Complaints & connections · borters.ch
Tendovaginitis
Thumb inside the fist, wrist bent towards the little finger — if the pain shoots, it is the tendon sheath and not the joint.
Also known as: tenosynovitis · tendon sheath inflammation · tendon overuse
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
It is not the tendon itself that is inflamed but its sheath — the tunnel it glides through. If a movement is repeated unusually often, this sheath swells and the tendon no longer runs smoothly through it. The best known form sits on the thumb side of the wrist. It can be checked in seconds: close the thumb inside the fist and bend the wrist towards the little finger — if a sharp pain shoots across the thumb side, the matter is fairly clear. What decides is not how much someone does in total but what has newly and repetitively been added: a renovation, a new device, a lot of typing, an instrument — and very often a newborn lifted under the arms several times an hour. Added to that are favouring circumstances such as the time after a birth, the menopause, diabetes or an underactive thyroid. Treatment is relative rest rather than complete immobilisation: a splint that includes the thumb, performing the triggering movement differently, cooling and an anti-inflammatory gel. If it stays stubborn, an injection into the tendon sheath is the most effective next step.
Close the thumb inside the fist, bend the wrist towards the little finger. If pain shoots across the thumb side, that speaks clearly for the tendon sheath — and against the joint.
A splint that includes the thumb, for a few weeks and above all at night. Complete immobilisation by contrast does harm: it stiffens and weakens.
Lift the baby under the back rather than under the arms, change the mouse, hold the phone differently, build in breaks. Without this step it reliably comes back.
An anti-inflammatory gel works well at this superficial site and does not burden the stomach. Cool several times a day for ten to fifteen minutes.
A targeted injection into the tendon sheath ends a large share of stubborn cases. It is the most effective next step, long before an operation comes into question.
A swollen, reddened, severely painful tendon sheath with fever — especially after a puncture or bite injury to the hand — is a bacterial infection and a surgical emergency.
Tendon sheath inflammation needs two to six weeks of relative rest from the movement that caused it — not immobilisation of the whole joint. The decisive point is that the movement which set it off drops away during that time; otherwise the clock restarts every time. A cortisone injection works in thumb tendon sheath inflammation in about eight out of ten people, and that effect sets in within a week.
Anti-inflammatories take the pain and make rest possible — they do not remove the irritation as long as the causing movement continues. A cortisone injection into the sheath works in about eight out of ten people and sets in within a week; repeated, it can weaken the tendon. A splint over two to six weeks works because it blocks exactly the movement that irritates. Without a change in load, the clock restarts after every treatment.
Right over the protruding bone on the thumb side of the wrist, often with a palpable thickening and sometimes a faint creaking on movement.
It is not the amount but the unfamiliarity. A week of painting, a new tool, a new hobby, or a baby constantly being lifted.
Both times favour this inflammation. The form after birth is so common that it has a name of its own — and it usually settles again.
If a finger catches on bending and then springs forward with a jerk, that is a related but separate matter — it sits in the palm.
In older people wear of the thumb saddle joint is the commonest confusion. It hurts on gripping and twisting, for instance opening a jar.
Normal in the ordinary overload form. Clearly raised, with fever and redness, it is a bacterial infection of the sheath — and that is a surgical emergency.
Diabetes clearly favours tendon and sheath problems in the hand. With repeated episodes the value is worthwhile.
An underactive thyroid makes tissue hold water and narrows the tunnels further. It also lies behind many cases of carpal tunnel trouble.
Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.
The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.
Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.
Bone is a third protein scaffold, and the muscles that hold it need protein too. In older people too little protein is more common than too little calcium.
Needed for building calcium in and for vitamin D to work. A lack slows both — even when calcium and vitamin D are supplied in sufficient amounts.
2–3 g EPA+DHA a day over at least 8 weeks; the data come from joint rheumatism, not from the tendon sheath. The measure that works here is relief — the tendon needs rest from the movement that irritated it.
10–15 g about an hour before loading, together with vitamin C, is the frame studied in small trials on tendon complaints. The numbers are preliminary and the groups small.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
In pregnancy and around menopause tendon sheath complaints occur more often; tendon tissue has receptors for this hormone. After birth it often recedes on its own — one reason waiting comes first here.
With diabetes the tendon sheath is more often thickened, and the complaints last longer. The same goes for trigger finger and carpal tunnel — with diabetes they often come as a set of three.
The tendon sheath settles over 2–6 weeks mainly through rest. Omega-3 and less heavily processed food contribute, but do not replace the break.
Cooling in the acute phase, then warmth before the movement exercises. Relief from load works more here than any application — 2–6 weeks is the usual period.