Tenosynovitis
‍_{(eyelid margin inflammation)}

   A tendon sheath, or synovial sheath, is a connective tissue sac that allows smooth movement of a tendon as it passes through ligaments and retinaculum (supporting bands). It is attached to the bone and consists of two layers. The inner layer, similar in structure to the synovial layer of a joint capsule, secretes viscous synovial fluid to facilitate smooth tendon movement. Tenosynovitis is the inflammation of this sheath. Certain tendons, like the Achilles tendon, lack a tendon sheath and are instead surrounded by loose connective tissue called the paratenon; inflammation of this tissue is known as paratenonitis.

   Causes of tenosynovitis include bacterial infection, trauma, metabolic disorders (e.g., diabetes, gout), and rheumatic diseases. However, the most common cause is inflammation due to repetitive mechanical irritation. This is frequently seen in office workers who type continuously, musicians, or athletes who perform repetitive motions, where tissues are overused without adequate rest, leading to inflammation. Symptoms can include mild warmth and swelling, pain during movement, and a creaking sound when moving the fingers, often occurring in the forearm, Achilles tendon, dorsum of the foot, hand, and other areas. Specific conditions include de Quervain’s disease (caused by stenosis in the sheath), synovial sheath inflammation, and trigger finger from thickening of the synovial or ligamentous sheath.

   Western medical treatments focus on stabilizing the affected area (splints or supports), restricting movement, warm baths, topical anti-inflammatory medications, and injecting a combination of water-soluble steroids and local anesthetics into the tendon sheath (1 session daily for up to 3-4 sessions) as conservative treatment. When there is no significant improvement in cases of stenosing tenosynovitis, surgical treatment to release the sheath is recommended. However, surgery should be approached with caution due to potential complications like insufficient release or formation of neuromas post-surgery. For purulent tenosynovitis, early incision and drainage along with antibiotics are necessary.

   A TKM practitioner treats tenosynovitis (inflammation of the tendon sheath) using a combination of targeted acupuncture techniques to reduce pain, alleviate inflammation, and promote healing in the affected tendons. Needles may be inserted around the affected tendon sheath to increase circulation, and accelerate the body’s own healing process. Trigger points or muscle knots can develop around the affected tendon due to compensatory movement or tension. Electro-acupuncture protocols such as IMEAST (Intramuscular Electro Acupuncture Stimulation Treatment) may be used to release these trigger points, reducing tension on the tendon sheath and relieving associated pain. This technique is effective for pain management and can stimulate healing by increasing blood flow to the tendon and surrounding tissues.

Treatment Case: 42 year old female

   The patient is an office worker who has recently started a much more demanding job compared to her previous position. She is spending a lot of time doing repetitive tasks on the computer, and sometimes takes her work home on the weekends to make up. After completing a particularly demanding project, she first noticed a tenderness and a general “off” feeling near her right thumb and dorsal aspect of her hand. She took some OTC painkillers and went back to work the next week. At the end of the week, she noticed increased pain, some swelling, and continuing tenderness on the thumb and wrist. The pain worsened with repetitive typing as well as wrist movements at home like cooking or housework. She put hot packs on it and continued to take OTC painkillers but the pain did not subside. She could only do computer work for about 30 minutes before her symptoms flared up.

   The practitioner concluded she was suffering from DeQuervain’s synovitis. Acupuncture sessions that target the locally affected tendon sheath on the hand and wrist were treated. Furthermore, the overly stressed forearm muscles were treated through electroacupuncture using IMEAST(Intramuscular Electroacupuncture Stimulation Treatment). Treatment was done 2 sessions per week for 4 weeks. 

• After the 3rd session, she noticed a change in how long she could do work on the computer before the onset of her symptoms. Before, she could only do 30 minutes, but now she should manage about 90 minutes.
• After the 5th session, she reported that she was able to resume some of her housework again without feeling too much discomfort.
• After the 7th session, she reported that she could now manage about 2 hours of work on the computer before the onset of symptoms. 
• After the 8th and last session, she reported that the swelling, tenderness, and pain was mostly diminished. It still flared up from time to time and bothered her, but she could manage and get through the day by taking sufficient breaks and doing stretches and exercises.