Tenosynovitis
What Is Tenosynovitis?
What do you notice or complain of?
Inflammatory type causes include:
Rheumatoid arthritis (proliferative) – this produces relatively painless and bulky swellings.
Deposition pathologies – conditions where normal excreted protein products are well excreted or poorly broken down so that they accumulate and get deposited in the tissues including tendons /other soft tissues, joints and bones. This includes amyloidosis and ochronosis.
Amyloidosis is due to the deposition of a low molecuar weight serum protein (beta microglobulin) in patients undergoing renal dialysis as the protein is not filtered by normal dialysis membranes or rarely because of an enzymatic defect. Ochronosis is deposition of homogentisic acid in the tissues and as well as excreted in the urine. in this autosomal recessive condition, there is an enzyme deficiency in tryptophan metabolism. (homogentisic acid oxidase)
Crystalline tendinopathy – gout (urate crystals), calcific tenosynovitis, pseudogout (calcium
pyrophosphate)
Infective – this can be acute or chronic (fungal, atypical mycoacteria, gonococcal).
Sarcoidosis – It is an immune mediated granulomatous disease but the cause is unknown.
The tendons pass through fibro-osseous canals on the back of the wrist (dorsum) or the palmar side of the tendons. They provide fulcrums for the acute angulation of these tendons. These canals are narrow and during this constant motion, there can be swelling and bunching of the tendon fibres which can lead to a restriction of gliding and finallycatching or locking of the tendon. This process leads to an acute inflammatory response with resultant edema and thickeneing of the retinacular sheath.
Symptoms include local pain and tenderness, swelling, redness and crepitus. Triggering of the digits and weakening of the grip strength depending on the site of the tenosynovitis may follow. Carpal tunnel syndrome can occur.
Each of the fibro-osseous canals may be involved in the condition but the most commonly involved are the first and sixth extensor compartments On the flexor surface, a very common site is deep to the A1 pulley (trigger finger).
Did you know!
This can masquerade as septic arthritis, rheumatoid arthritis or a neoplasm and this can lead to a delayed diagnosis.
Laboratory estimation of the uric acid level is not enough as it is high in about 7% of adult males. Confirmation of the nature of the crystals by examination under polarised light (negative birefringence) as well as gram stain may be helpful in differentiating acute gout tenosynovitis from infective causes or rheumatoid arthritis. Sample of the material should be transported to the laboratory in alcohol instead of formalin to avoid degradation of the urate crystals.