The Skeletal System
Tendinitis and Tenosynovitis
of a tendon (tendinitis) and the
lining of the tendon sheath (tenosynovitis)
usually occur simultaneously. The synovial-lined tendon sheath usually is the
site of maximum inflammation, but the inflammatory response may involve the
enclosed tendon when calcium deposits can be found. Bursitis (inflammation of
the bursa) is a closely related condition that may develop together with
tendinitis since bursae are often located near tendons.
aetiology is often unknown, but most instances occur in middle and older ages
as the vascularity of tendon sheaths diminishes, and repetitive microtrauma
may result in greater injury. Repeated or extreme trauma, strain, or excessive
(unaccustomed) exercise is most frequently causative. The tendon sheaths may
also be involved in systemic diseases (most commonly rheumatoid arthritis,
systemic sclerosis, gout). The most common sites of inflammation are the
shoulder capsule and associated tendons, radial or ulnar carpal flexor, flexor
digitorum, hip capsule and associated tendons, hamstrings, and Achilles
Clinical features: < BACK TO TOP >
involved tendons are usually painful on motion.
sheaths may be visibly swollen because of inflammation and fluid accumulation,
or they may remain dry but cause friction rubs felt on movement of the tendon
in its sheath or heard with a stethoscope.
Along the tendon, localised tenderness of variable severity is present; it may be severe and associated with disabling pain on movement.
Diagnosis: < BACK TO TOP >
clinical picture and physical exam are usually sufficient to establish the
Calcium deposition in the tendon and its sheath may be sometimes seen by X-ray.
Management < BACK TO TOP >
relief is provided by rest or immobilisation (splint or cast) of the part,
application of heat or cold (whichever benefits the patient) and analgesic
agents locally (creams or gels) such as Voltaren gel.
within the tendon sheath of a depot corticosteroid mixed with local
anaesthetic may be helpful and this approach is frequently practiced by
athletes who wants fast recovery.
exercise several times daily (becoming progressively more active with
tolerance) is indicated after acute inflammation has subsided significantly.
ultrasound is used to brake down calcium deposits, and may offer some relief
due to its deep massage effect.
and removal of inflamed or calcific deposits, followed by graded physical
therapy, may be considered in persistent cases.
Prognosis < BACK TO TOP >
Dr Zoran Pletikosa)
3 5 June 20096December 2005
10 December 2004 Human Rights DayInternational Day of Disabled Persons
World Environment Day
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails