Synovitis and Tenosynovitis

Synovial membrane is the lining of the joint and its surrounding tissues like bursa and tendon sheath. The lining or synovial membrane secretes a clear fluid called synovial fluid, which act as a lubricant. While synovial fluid is a normal fluid present in the joint cavity and surrounding tissues, excess accumulation of fluid can be a result of irritation or injury.

Synovitis is the inflammation of synovial membrane of the joint. The main presenting features include joint pain, more on movement; swelling or effusion due to collection of fluid in the synovial sac. Synovitis is commonly noticed in knee, hip, wrist and ankle but any joint can get affected.

Tenosynovitis is the inflammation of a tendon and lining of the tendon sheath. Tendon is a band of tissue that connects a muscle to the bone. The protective sheath lining the tendon is the synovium, which may get inflamed. The presentation generally includes swelling, pain along the tendon and difficulty in moving the affected joint. Tenosynovitis is commonly seen in wrists, hands, feet, fingers and small joints but any tendon sheath can get affected.

Inflammation of joint lining can occur due to underlying joint conditions andarthritis like rheumatoid arthritis, osteoarthritis, gout, psoriatic arthritis, juvenile arthritis and other types of arthritis. Infection and injury can lead to synovitis; tuberculosis is also a common cause.

The exact cause of tenosynovitis is not clear. However, inflammation of tendon sheath can commonly occur due to joint disorders, injury and infection. A possible cause includes overuse of a tendon, repeated or strenuous activities that require using hand tools, etc. Some other causes may include rheumatoid arthritis, psoriatic arthritis, crystalline deposition and conditions like lupus and diabetes. Tenosynovitis can be a result of infection after wounds in the area or infective arthritis, mostly due to bacteria gonococci.

The joint is swollen due to effusion and appears puffy. There is joint tenderness and hard lumps or nodules may be noticed. Synovitis due to rheumatoid arthritis usually shows marked joint swelling. The joint may be warm due to inflammation and increased blood flow to the affected area. There may be complaints of joint stiffness, inability to move the joint freely, pain on making certain movements and morning stiffness. Fever may or may not be present depending on the cause.

The main symptoms include pain and tenderness of the affected tendon, at common sites like hands, wrists and foot. Pain and difficulty when moving the joint where inflammation is present may be noticed. There can be reddening of the area along the course of the tendon due to inflammation.

There may be history of cuts, infection, injury, strain or overuse of the tendon due to activities demanding the use of that part. In case of an infection, associated symptoms may include tenderness, swelling and redness along with fever. As infection can be an important cause, gonococcal type of tenosynovitis, can be seen more in young adults and women. In infectious tenosynovitis of non-gonococcal type, signs of injury or bite may be noticed.

Tenosynovitis of fingers, possibly due to overuse can lead to flexion of the finger, which can appear as if the finger is locked in the flexed position and is then suddenly released. This can be a trigger finger and in extreme cases the locked finger may have to be released by manipulation.

Synovitis can be detected using relevant investigations. Joint aspiration may be done for synovial fluid analysis, in which the excess fluid is drained using a local anesthetic. Fluid analysis can determine the nature of fluid and reveal the presence of microorganisms causing infection or crystals causing gout like conditions.

Synovitis is treated based on the clinical symptoms, underlying condition and findings of synovial fluid analysis. Anti-inflammatory drugs help in relieving pain, swelling and to improve joint movement. Fever and infection is treated with appropriate medicines. Steroid medications and injections may be given depending on the case.

Tenosynovitis can be diagnosed with history, clinical examination, investigations and imaging studies. It is managed using anti-inflammatory drugs in mild cases, which help to reduce swelling and pain. Treatment is decided according to the underlying cause, its location and severity. Overuse related tenosynovitis is managed by taking steps to avoid the use of the affected tendon and the joint. Rest to the tendon can aid in recovery. Use of splint or braces may be advised. Application of ice packs or heat packs can be done as advised. In some cases, surgical consideration may be required.

For infectious tenosynovitis, appropriate antibiotics are given along with other measures like elevation to reduce swelling and splinting if required. Some cases may be an emergency and some may even require surgical procedures to remove the infected material around the tendon. For non-infectious conditions, steroid injections followed by pain reliving medicines may be considered.

Following the initial treatment, rehabilitation with physical and occupational therapy is advised in most cases. Strengthening exercises of the muscles and tendons can help to keep them strong and prevent injury from recurring.

Synovitis may take few days to few weeks to recover in acute episodes, with prompt treatment and proper after-care. Recovery and outcome in chronic cases of synovitis may depend on the cause and its treatment. Recurrence of synovitis can be seen if the underlying cause of inflammation recurs. Avoiding trigger factors and taking immediate steps during the initial stages can help.

Tenosynovitis may take few weeks to recover depending on the cause. Complete recovery is generally seen with prompt treatment. In overuse tenosynovitis, appropriate activity restrictions and modifications can prevent recurrence and further damage to the tendon. Infections should be promptly treated to avoid permanent stiffness and damage to the tendon or the joint.

References:

Also Read:

• 5 Exercises for DeQuervain’s Tenosynovitis
• 4 Exercises for Achilles Tenosynovitis or Paratenonitis
• What Causes Synovitis of Elbow & How is it Treated?
• Synovitis of Knees, Hips, Ankles, Shoulders, Wrists, Jaw Joint