Synovitis

What is it?

Inflammation of tendons or joint capsules.

Symptoms

Localised pain, swelling, and sometimes redness. The inflamed joint is frequently tender to the touch with there being pain on moving the joint. The inflamed (or torn) tendon is tender to touch with there being increased pain on using the associated muscle. Prolonged loss of use can result in loss of movement of the affected joint, or loss or weakness of the affected muscle.

Incidence

This is a common condition in the physically active population. Most cases are relatively mild resolving within a matter of weeks. A small proportion of these injuries can be severe and a small proportion may become chronic.

Key Points (from ACC Treatment Profiles, 2001)

• Inflammation is involved with tenosinivitis of the tendon and tendon sheath

• Overuse, poor technique or continuation from an acute injury are frequent causes of tenosinivitis

• Rest is important in recovery

• Infection may be a risk

• Synovitis/Tenosinivitis is rare in patients less than 18 years of age

• Identify and then modify the precipitating activity

Differential Diagnosis (From ACC Treatment Profiles, 2001)

• Carpal tunnel syndrome

• Mixoedema/pregnancy

• Inflammatory arthritis

• Joint sprain/fracture

• Nerve entrapment

• Old carpal injury

• Gout/pseudo-gout

• Soft tissue infections

Recommended Treatments

• Resting night splints (for nocturnal symptoms) (Mills R, 2003)

• Physiotherapy (Mills R, 2003)

• Reduced stressors (ACC Treatment Profiles, 2001)

Other options suggested by the ACC include:

• Physiotherapy

• Joint aspiration

• Local anaesthetic sterile injections

• Occupational Therapist to assess the workplace

Red flag conditions (Dr R Mills):

• Muscle atrophy

• Significant impairment of activities in daily living

• Altered finger/hand profusion

• Systemic signs/symptoms

• Sudden onset of symptoms

Yellow flag conditions:

• Attitudes and beliefs about pain

• Emotions

• Behaviour

• Family

• Compensation issues

• Work

• Diagnostic and treatment issues

• Workplace conflict

When to Consider Referral for a Specialist Opinion:

• The presence of any red flag conditions

• The worker has had more than two weeks certified unfit for duties, or more than one month on selected duties

• The worker has had more than three weeks off work, or on selected duties and has significant yellow flag conditions

• Not back at pre-injury duties within six weeks of the injury

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