ANKLE TENOSYNOVITIS |
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General Information
DEFINITION--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.
BODY PARTS INVOLVED
Any ankle tendon and its lining.
Soft tissue in the surrounding area, including blood vessels, nerves, ligaments, periosteum (covering to bone) and connective tissue.
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SIGNS & SYMPTOMS
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.
CAUSES
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.
RISK INCREASES WITH
Contact sports, especially kicking sports such as football or soccer.
Skiing.
If surgery is needed, surgical risk increases with smoking, poor nutrition, alcoholism or drug abuse, and recent or chronic illness.
HOW TO PREVENT
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.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
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.
DIAGNOSTIC MEASURES
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.
POSSIBLE COMPLICATIONS
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.
PROBABLE OUTCOMETenosynovitis 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.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This problem develops slowly.
CONTINUING CARE
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.
MEDICATIONYou 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.
ACTIVITYResume normal activity slowly.
DIETDuring 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.
REHABILITATION
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.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of ankle tenosynovitis.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may produce side effects.
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