ganglion cyst. Trigger finger is a type of tenosynovitis, otherwise known as stenosing tenosynovitis and occurs from repetitively using the fourth finger 

and thumb. This usually occurs for athletes that need to constantly grip such as in basketball, tennis, golf or rock climbing.

Symptoms and diagnosis

Common symptoms of tenosynovitis include:

• Discomfort in the wrist 
• Pinching feeling when flexing the wrist
• Soreness when fingers are moved
• In some cases, the formation of a lump 
• Painful snapping feeling when extending fingers 

Symptoms tend to come and go and with time but may also be experienced without movement, such as when sleeping. If you feel any sudden pain or if it worsens, it is advised to consult a medical professional. 

In terms of diagnostic methods/tools, typically an MRI is conducted on the affected area and in some cases a Doppler ultrasound. A physical examination would be followed out prior to the imaging by the medical professional which includes looking at the range of motion, Tinel’s sign test, Phalen’s test and Finkelstein test. The aim is to look at motor and sensory functions of the affected area before assessing the need for any diagnostic imagery. The tinel’s sign test looks at whether there is a tingling sensation when tapping. 

Treatment and recovery

The following treatment options may be considered:

• Immobilization 
• Pain relief
• Physical therapy 
• Massage 
• Steroid injections 
• Surgery 

The first plan of action is to rest the affected area and avoid repetitive movements that led to the initial injury. It may be helpful to follow the RICE method which involves putting ice on the affected area, adding compression and elevating. Painkillers can be swallowed or applied directly to the painful area and are useful in reducing the pain and inflammation.¹⁶ The above RICE method mentioned cold, it is useful to also try and see if a hot pack or heat improves the symptoms.¹⁶ In cases where the inflammation is in the fingers, physical therapy may be suggested in order to mobilize the surrounding joints correctly.¹⁶ When the inflammation is persistent and won’t go down, a medical professional can suggest the use of a corticosteroid steroid which is injected directly to the inflamed area.¹⁶ There is a minor surgery that can be scheduled to allow for the tendons to move more easily again if all other treatment options fail and after a few weeks it should be back to full function.¹⁶ As with most inflammations, you should use the RICE method initially alongside pain relief to see if the inflammation goes down. It is important to enforce proper technique and proper recovery for athletes so that they can return to their sport in due course without them having to miss a competition season or personal best. 

Summary

Tenosynovitis is a condition that athletes should be aware of due to the fact that it can impact performance as well as mobility. It is important to detect the condition early by understanding the causes, whether due to repetitive strain, an autoimmune condition or an infection to determine the most relevant treatment plan. By recognising symptoms such as wrist discomfort and reduced mobility, athletes can seek timely medical attention and avoid prolonged injury. Effective treatment involves a combination of rest, physical therapy and taking pain relief.

Beyond treatment, long term prevention is essential for ensuring an athlete’s longevity in their sport. Proper warm-ups, cool downs and strengthening exercises help maintain the tendon health. A coach may suggest making adjustments to the training intensity or volume in order to further prevent injuries arising from overuse. Seeking medical guidance at the first signs of discomfort can also prevent the minor inflammation from turning into a chronic issue.