12/12/2025
Tendon Series: Part 3 — Tenosynovitis
What Is Tenosynovitis?
Tenosynovitis is an irritation or inflammation of the sheath surrounding the tendon (the synovial sheath), rather than the tendon fibres themselves.
It’s often triggered by repetitive friction, overuse, or sudden increases in loading. Commonly in the wrist, thumb, or Achilles region.
Common Signs & Symptoms:
• Diffuse pain running up and down the tendon
• Pain that’s worse with slow movements compared to quick/dynamic ones (classic in Achilles cases)
• Puffy swelling around the tendon sheath
• Crepitus or a “creaking” sensation
• Stiffness after rest
• Local tenderness along the sheath, not just one spot
This presentation is usually more “irritated” and spread out, not pinpoint like tendonitis.
Treatment Goals:
✔ Reduce irritation and inflammation
✔ Restore smooth tendon glide
✔ Maintain pain-free mobility
✔ Gradually return to normal load without flare-ups
✔ Prevent recurrence by improving strength + movement patterns
Rehab Approach for Tenosynovitis:
1️⃣ Respect the irritated sheath
We avoid or reduce aggravating movements in the short term and modify activity to keep symptoms and inflammation under control.
2️⃣ Short-term symptom management
A mixed approach works best:
• Anti-inflammatory + Hirudoid cream
• Applied twice daily for 7–10 days
• Wrap with cling wrap overnight to help absorption and reduce irritation
(This protocol is especially helpful for Achilles tenosynovitis.)- always important to note to receive medical clearance to use these topical creams.
3️⃣ Keep moving — but pain free
We use:
• Adjacent joints and muscles to offload the tendon
• Pain-free mobility drills
• Gentle isometrics if tolerated
The goal is to maintain movement without aggravating the sheath.
4️⃣ Restore tendon glide
Incorporate controlled range-of-motion exercises to help the tendon sheath settle and glide normally again. With the goal to keep pain less than 3-4/10.
5️⃣ Gradual loading
Once symptoms decrease, we begin progressive strengthening to build resilience and reduce friction on the sheath long-term.
