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The Merck Manual--Second Home Edition logo
 
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Chapter 74. Disorders of Muscles, Bursas, and Tendons
Topics: Introduction | Muscle Cramps | Fibromyalgia | Bursitis | Tendinitis and Tenosynovitis | De Quervain's Syndrome | Baker's Cysts
 
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Tendinitis and Tenosynovitis

Tendinitis is inflammation of a tendon; tenosynovitis is tendinitis accompanied by inflammation of the protective sheath around the tendon (tendon sheath).

Tendons are fibrous cords of tough tissue that connect muscles to bones. Tendon sheaths surround some tendons.

Tendinitis usually occurs in middle or old age, as the tendons become more susceptible to injury. However, it also occurs in younger people who exercise vigorously (who may develop rotator cuff tendinitis (see Section 5, Chapter 75)) and in people who perform repetitive tasks.

Certain tendons, especially those of the hand and forearm, are particularly susceptible to inflammation. Inflammation in the tendon that extends the thumb away from the hand is called de Quervain's syndrome. Also, inflammation can cause the flexor tendons that control clenching of the fingers to get caught in their sheaths, producing a popping feeling (trigger finger (see Section 5, Chapter 71)). Tendinitis above the biceps muscle in the upper arm (bicipital tendon) causes pain when the elbow is bent or the arm is elevated or rotated. The Achilles tendon in the heel (see Section 5, Chapter 75) and a tendon that runs over the top of the foot also commonly become inflamed.

Certain joint diseases, such as rheumatoid arthritis, scleroderma, gout, and Reiter's syndrome, can cause tenosynovitis. In people who contract gonorrhea, especially women, gonococcal bacteria can spread during menstruation or pregnancy and cause tenosynovitis, usually affecting the tissues of the shoulders, wrists, fingers, hips, ankles, and feet.

Symptoms and Diagnosis

The inflamed tendons are usually painful when moved or touched. Moving the joints near the tendon, even a little, may cause severe pain. The tendon sheaths may be visibly swollen from the accumulation of fluid and inflammation. In chronic tenosynovitis, as may occur in scleroderma, the tendon sheaths may remain dry and rub against other tissues, causing a grating sensation that may be felt or a sound that may be heard with a stethoscope when the joint is moved; this is called a "tendon friction rub."

Treatment

Several forms of treatment may relieve the symptoms of tendinitis. Rest, immobilization with a splint or cast, and application of heat or cold--whichever works--are often helpful. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the pain and inflammation when used for 7 to 10 days.

Sometimes corticosteroids (for example, dexamethasone, methylprednisolone, or triamcinolone) and local anesthetics (for example, lidocaine) are injected into the tendon sheath. Rarely, the injection causes pain because crystals of the corticosteroid temporarily form inside the joint or sheath; this flare-up lasts for less than 24 hours and can be treated with cold compresses and analgesics.

Treatments may have to be repeated every 2 or 3 weeks for a month or two before the inflammation subsides completely. Chronic, persistent tendinitis, as may occur in rheumatoid arthritis, may have to be treated surgically to remove inflamed tissues, and physical therapy may be needed after surgery. Surgery is occasionally needed to remove calcium deposits from areas of long-standing tendinitis, such as the area around the shoulder joint.

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