Treatment of Flexor and Extensor Tendon Sheath Tenosynovitis

Ankle tendons provided by a synovial sheath (e.g., peroneal, tibialis posterior tendons) can be affected by acute or chronic tenosynovitis, which can cause pain and functional limitations. Acute tenosynovitis is characterized by fluid effusion within the tendon sheath, while chronic tenosynovitis usually presents with synovial thickening or proliferation. The lateral compartment differs from the others, as, in case of calcaneofibular ligament tear, there could be a communication between joint space and synovial sheath. In this case, sheath effusion frequently occurs in conjunction with joint effusion and should not be treated alone. Even in these cases, steroid injection is a valid option, as it is able to reduce pain and effusion. Sometimes, hyaluronic acid may be injected to improve tendon sliding and to stretch a retinaculum.