Tendon Disorders

Geriatric Essentials

• Digital tendinitis and tenosynovitis are common in the elderly, especially those with RA or diabetes mellitus.

Although the digital flexor tendons and extensor pollicis brevis are commonly affected, tendinitis and tenosynovitis may involve any of the tendons in or around the hand.

Digital tendinitis and tenosynovitis: Digital tendinitis and tenosynovitis are forms of inflammation of tendons and tendon sheaths of the hand, often with fibrosis. These idiopathic disorders are common in elderly patients, particularly those with RA or diabetes mellitus. In patients with diabetes, they often coexist with carpal tunnel syndrome and occasionally with Dupuytren's contracture. Pathologic changes begin with inflammation and thickening or formation of a nodule within the tendon; when located at the site of the tight, 1st annular pulley, the thickening or nodule blocks smooth extension or flexion of the finger. The finger may lock in flexion, "trigger" (suddenly extending with a snap), or both (see Figure 55-5).

Treatment includes local rest or splinting, moist heat, and NSAIDs. If these measures do not work, local injection of a corticosteroid suspension into the flexor tendon sheath is relatively simple and safe and may rapidly relieve pain and triggering. Surgical release can be done if corticosteroid injection does not work.

De Quervain's syndrome (De Quervain's tenosynovitis, washerwoman's sprain): De Quervain's syndrome is stenosing tenosynovitis of the short extensor (extensor pollicis brevis) and long abductor (abductor pollicis longus) tendons of the thumb in the tendon sheaths just distal to the radial styloid process.

This syndrome usually occurs after repetitively using (especially wringing) the wrist, although it occasionally occurs in RA. The major symptom is aching pain at the wrist and thumb, aggravated by motion. Tenderness is elicited just distal to the radial styloid process.

The Finkelstein test is done; the patient adducts the thumb on the involved side into the palm and wraps the fingers over the thumb. The examiner then passively moves the wrist in all directions of motion; pain specifically with ulnar deviation at the site of the affected tendon sheaths confirms the diagnosis.

Rest, warm soaks, and NSAIDs are effective only in very mild cases. Local injections of corticosteroids and a thumb spica splint are helpful in 70 to 80% of patients. Tendon rupture, a rare complication, can be prevented by careful injection of corticosteroid into the tendon sheath, avoiding the tendon itself. Intratendinous location of the needle is likely if injection is met with moderate or severe resistance. If conservative therapy does not work, surgical release of the sheaths is very effective.

This topic was last updated May 2006.