Tenosynovitis is the inflammation of the protective tissues that surround the tendons.¹ Tendons are connective tissues that connect muscles to bones. The protective tissue around the tendon is called the tendon sheath, and it can become inflamed for several reasons, including injury, infections or overuse. In some cases, the cause of the inflammation may be unknown and is referred to as idiopathic.¹ 

Causes of tenosynovitis are broadly categorised into infectious and non-infectious causes. The infectious causes are usually due to infections from bacteria organisms like Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus, and Pseudomonas aeruginosa. While the non-infectious causes are usually due to some underlying health conditions, like rheumatoid arthritis, stress due to overuse or repetitive motions.¹

Tenosynovitis commonly affects the wrist, hand, and foot, causing inflammation, pain, stiffness, and discomfort.¹ When tenosynovitis occurs, there is usually pain and difficulty in moving the affected area. The underlying cause usually determines its treatment.

This article will discuss the treatment options for tenosynovitis due to non-infectious causes.

Treatment options for non-infectious tenosynovitis

There are several treatment options for tenosynovitis due to non-infectious causes. From rest to medications, to some invasive procedures.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These are drugs used to reduce pain and inflammation. NSAIDs are the first line of drugs for anyone experiencing tenosynovitis due to non-infectious causes.² 

NSAIDs include drugs like ibuprofen, diclofenac, and naproxen.³ These drugs are effective in the treatment of non-infectious tenosynovitis, and their mechanism of action is by inhibiting the cyclooxygenase enzyme, which is involved in and regulates the inflammatory process.⁴

Corticosteroids

Corticosteroids are anti-inflammatory agents of steroidal origin.⁵ Corticosteroid injections are given to people with more severe cases of non-infectious tenosynovitis.² These injections are usually injected directly into the affected tendon sheath and have proven to be very effective. 

However, care should be taken when using corticosteroid injections as repeated use may weaken the tendons and also increase the risk of tendon rupture.⁶ Common examples of corticosteroid injections that can be used include triamcinolone and methylprednisolone.⁵ 

Disease-modifying antirheumatic drugs

Disease-modifying antirheumatic drugs (DMARDs) are medications used to treat autoimmune diseases like rheumatoid arthritis and psoriatic arthritis.⁷ The rationale behind using this medication in the treatment of tenosynovitis is that it helps address the underlying cause of the tenosynovitis, and they are given to people who don’t respond to NSAIDS.⁸

These medications work by suppressing the immune system, making them effective in relieving pain, reducing inflammation, and also slowing down the disease condition. Examples of these medications include azathioprine and tumour necrosis factor inhibitors.⁷

Rest and inactivity

One simple way of managing non-infectious tenosynovitis is by resting the affected area.⁹ Since overusing the tendon can lead to tenosynovitis, it only makes sense to rest it. Arresting the affected area helps reduce stress and encourages healing.

However, if completely resting the affected area is not possible, it is best to reduce the frequency and intensity of certain movements. Also, avoid engaging in activities that might worsen the symptoms, such as repeated motions or lifting heavy objects. 

Finally, adjusting posture may help reduce stress on the affected tendon depending on the location.⁹ 

Physical therapy

Physical therapy is another effective way of treating and managing non-infectious tenosynovitis.⁹ Engaging in exercises like stretching may help in increasing the flexibility of affected tendons, thus preventing stiffness and reducing the risk of reinjury. 

Also, strengthening exercises are another common form of physical therapy. Strengthening exercises focus on building the muscles around the tendon, which helps in supporting the tendon and preventing further injuries due to overuse.⁹ 

Surgery

In rare cases, there might be a need for surgical intervention.² Surgical intervention is usually a last resort and is only recommended after every other treatment option has been explored and failed.¹ It is normally used in patients who have non-infectious tenosynovitis that progresses after 3-6 months after other non-invasive therapies have been used.¹ 

Surgical intervention may involve easing compression of the affected area and also debriding the affected inflammatory tissues, that is removal of the damaged tissues.¹ However, if the tendon is not severely damaged, it can be repaired. Tenosynovectomy is a process that involves the removal of the inflamed synovial membrane surrounding the tendon. 

Also, it is worth noting that there is a risk of infection during the surgical process and recovery from surgery often takes a long time. 

Summary

Non-infectious tenosynovitis is a common condition which affects mainly the hand, wrist, and feet. Treatment may require therapy, drugs or in rare cases surgery. Finally, it is important to know the cause of tenosynovitis as it guides the treatment options.