Features
Tendonitis is an acute or chronic inflammation of the tendons, often involving their bone anchors (apophysitis), synovial sheaths (tenosynovitis) or bursae (bursitis). Tendonitis is often caused by trauma:
- They can result from micro-traumas, caused by repetitive movements made during professional activities, in daily life or during the practice of certain sports.
- They can also result from conflicts between tendons and bone asperities caused by osteoarthritis or previous trauma.
Symptoms vary depending on which tendons are affected. There are almost a dozen different types of tendonitis in the hand and wrist. Typically, tendonitis causes pain when the tendons are tightened, tenderness when the tendon area is touched, sometimes painful local swelling and pain where the tendon attaches to the bone. At an advanced stage, spontaneous rupture of the tendon may occur. The decision to undergo surgery is taken only if medical treatments (anti-inflammatory drugs, immobilization, rehabilitation) have failed. Surgery is generally performed under local or locoregional anesthesia. The skin incision is centred on the affected tendon. In some cases, tendons have a thick sheath which may require an opening to gain access to the diseased tendon area. Surgical procedures may vary according to the situation:
- Release of adhesions around the tendon caused by chronic inflammation,
- Removal of the tendon sheath (tenosynovectomy),
- Tendon combing,
- Elimination of areas of tendon degeneration (necrosis),
- Excision of bony asperities,
- Reconstruction of the tendon sheath.
After surgery, a period of temporary immobilization followed by rehabilitation may sometimes be necessary. The risks associated with surgery vary in frequency according to the type and location of tendonitis:
- Recurrence: More frequent when traumatic causes, such as repetitive movements, are not eliminated after surgery.
- Tendon adhesions: linked to the way the tendon heals, they can restrict tendon movement. This may require prolonged rehabilitation.
- Tendon ruptures: Result from tendon fragility. In some cases, secondary repair by grafting or transfer from another tendon may be necessary.
- Tendon dislocation: Indicates ineffective tendon sliding. Generally well tolerated.
- Irritation of cutaneous nerve branches: responsible for pain and sensitivity disorders around the scar. They may be due to inflammatory processes, local scarring or the maneuvers required to access the tendon. These symptoms often subside after several months.
- Algodystrophy: A rare but worrying condition characterized by swelling, pain, excessive sweating and stiffness of the hand. Progression can be prolonged over several months or even years, with possible sequelae.
- Infection: Although possible, not specifically related to tendonitis surgery. Generally manageable.
- Scars: Hand scars take several months to fade and become less sensitive.
