The difference between tendinitis and tenosynovitis

Written by Na Hong Wei
Orthopedics
Updated on September 11, 2024
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Actually, tendinitis and tenosynovitis are essentially two aspects of the same condition. The term tendinitis usually refers to the part where the muscle transitions into the tendon, whereas tenosynovitis generally refers to the fibrous sheath over the tendon surface. Thus, tendinitis and tenosynovitis often coexist; tendinitis can lead to tenosynovitis, and conversely, tenosynovitis can also affect tendinitis, causing or exacerbating it.

Therefore, in clinical practice, there usually is not a clear distinction between tendinitis and tenosynovitis. It is common during surgeries for stenosing tenosynovitis to observe that the tendon is also congested and swollen, and even adhered to the tendon sheath. Thus, tendinitis and tenosynovitis are generally considered the same disease, merely referred to by two different names. However, if strictly distinguished, there is a certain difference, which lies in the location: tendinitis refers to the tendon itself, while tenosynovitis refers to the sheath outside the tendon.

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Why does tendonitis recur?

Tendonitis, if not well-rested, can easily recur. It mostly occurs during activities, work, or exercise, presenting with pain, swelling, and limited mobility. Tendonitis primarily involves the tendons, which are very hard connective tissues connecting bones and muscles. Tendonitis is mainly caused by the excessive use of muscle fibers and repetitive strain leading to degenerative changes in tendon collagen fibers. This accumulation of degeneration in tendon collagen fibers is commonly referred to as tendinopathy. Examples include common types such as Achilles tendonitis, patellar tendonitis, quadriceps tendonitis, or injuries to the rotator cuff, and lateral epicondylitis of the humerus. Long-term repetitive friction and fatigue can easily cause repeated episodes in these areas. Strict immobilization, along with physical therapy, massage, electric stimulation, and heat application can help alleviate symptoms. Additionally, taking blood-activating and pain-relieving medications, and when necessary, undergoing injective treatments can effectively prevent recurrences and promote relief, reducing symptoms.

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Can tendinitis be seen on an X-ray?

If you are referring to taking an X-ray, tendonitis can only be detected in one situation by X-ray, that is, if the tendonitis has caused calcification. Only then the calcification appears as a high density on the X-ray; otherwise, X-rays won’t show tendonitis. The best examination for tendonitis is magnetic resonance imaging (MRI) because MRI excels in viewing soft tissue disorders, a capability unmatched by other examinations. So, if you suspect you have tendonitis, an MRI should be the first choice, and taking X-rays is not very significant.

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Tendonitis

Tendonitis refers to a sterile inflammation of the tendon itself or its surrounding sheath caused by various reasons. The term "tendonitis" means that, firstly, the affected area is either the tendon or the surrounding tissue. Secondly, it is a sterile inflammation. The causes of tendonitis are generally the following four points: The first point is acute injury. The second point is chronic overuse. The third point is an increased load on the tendon itself, causing some micro-damage inside the tendon. This leads to inflammation due to bleeding and inflammatory irritation in the tendon or around the tendon. The fourth point involves prolonged exercise or excessive exercise load, which then leads to congestive hematoma around the tendon, ultimately leading to inflammation.

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What should be paid attention to with tendinitis?

When tendonitis occurs, the first thing to do is to rest and avoid excessive bending and extending of the tendon. Tendonitis is a sterile, chronic inflammation of the tendon due to overuse, which can lead to pain and impaired movement. It is important to avoid excessive bending and loading activities, and some physical therapy, hot compresses, and the topical application of non-steroidal anti-inflammatory drugs can be used for symptomatic treatment.

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Treatment of Tendonitis

The causes of tendinitis usually fall into the following three categories: The first is acute injury, commonly referred to as tendon strain. The initial step is to stop any activity, followed by immobilization of the affected tendon area. Immobilization typically involves allowing the part to be completely relaxed, under no pressure, and is usually for a period of three weeks. The second cause is chronic overuse, which is the most common reason for tendinitis. It frequently occurs at sites of bony protrusions or where there is a tunnel, and this can easily lead to constrictive tendinitis. Treatment might start with rest, followed by non-steroidal anti-inflammatory drugs if rest is ineffective. Then, injection treatments are considered, typically around three times; symptoms or pain from tendinitis will significantly reduce or even disappear. If there is no improvement after three injections, a fourth should not be attempted, and surgical treatment to release the tendon and alleviate the constriction may be considered. The last cause is due to a purulent infection. This condition requires symptomatic treatment, initially with antibiotics, followed by cultures and sensitivity tests of the effusion. If the infection occurs adjacent to the tendon or in the tendon sheath, surgery might be necessary to perform drainage again. In summary, the treatment of tendinitis largely depends on the specific cause and involves different approaches.