TENOSYNOVITIS & TENDINITIS TREATMENT
Often associated, tenosynovitis (inflammation of the synovial lined tendon sheath), and tendinitis (inflammation of the enclosed tendon), have common clinical presentations that can last for days or even months. This condition is often common amongst computer workers, factory line workers, and manual laborers. Tendinitis and tenosynovitis are categorized as repetitive strain injuries (RSI’s) mostly caused by repetitive microtrauma, although, may be related to systemic diseases such as RA, systemic sclerosis, gout, Reiter’s syndrome, diabetes, etc. The involved tendons are usually painful with a loss of normal range of motion. The tendons and/or sheaths may accumulate fluid due to inflammation, or may remain dry but cause friction, which is felt or heard as “cracking.” Chronic conditions often lead to stenosis in the tendon sheath.
Common clinical presentations include:
Affecting the extensor pollicis brevis, abductor pollicis longus, and sometimes the extensor pollicis longus of the thumb. Usually insidious onset that often radiates up forearm on dorsolateral side, with activity related pain. Increased pain with active/passive opposition of thumb and ulnar deviation at the wrist (Finkelstein’s test) is the confirmatory test. Decreased grasp or pinch strength of the affected digit may also be affected. This condition is common with computer work, cashiers, mechanics, piano or guitar musicians, racket sports, and excessive cell phone use (Blackberry thumb).
Bicipital tendinitis is inflammation of the long tendon and tendon sheath of the biceps brachii, often associated with subacromial bursitis, rotator cuff tendonitis, and frozen shoulder. The two most common causes are muscular/tendinous impingement (pectoralis, deltoid, etc) or subluxation of the tendon at the bicipital groove of the humerus, due to transverse ligament laxity or injury. Common with overhead sports or work activities, this condition can lead to calcific changes to the ligament with audible popping and pain especially with flexion of the humerous (70-120 degrees). Resisted flexion and supination of the forearm will also aggravate pain.
Iliotibial Band Syndrome (ITB)
ITB syndrome is tendonitis of the iliotibial band (ITB) and/or tensor fascia latae (TFL), causing pain along the lateral aspect of the knee. Etiology is tight TFL and ITB muscles/tendons that rub against the lateral epicondyle of the femur at 30-40 degrees of knee flexion. Symptoms are commonly diffuse lateral knee pain during running. Increased pain with downhill running may be present, or absence of pain while uphill running. Most commonly associated with overtraining, ITB syndrome can also be caused by overpronation of the feet (leading to medial rotation), ACL laxity or injury, or asymmetry of leg length.
The initial clinical focus is to reduce the cycle of inflammation through a combination of anti-inflammatory pharmaceuticals, local site injections, or through ice, rest, and bracing. The clinical focus is to reduce the mechanical dysfunction by reducing myotendinous friction. The biomechanical, myotendinous friction, must be a clinical focus or this chronic inflammatory condition will likely progress.
Passive modalities such as electrical muscle stimulation (EMS), heat/ice, and passive stretching may initially be used. As range of motion increases and inflammation decreases, a specific manual therapy technique called active release technique (A.R.T.) is implemented to reduce tissue hypoxia, reduce scar tissue formation, and break up soft tissue adhesions.
A.R.T.’s basic premise is simple. Using precisely directed tension and very specific patient movements, the doctor manually shortens the affected tissue, applies a contact tension with the thumb or finger to the affected muscle, tendon or nerves. This lengthens the shortend and contracted tissue to make it slide relative to the adjacent tissues, by breaking the scar tissue that is binding up the tissues that need to move freely and independently. As this scar tissue builds up, muscles become shorter and weakened, causing tension on their tendons, causing tendonitis, and peripheral nerve entrapments.
A progressive, active care rehabilitation plan is also designed to promote long term success. A series of concentric, eccentric, and isometric exercises are designed to develop muscle strength, endurance, and flexibility. The affected joint is an obvious focus for rehab, but often the joints above and below need to be addressed to correct any biomechanical compensation. With progress, patients are released to supportive care. Some patients require flare-up visits 1-2 times per month while others report full resolution with continued use of prescribed rehab programs at home, prevents regression. A focus on posture, technique, and determining a threshold of over-use becomes key in prevention of future recurrent flare-ups.