Tendovaginitis is classified according to cause and course:

1. Aseptic tendovaginitis: Inflammation without infection, often due to overuse or mechanical irritation.
2. Septic tendovaginitis: Infectious inflammation caused by bacteria, often after injuries or injections.
3. Tendovaginitis stenosans: Narrowing of the tendon sheath, often with repeated stress (e.g., trigger finger).
4. Tendovaginitis crepitans: Mechanical inflammation accompanied by a palpable crunching (crepitation).

The main causes of tendovaginitis can be divided into mechanical, inflammatory, and infectious factors:

• Mechanical stress:
  • Repeated movements, such as in manual work, computer use, or playing music.
  • Overuse of tendons, especially due to unfamiliar or monotonous strains.
• Inflammatory diseases:
  • Rheumatoid arthritis, which can chronically inflame the tendon sheaths.
  • Gout, which leads to deposits in the tendon sheath.
• Infections:
  • Bacterial infections following injuries, surgeries, or injections.
• Traumatic causes:
  • Direct injuries to the tendon or surrounding structures.

The symptoms vary depending on the cause and severity of the inflammation, but typically include:

• Localized pain: Often along the affected tendon, especially during movement.
• Swelling: Visible and palpable thickening in the area of the inflamed tendon sheath.
• Movement restrictions: Pain or blockages during movements of the affected area.
• Crepitation: Noticeable or audible crunching during movement (in tendovaginitis crepitans).
• Redness and overheating: Signs of acute inflammation, especially in infectious tendovaginitis.
• Tenderness: Pain when touching the affected region.

The diagnosis is made through a combination of medical history, clinical examination, and, if necessary, imaging techniques:

• Medical History:
  • Collection of the medical history, possible overuse or injuries, and accompanying symptoms.
• Physical Examination:
  • Palpation of the tendon for swelling, tenderness, and crepitation.
  • Functional tests to assess mobility and pain induction.
• Imaging:
  • Ultrasound: Visualization of fluid accumulations and thickening in the tendon sheath.
  • MRI: Detailed assessment of chronic or complicated cases.
• Laboratory Tests:
  • Analysis of inflammatory parameters or fluid samples if infectious causes are suspected.

Conservative Therapy

Most cases of tendovaginitis can be successfully treated without surgical intervention:

• Immobilization: Use of splints or bandages to relieve the affected tendon.
• Medication Therapy:
  • NSAIDs: For pain relief and anti-inflammatory effects.
  • Corticosteroid injections for severe inflammation.
  • Antibiotics for septic tendovaginitis.
• Physiotherapy:
  • Stretching and strengthening exercises to restore mobility.
  • Manual therapy to release adhesions.
• Local Applications:
  • Cold therapy for acute inflammation.
  • Heat treatment for chronic complaints.

Surgical Therapy

In chronic cases or severe instances, surgery is required:

• Tendon Sheath Opening (Synovectomy): Removal of inflamed tissue to restore gliding ability.
• Debridement: Cleaning of infected or necrotic tissue parts.
• Reconstruction: Restoration of the tendon sheath in cases of severe damage. 

To prevent tendovaginitis and support recovery, the following measures are recommended:

1. Ergonomic work design: Avoidance of unilateral strain through adapted workplaces and tools.
2. Regular breaks: Relief of the affected areas during repetitive activities.
3. Muscle strengthening: Targeted training to stabilize and support the tendons.
4. Stretching exercises: Regular stretching of the affected muscles and tendons.
5. Early treatment: At the first signs of pain or swelling, medical advice should be sought as soon as possible.