What’s the Best Way to Treat Chronic Tenosynovitis?

Question by ShakeRattleRollNY: What’s the best way to treat chronic tenosynovitis?
I obtained this condition above my left ankle about a couple of years ago playing soccer. It really hasn’t gone away; when I poke at that area, it feels like a fresh painful bruise. I’m able to run and move around since the injury is above where my sneaker tops off.

I heard that acupuncture is helpful. Your suggestions are welcome.

Best answer:

Answer by Sue O
i feel your pain! i had this when i played soccer my first year in college. i was also at a military school, so the combat boots we wore only made it worse. my injury did go away completely, but only after i spent about three weeks on crutches, giving the tendon TOTAL REST. it’s possible that since your case doesn’t sound as severe that accupuncture may help, but i really haven’t heard anything about that. do you take anti-inflammatories for it too? possible that advil and rest might do the trick…

Answer by Jeffrey
Looks like applying heat for 4-6 weeks/corticosteroid injections or surgery is the basic treatments. Below is a good article on the subject.

Inflammation of a tendon or the lining of a tendon sheath in the ankle. This lining secretes a fluid that lubricates the tendon. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering.

Any ankle tendon and its lining.
Soft tissue in the surrounding area, including blood vessels, nerves, ligaments, periosteum (covering to bone) and connective tissue.

Constant pain or pain with motion.
Limited motion of the ankle.
Crepitation (a “crackling” sound when the tendon moves or is touched).
Heat and redness over the inflamed tendon.

Strain from unusual use or overuse of muscles and tendons in the ankle.
Direct blow or injury to the ankle. Tenosynovitis becomes more likely with repeated ankle injury.
Infection introduced through broken skin at the time of injury or through a surgical incision after injury.

Contact sports, especially kicking sports such as football or soccer.
If surgery is needed, surgical risk increases with smoking, poor nutrition, alcoholism or drug abuse, and recent or chronic illness.

Engage in a vigorous program of physical conditioning before beginning regular sports participation.
Warm up adequately before practice or competition.
Wear protective footgear appropriate for your sport.
Learn proper moves and techniques for your sport.

Doctor’s examination and diagnosis.
Surgery (sometimes) to enlarge the tendon’s covering and restore a smooth gliding motion. The surgical procedure under general anesthesia is performed in an outpatient surgical facility or hospital operating room.

Your own observations of symptoms and signs.
Medical history and physical examination by your doctor.
X-rays of the area to rule out other abnormalities.
Laboratory studies: Blood and urine studies before surgery. Tissue examination after surgery.

Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Adhesive tenosynovitis: The tendon and its covering become bound together. Restriction of motion may be complete or partial. Surgery is necessary to remove the covering or transfer the tendon to a less constrictive area.
Constrictive tenosynovitis: The walls of the covering thicken and narrow, preventing the tendon from sliding through. Surgery is necessary to cut away part of the covering.

Tenosynovitis of the ankle is usually curable in about 6 weeks with heat treatments, corticosteroid injections and rest of the inflamed area. Recovery is usually quicker if the inflammation is caused from a direct blow rather than from a sprain or strain.

Follow your doctor’s instructions. These instructions are supplemental.

None. This problem develops slowly.

If surgery is not necessary, you may need a walking-boot cast for 10 to 14 days. See Appendix 2 (Care of Casts). Then wrap the ankle with an elasticized bandage until healing is complete.
Apply heat frequently. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.

You may use non-prescription drugs such as acetaminophen for minor pain. Your doctor may prescribe: Stronger pain relievers. Don’t take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
Injection of the tendon covering with a long-acting local anesthetic and a non-absorbable corticosteroid to relieve pain and inflammation.

Resume normal activity slowly.

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your doctor may suggest vitamin and mineral supplements to promote healing.

Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.


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