is an inflammation of the tendon and its surrounding sheath. Unlike tendonitis, it develops in the area of the tendons, which have a sheath - a kind of soft tunnel, consisting of connective tissue. May be acute or chronic. It is manifested by pain, aggravated by movement. Swelling and an increase in local temperature are possible. With infectious tendovaginitis, symptoms of general intoxication are observed, non-infectious ones occur without disturbing the general condition of the patient. Treatment depends on the form and variant of the course of tendovaginitis and can be both conservative and operative.
M67 Other synovial and tendon disorders
Tenosynovitis is an inflammation that develops in the tissue of the tendon and tendon sheath. Suffer tendons covered with a connective tissue sheath in the forearm, wrist and hand, as well as the ankle, foot and Achilles tendon. Tenosynovitis can be infectious or non-infectious (aseptic) in nature, be acute or chronic. Infectious tendovaginitis is usually treated promptly, other forms - conservatively.
An aseptic process may appear as a result of constant overload and the associated microtraumatization of the tendon and its vagina. Such tendovaginitis occurs in people of certain professions: pianists, typists, loaders, etc., as well as in some athletes, for example, skaters or skiers. In some cases, tendovaginitis develops as a result of trauma to the ligamentous apparatus (stretching or bruising).
Aseptic tendovaginitis is sometimes observed in rheumatic diseases. In this case, toxic reactive inflammation becomes the cause of tendovaginitis. Nonspecific tendovaginitis occurs when the infection spreads from a nearby purulent focus. May occur with panaritium, purulent arthritis, osteomyelitis, or phlegmon. Specific tendovaginitis can occur with tuberculosis, brucellosis, and gonorrhea, with pathogens usually entering the tendon sheath through the bloodstream.
A tendon is a dense, inelastic cord that connects a bone and a muscle or two bones. During movement, the muscles contract and the tendon shifts relative to the surrounding tissues. In the middle part and adjacent to the muscle, the tendons are covered with a case of connective tissue, which continues onto the tendon tissue directly from the surface of the muscles.
From the inside, such cases are lined with a synovial membrane that produces a small amount of oily fluid. Due to this, during movements, the tendon easily slides inside a kind of channel without encountering resistance. With inflammation or degeneration of the tendon or tendon sheath, sliding is difficult, symptoms of tendovaginitis occur.
Taking into account the etiological factor, there are:
Given the nature of the inflammatory process, there are:
Taking into account the course, acute and chronic tendovaginitis are distinguished.
This form of tendovaginitis usually develops after an overload (for example, intensive work at a computer, while preparing for exams at a music school, during preparation for competitions, etc.). Tendons and tendon sheaths on the dorsum of the hands are usually affected, less often the feet. There is also tendovaginitis in the tendon of the biceps muscle of the shoulder.
Tendovaginitis develops acutely. Edema appears in the affected area. Movements become sharply painful and are accompanied by a kind of soft, quiet crunch in the area of the affected tendon. With adequate treatment, the symptoms of acute tendovaginitis completely disappear within a few days or weeks. However, due to continued excessive loads on the tendon already “weakened” by the disease, such tendovaginitis often becomes chronic.
A patient with tendovaginitis is advised to limit the load on the limb, possibly using orthoses. Cold is applied to the affected area. With intense pain syndrome, painkillers are prescribed. Physiotherapy and shock wave therapy are also used. With tendovaginitis with persistent pain that is not relieved by analgesics, therapeutic blockades with glucocorticosteroid drugs are performed. After the pain syndrome is eliminated, therapeutic exercises are prescribed to strengthen the muscles.
Post-traumatic tendovaginitis occurs with sprains and bruises in the area of the wrist joint. In the anamnesis - a characteristic injury: a fall on a sharply bent or straightened arm in the wrist joint, less often a bruise of the wrist area. There is pain and swelling in the affected area.
Immobilization is prescribed using a tight bandage, plaster or plastic splint. On the first day after the injury, cold is applied to the affected area, then thermal procedures are performed and UHF therapy is prescribed. In very rare cases (with significant hemorrhage in the tendon sheath), a puncture is performed to remove the accumulated blood. Symptoms of post-traumatic tendovaginitis completely disappear within a few weeks.
It can be primary chronic or develop after acute aseptic or post-traumatic tendovaginitis. The reason is chronic microtraumatization with subsequent dystrophy of the tendon sheaths. The course is recurrent. A patient with tendovaginitis complains of pain that worsens with movement. Edema is usually absent. Palpation reveals tenderness along the tendon and a crunch or crepitus during movement. A special form of chronic aseptic tendovaginitis is stenosing tendovaginitis, in which the tendon is partially blocked in the bone-fibrous canal. There are several syndromes caused by stenosing tendovaginitis.
Carpal tunnel syndrome develops when the carpal tunnel, which is located on the palmar surface of the wrist joint, becomes narrowed. This compresses the flexor tendons of the fingers and the median nerve. On examination, pain along the tendons and sensitivity disturbances in the area of I-III and the inner surface of the IV fingers, loss of the ability to precise and subtle movements and a decrease in hand strength are revealed.
De Quervain's disease is a stenosing tendovaginitis of the tendons of the short extensor and long abductor muscles of the first finger of the hand, which are compressed in the bone-fibrous canal located at the level of the styloid process. There is a violation of movements, swelling and pain in the "anatomical snuffbox".
With stenosing ligamentitis, fingers I, III and IV are more often affected. The disease develops as a result of sclerotic changes in the region of the annular ligaments and is accompanied by some difficulty in extending the finger - as if at a certain moment some obstacle must be overcome for further movement.
During the period of exacerbation of tendovaginitis, the limb is immobilized, physiotherapy is prescribed (phonophoresis with hydrocortisone, electrophoresis with potassium iodide and novocaine), anti-inflammatory drugs are administered. With severe pain syndrome, blockades with glucocorticosteroids are performed. In the recovery period, patients with tendovaginitis are prescribed ozokerite in combination with dosed therapeutic exercises. In the absence of the effect of conservative therapy, dissection or excision of the affected tendon sheaths is performed.
Reactive tendovaginitis develops with rheumatic diseases: Reiter's syndrome, Bechterew's disease, systemic scleroderma, rheumatism and rheumatoid arthritis. Usually proceeds sharply. It is manifested by pain and slight swelling in the area of the affected tendon.
Treatment - rest, if necessary, immobilization, anti-inflammatory drugs and painkillers.
Infectious tendovaginitis can occur when pyogenic microflora is brought in from a nearby focus (with purulent inflammation) or from the external environment (with trauma). It often develops in the area of the tendon sheaths of the flexors of the fingers, and in this case it is called the tendinous panaritium. Initially, serous exudate accumulates in the cavity of the tendon sheath. Then pus forms. Swelling and squeezing with accumulated pus cause sharp pains and disrupt the blood supply to the tendon.
A patient with tendovaginitis complains of acute pain, which, when an abscess forms, becomes jerking or throbbing, depriving sleep. On examination, significant swelling, hyperemia and severe pain in the area of the affected finger are revealed. The pain is aggravated by movement. The finger is in a forced position. Regional lymphadenitis is revealed. Unlike other types of tendovaginitis, with infectious tendovaginitis, signs of general intoxication are found: fever, weakness, weakness.
If tendovaginitis occurs in the area of the fifth finger, pus can spread into the ulnar synovial bag. With the defeat of the first finger, the purulent process may spread into the radial synovial bag. In both cases, tenobursitis develops. If the ulnar and radial bags communicate with each other (about 80% of people have such a message), phlegmon of the hand may develop.
The spread of pus entails a deterioration in the patient's condition with a significant increase in temperature, chills and severe weakness. There is significant swelling and forced position of the hand. The skin of the affected area is purple-cyanotic. A patient with tendovaginitis complains of sharp pains that increase when trying to move.
In the early stages (before the formation of an abscess), the treatment of infectious tendovaginitis is conservative: immobilization with a plaster or plastic splint, novocaine blockades, alcohol lotions, UHF and laser therapy. With suppuration, surgical treatment is indicated - opening the tendon sheath with its subsequent drainage. In the pre- and postoperative period, antibiotic therapy is performed.
With tenobursitis and phlegmon of the hand, surgical treatment is also necessary, which consists in a wide opening, washing and subsequent drainage of purulent cavities while taking antibiotics. In the remote period after infectious tendovaginitis, stiffness of the finger may be observed due to cicatricial changes in the tendon area. In the case of melting and death of the tendon, a flexion contracture of the affected finger develops.
Tendovaginitis develops after repeated minor injuries, infectious pathologies and reactive diseases. Inflammation of the inner sheath of the tendon sheath is manifested by pain during movement, swelling of the tendon and a sharp limitation of movement in the affected limb. Treatment consists in observing bed rest, thermal exposure in the chronic form and applying cold in the acute phase of the pathology. Pain and inflammation in tendovaginitis is relieved with the help of NSAIDs and corticosteroids, exercise therapy is prescribed during the rehabilitation period with a gradual increase in therapeutic load.
Inflammation of the synovial membrane lining the fibrous sheath of the tendon is called tendovaginitis. Pathology develops as a result of tendon degeneration after active movements, infections or autoimmune abnormalities.
A characteristic pain syndrome accompanies movements or is felt during palpation of the diseased area. The chronic course is dangerous due to the replacement of healthy scar tissue, leading to immobility of the upper or lower limb.
A tendon is a dense formation of connective tissue that provides the terminal connection of the striated muscles and bones of the skeleton. The formation has a dense structure, due to which the tendon is strong and practically does not stretch.
At the border with muscle fibers, the tendon forms a thickening in the form of a flexible tunnel, called the tendon sheath. The inner surface of the vaginal bursa is covered with a synovial membrane, which produces a small amount of fluid, which ensures the gentle movement of the tendon during the motor process.
During repeated microdamages or the influence of an infectious stimulus, an inflammatory response appears to the process of cell damage. On the surface of the inflamed membrane, metabolic reactions are disturbed, which is the cause of tissue necrosis. When you try to make a movement in the area of the junction of the connecting cord and muscle fibers, pain and difficulty in further movement occur.
A third of the cases of diagnosing tendovaginitis was recorded by the defeat of the muscles involved in the flexion of the upper or lower extremities. Most often, the tendons of the muscles of the shoulder, hand, elbow, fingers, popliteal region, Achilles tendon become inflamed.
Inflammatory tendovaginitis most often develops in elderly people, when tendon trophic disorders appear. Against the background of dystrophic changes, microtrauma, regularly repeated by the same type of movements, or severe damage as a result of a single injury causes primary inflammation.
Cases of diagnosing tendovaginitis in young people can be triggered by the following factors:
In medical practice, tendovaginitis is classified depending on the etiology, duration of the disease and clinical signs. Inflammation can be acute or chronic. The acute form is characterized by the sudden onset of intense pain, the rapid development of a vivid clinical picture. Chronic course is a sluggish inflammatory process without severe symptoms with alternating stages of remissions and relapses.
Due to the origin of tendovaginitis, there are:
The nature of the inflammatory lesion of tendovaginitis affects the composition of the effusion, which can accumulate in the articular sheath. According to this type, serous, serous-fibrous and purulent form of tendovaginitis can be distinguished. The acute course is often associated with serous exudate, which is a clear liquid in which an infectious factor is not detected.
Purulent forms of tendovaginitis signal the addition of an infection that significantly worsens a person's condition. The chronic process of inflammation contributes to the appearance of a serous-fibrous structure of the effusion with the synthesis of protein filaments, which can subsequently form a fibrous plaque on the synovial sheath of the tendon.
The symptoms of tendovaginitis are different and depend on the etiology of the pathology. Common symptoms include pain in muscle movement involving the diseased tendon, swelling is observed when effusion accumulates in the tendon sheath, stiffness in the movements of the diseased limb, if you press on the inflamed area, a sharp pain appears. In the absence of effusion, crepitus is present in the tendon, which can be heard with a stethophonendoscope.
Acute nonspecific form
Sudden pain in the inflamed tendon appears along with a pronounced swelling of the tendon sheath, which is easily determined by probing with the hand. Gradually, the edema spreads to nearby tissues, turning off the entire limb from the process of movement.
Orthopedist: "If your knees and hip joint ache, immediately eliminate from the diet ...
Do not destroy diseased joints with ointments and injections! Arthritis and arthrosis are treated ...
The most common localization of the acute nonspecific form of tendovaginitis is the outer side of the hands and feet, less often the tendons located on the fingers become inflamed. When the hand is damaged, the swelling passes to the forearm and shoulder, with inflammation on the feet, the lower leg and femoral part suffer.
Purulent forms of tendovaginitis sharply worsen the condition, causing general intoxication of the body against the background of a feverish state. Manifestations of inflammation intensify, hyperemia appears over the diseased area, the pain is pulsating.
Acute aseptic form
The main difference between the aseptic form of tendovaginitis is the absence of exudate and the appearance of a crepitus sound in a sore spot. This course often develops on the hands and in the area of the shoulder joint. The sudden onset with acute pain is accompanied by swelling in the inflamed tendon, on palpation of which a crisp sound is clearly audible. Fingers lose their mobility, movements are accompanied by severe pain. The aseptic form may be followed by a chronic process.
Chronic form
Inflammation of tendovaginitis takes a chronic course with repeated mechanical damage to the tendon in the same place, or as a complicated condition after an acute form of non-infectious etiology. The patient has constant soreness, which increases with movement. In the area of the affected tendon, an oblong formation is formed, which has an elastic structure.
This symptom is more often observed in carpal tunnel syndrome with tendovaginitis of the tendons of the muscles of the hand. The long course of the chronic stage in the tumor-like formation can be felt for dense formations, the so-called "rice bodies". When pressing on the tendon with two fingertips, a push is felt from opposite sides, indicating the accumulation of fluid in the tendon canal.
The diagnosis of "Tendovaginitis" is carried out on the basis of symptoms, specific pain tests, percussion and palpation methods, as well as an external examination of the patient. From the instrumental study, MRI is used to exclude tendon ruptures and ultrasound to detect inflammation.
Diagnostic signs of inflammation of the tendon sheath:
Therapeutic measures begin with ensuring complete rest of the limb. This can be achieved by strict adherence to bed rest or immobilization with rigid fixation orthopedic products.
Acute forms of tendovaginitis require cooling of the inflamed surface, this can be done using frozen foods, a heating pad with cold water, or a Snowball hypothermic package, which can be purchased at a pharmacy. Chronic course is treated with warming procedures in the form of therapeutic compresses or ointments.
Drug therapy for tendovaginitis, which your doctor will prescribe, is selected taking into account the clinic of the disease by the attending doctor:
Surgical treatment of tendovaginitis may be required for persistent pain and limited movement, more often in the shoulder joint. During the operation, the scar tissue is excised, followed by suturing of the tendon. During the rehabilitation period, sessions of physiotherapy exercises are shown to restore the work of the tendon.
Conservative treatment of tendovaginitis is supplemented by a course of massage, UHF, and ultrasound treatment. Particular attention is paid to swimming and performing a special set of exercises in the water, which is compiled by a medical specialist, taking into account the stage of the disease and the functional state of the patient.
Therapeutic exercise is carried out taking into account the therapeutic load on the diseased limb. The set of exercises is constantly changing to increase the load on the tendon. Proper dosing of the intensity of movements determines the rate of recovery of affected tissues. Excessive efforts can nullify all previous treatment.
You can prevent the development of tendovaginitis if you follow the well-known rules of a healthy lifestyle:
When the first symptoms of tendovaginitis appear, consult a doctor for diagnosis and proper treatment.
If the joints of the arms and legs begin to hurt, immediately remove from the diet ...
Orthopedist: "If your knees and lower back start to hurt, make it a habit ...
In the acute form of tendovaginitis, severe swelling of the synovial membrane appears, as a result of a rush of blood to the sore spot. At the site of the lesion of the tendons, a swelling appears, which, when pressed or moving, gives off severe pain. In the acute course of the disease, the movements of the fingers are limited, there is a characteristic creaking sound when pressed (crepitus), pain. The limitation of movements in the acute form of tendovaginitis can be expressed in a strong reduction of the fingers in an unnatural position.
As a rule, in an acute process, the tendons are affected only from the opposite palm or foot of the side, tendovaginitis is much less common in the acute form of the fingers. Usually this kind of inflammatory process flows into a chronic form. In acute tendovaginitis, the forearm or lower leg may also swell. If a purulent form of the disease begins to develop, then the patient's condition worsens with fever (chills, temperature, inflammation of the lymph nodes, blood vessels). In the synovial cavity, a serous or purulent filling is formed, which compresses the place connecting the blood vessel to the tendon. As a result, tissue nutrition is disrupted and in the future it can cause necrosis.
Chronic tendovaginitis is often caused by the performance of professional duties and appears as a result of frequent and severe stress on the tendons and certain muscle groups, and the disease can also result from ineffective or incorrect treatment of the acute form of tendovaginitis. The elbows and wrists are primarily affected. Chronic tendovaginitis is manifested by weak joint mobility, pain during sudden movements, a characteristic creaking sound or clicking when you try to squeeze your hand. Usually, the chronic form of tendovaginitis occurs in the sheath of the tendons responsible for flexion and extension of the fingers.
Crepitating tendovaginitis is one of the most common occupational diseases. As a rule, the disease develops against the background of regular trauma to the tendons, muscles, and adjacent tissue due to the often repetitive monotonous movements of the fingers or feet.
The disease in most cases affects the extensor surface of the forearm (usually the right one), less often occurs on the Achilles tendon, the anterior surface of the lower leg.
The disease is accompanied by swelling over the site of the lesion, soreness and a creaking sound, similar to the crunch of snow. As a rule, the duration of the disease does not exceed 12-15 days, crepitating tendovaginitis can reappear and often flows into the chronic stage.
Stenosing tendovaginitis is an inflammation of the tendon-ligamentous apparatus of the hand. The most common cause of the development of the disease is an occupational injury. The disease proceeds rather slowly, at first there are painful sensations in the area of the metacarpophalangeal joints. It is difficult to bend the finger, often this movement is accompanied by a creaking sound (crepitus). You can also feel a dense formation along the tendons.
Purulent tendovaginitis usually develops as a primary disease, due to penetration through microtrauma and damage to bacteria. Less often, secondary tendovaginitis with the formation of purulent masses is observed - as a rule, the tendon is affected as a result of the transition of purulent inflammation from adjacent tissues, for example, with phlegmon.
Usually, the causative agents of the purulent process in the tendon are E. coli bacteria, streptococci, staphylococci, and very rarely other types of bacteria. When bacteria enter the wall of the tendon sheath, swelling appears, suppuration appears, which prevents tissue nutrition, resulting in necrosis of the tendon.
With a secondary disease, usually purulent inflammation begins in the adjacent tissues, and only after that it spreads to the wall of the tendon sheath. As a rule, with purulent inflammation, the patient is worried about fever with high fever and general weakness. With advanced forms of purulent tendovaginitis, the risk of developing sepsis (blood poisoning) increases.
Aseptic tendovaginitis is non-infectious in nature, the disease occurs quite often, mainly in people who, by the nature of their professional activities, must perform monotonous movements for a long time, usually only one muscle group is involved in such work, and as a result, due to overstrain, various microtraumas of the tendons and adjacent tissue begins an inflammatory process.
Tenosynovitis of the hand is often found in musicians, volleyball players, etc. Skiers, skaters and other professional athletes are more susceptible to foot damage. The aseptic form of tendovaginitis, which has developed into a chronic stage, can force a person to change his profession.
The development of aseptic tendovaginitis in an acute form can be caused by trauma, it is often found in young athletes. Usually a person does not notice how he got injured, because during training he may not even pay attention to a slight crunch in his wrist or foot. At the initial stage of the disease, the pain may not be strong, but it increases with time.
Tendovaginitis in acute form usually occurs as a result of infection. In the acute course of the disease, there is severe pain in the affected tendon, swelling over the affected area, high fever (lymph nodes often become inflamed). An acute process usually develops on the back of the foot or palm. Quite often, the swelling extends to the lower leg or forearm.
With tendovaginitis in an acute form, movements are constrained, sometimes there is complete immobility. The patient's condition worsens over time: the temperature rises, chills appear, pain increases.
Chronic tendovaginitis usually does not greatly affect the general condition of the patient. As a rule, in chronic tendovaginitis, the tendon sheaths of the extensor and flexor fingers suffer, and swelling appears, oscillatory movements are felt when probing, and the mobility of the tendons is limited.
The disease begins with the appearance of pain in the affected area (usually in the region of the styloid process). Painful swelling appears along the course of the tendons, movements of the fingers are hampered by pain, stiffness, while the pain can radiate to the shoulder or forearm.
Tenosynovitis of the hands is a fairly common disease, since it is on the hands that the maximum load is placed, they are most susceptible to injury, hypothermia, which provokes the disease. Typically, tendovaginitis of the hands affects people whose work is associated with frequently repetitive movements that load only a certain muscle group, as a result of which the tendons are injured and the inflammatory process begins.
Musicians often suffer from tendovaginitis of the hands, it is known that some famous musicians were forced to give up their favorite pastime and become composers because of pain.
As already mentioned, the hands are the most vulnerable organ. Frequent hypothermia, minor injuries, excessive loads lead to inflammation of the tendon sheaths. Tenosynovitis of the hands is the most common pathological process that affects musicians, stenographers, typists, etc. In most cases, the disease is non-infectious in nature, and is associated with professional activities. A little less often, tendovaginitis of the hand develops as a result of infection.
The forearm (most often the dorsal side) is usually affected by crepitant tendovaginitis. As a rule, the disease progresses rapidly. In most cases, the disease begins with an ache, increased fatigue of the hand, in some cases there is a burning sensation, numbness, tingling. Many patients, even after the onset of such symptoms, continue their usual work and after a while (usually after a few days, in the late afternoon) severe pain appears in the forearm and hand, while movements of the arm or hand increase discomfort in the arm. Tendovaginitis in this case is associated with increased load and fatigue of the muscles of the hand due to monotonous long movements.
In addition, the disease can develop as a result of bruises or injuries of the forearm.
If the bruised hand is not spared, then this can quickly lead to swelling, severe pain, in addition to this, a creaking sound may appear. Usually a person independently notices the appearance of swelling on the forearm, while the appearance of a creaking sound is not paid attention to.
But not even swelling, the appearance of a crunch or severe pain force a person to seek help from a specialist. Usually, when contacting a doctor, the patient complains of the inability to fully work due to weakness of the arm, increasing pain during movement. With creeping tendovaginitis, the swelling has an oval shape (resembles a sausage) and is concentrated on the back of the forearm, along the tendons.
Finger tendovaginitis at the initial stage of development is difficult to recognize. The specialist makes a diagnosis on the basis of examination, palpation, anamnesis. There are several characteristic signs by which the development of tendovaginitis can be determined:
All these signs can appear both individually and all together at the same time (with tendovaginitis in a purulent form).
A purulent infection can spread quickly, and excruciating pain appears, due to which a person cannot sleep and work normally, the patient keeps his finger in a half-bent position. The swelling spreads to the back of the hand, when you try to straighten the finger, a sharp pain is felt. Against the background of inflammation, the temperature may rise, the lymph nodes become inflamed, the person assumes a position in which he unconsciously tries to protect the sore hand.
Diagnosis of the disease can be helped by radiography, which reveals a thickening in the tendon with clear (rarely wavy) contours.
Tendovaginitis harness develops on the dorsal ligament. The disease affects the tendon that is responsible for straightening the thumb. A typical symptom is pain over the wrist at the base of the thumb. Over time, the pain increases with movement and calms down a little when the arm is relaxed and rested.
Tendovaginitis of the wrist joint is manifested, as in other cases, by pain during the movement of the wrist, thumb. With this disease, the tendon responsible for the thumb is affected, and often the affected tendon thickens. Often pain from the wrist is given to the forearm and even the shoulder.
The most common cause of tendovaginitis in the carpal tunnel is tiresome repetitive hand movements, often accompanied by injuries and injuries. An infection can also cause inflammation of the tendons.
Women are more susceptible to tendovaginitis of the wrist, and there is a connection between the disease and excess weight.
It is noted that women of short stature are more prone to developing tendovaginitis. Also, heredity plays a significant role in the development of the disease.
A characteristic feature of tendovaginitis of the wrist joint is that the disease is expressed not only by severe pain, but also by numbness or tingling, which is associated with compression of the median nerve. Many patients are concerned about "naughty" hands, numbness. A tingling sensation appears on the surface of the hand, usually in the area of the index, middle and thumb, in rare cases, tingling occurs in the ring finger. Often the tingling is accompanied by a burning pain that can radiate to the forearm. With tendovaginitis of the wrist, the pain becomes worse at night, while the person may experience temporary relief after rubbing or shaking the hand.
Tendovaginitis of the shoulder joint is manifested by dull pain in the shoulder area. When probing, pain appears. Most often, damage to the shoulder joint occurs in carpenters, blacksmiths, ironers, grinders, etc. The disease usually lasts 2-3 weeks, proceeds in a subacute phase. With tendovaginitis, the pain has a burning character, with muscle tension (during work), the pain can intensify many times, swelling often appears, a creaking sound.
Tenosynovitis of the elbow joint is quite rare. Basically, the disease develops as a result of injury or damage. As in other cases of the development of tendovaginitis, the disease proceeds with pronounced soreness in the area of the affected joints, swelling, and creaking. Usually, at rest, the joint does not bring any particular discomfort to the patient, however, when moving, the pain can be quite sharp and severe, which leads to forced immobilization.
Tenosynovitis of the flexors of the fingers is expressed in the defeat of the tendon-ligamentous apparatus of the hand. In this case, there is an infringement of the tendons, which are responsible for flexion and extension of the fingers. The disease occurs most often in women. Usually the development of the disease is related to professional activities associated with manual labor. In childhood, the disease can be noticed at the age of 1 to 3 years. It is the thumb that is most often affected, although there is an infringement of the tendons on the other fingers.
Tendovaginitis of the foot manifests itself in the form of pain along the tendons, with movement of the foot the pain intensifies. Along with the pain, redness and swelling appear. With infectious tendovaginitis, a temperature appears, a deterioration in general well-being.
Tenosynovitis of the Achilles tendon develops mainly after increased stress on the Achilles tendon or calf muscles. Especially often the disease affects cyclists, both professional and amateur, long-distance runners, etc. A sign of the disease is a thickening of the Achilles tendon, pain when moving the foot, swelling, and when probing the tendon, you can feel a characteristic creaking.
Tendovaginitis of the ankle joint develops mainly in those who experience frequent and heavy loads on the legs. Often, tendovaginitis develops in military personnel, after making long transitions. Also, athletes (skaters, skiers), ballet dancers, etc. often suffer from ankle tendovaginitis. In addition to professional tendovaginitis, the development of the disease occurs after prolonged hard work.
In addition to external factors, tendovaginitis can develop due to a congenital anomaly of the foot (clubfoot, flat feet).
As in other cases, tendovaginitis of the knee joint develops as a result of prolonged physical stress on the joint, anatomically incorrect structure of the body, in violation of posture, and also as a result of infection.
The disease, as a rule, affects people whose lifestyle is associated with increased physical exertion or who, by the nature of their professional activities, are forced to stay in one position for a long time (often in an uncomfortable position). Knee tendovaginitis is widespread among basketball players, volleyball players, etc., since frequent jumping leads to knee injury.
The classic symptoms of the development of tendovaginitis is the appearance of pain in the affected area, which over time (with the development of the inflamed process) becomes stronger. The pain may increase with physical exertion, depending on the weather. In addition to pain, there is a limitation in the movement of the limb, when probing, pain appears, sometimes creaking, you can also feel the formed tendon nodule. The affected area is red and swollen.
Symptoms of tendovaginitis do not appear immediately, but a few days after the inflammation process has begun. Tenosynovitis of the lower leg develops, as in other cases, with an increased load on the lower leg or infection, as well as in the case of abnormal development of the foot. On x-ray, you can see a seal in the place of the affected tendon.
Quite often, tendovaginitis of the thigh is caused by various injuries, overloads of the tendons and muscles. Women are more susceptible to the disease than men. The disease occurs as a result of overloading the legs, after a long or unusual walk, running, after carrying heavy loads. In some cases, the disease develops as a result of damage.
De Quervain's tendovaginitis occurs with severe inflammation of the ligaments of the wrist, which is characterized by inflammation, pain, and limited movement. Many years ago, the disease was called "washerwomen's disease" because it affected mainly women who had to wash large amounts of laundry by hand every day, but after 1895 it was named after the surgeon Fritz de Quervain, who first described the symptoms.
De Quervain's tendovaginitis is characterized by soreness of the tendons on the back of the wrist, with inflammation, the walls of the tendon sheath thicken, which can cause a narrowing of the canal. Inflammation can cause the tendons to stick together. In women, the disease develops eight times more often than in men, as a rule, women older than 30 years suffer.
Inflammation can be triggered by some damage to the first canal of the dorsal ligament, for example, after various injuries to the radius. The disease can be provoked by frequent inflammations, injuries, muscle strain (especially caused by hard work involving one muscle group). However, for the most part, it is not possible to establish the exact causes of the disease.
Tenosynovitis is manifested by pain along the radial nerve, which can be aggravated by tension or movement (most often when trying to forcefully grasp something). A painful swelling appears over the first canal of the dorsal carpal ligament.
Tenosynovitis is an acute or chronic inflammation of the fibrous (synovial) sheath of the tendon of the muscle, which is often combined with inflammation of the tendon itself.
Etiopathogenesis
Tendovaginitis can develop as an independent disease, and as a result of a complication of the infectious process.
The disease can be acute or chronic. Depending on the etiology, infectious and aseptic tendovaginitis are distinguished, including rheumatic and allergic diseases.
Most often, aseptic tendovaginitis occurs, which is caused by prolonged and / or heavy physical exertion on the ligamentous apparatus, often repeated movements of the same type as a result of professional activity or hypothermia. Synovial sheaths of long and thick tendons are more susceptible to aseptic inflammation. Due to the higher activity of the muscles of the upper extremities, tendovaginitis in this area occurs most often.
Traumatization of the skin (bruises, skin cuts in the area of the tendon sheaths) can also cause purulent or aseptic tendovaginitis.
In addition, tendovaginitis can be one of the manifestations of rheumatoid or specific arthritis, gout, Bechterew's disease, Reiter's syndrome, osteomyelitis, tendovaginitis that occurs with sepsis, some allergic and infectious diseases (tuberculosis, gonorrhea, brucellosis).
As a result of a violation of regional blood and lymph circulation (for example, with varicose veins of the lower extremities), degenerative tendovaginitis may develop.
There are the following anatomical and histological forms of tendovaginitis, which in some cases characterize the sequential development of the pathological process:
In addition, the morphological changes in the synovial sheath are dependent on the specific properties of the damaging factors that provoked the occurrence of tendovaginitis: the presence of microflora causes the predominance of inflammation elements, in the absence of microflora, degenerative processes predominate.
General clinical picture
Acute tendovaginitis is accompanied by severe pain, greatly aggravated by active and passive movements. The area of the affected tendon becomes swollen and painful on palpation. The swelling may spread to the entire forearm or lower leg. In some cases, palpation may cause crepitus, an unnaturally pronounced flexion of the fingers. When you try to straighten your fingers, severe pain occurs.
Most often, the pathological process develops in the tendons of the back surface of the hands and feet. Relatively rarely, acute inflammation of the tendons of the fingers is observed, which usually transforms into a chronic form.
With a purulent form of tendovaginitis, general intoxication symptoms occur (fever, an increase in body temperature), regional lymphadenitis develops. The accumulation of inflammatory serous or purulent exudate can lead to compression of the blood vessels that feed the tendon, and its subsequent necrosis.
Chronic forms of tendovaginitis, as a rule, occur during certain types of labor activity (playing the piano, playing tennis), which is accompanied by frequent and / or pronounced stress on the tendons of certain muscle groups. Also, the chronic form of tendovaginitis can occur with incorrect treatment of the acute period of the disease. Most often, chronic tendovaginitis occurs in the area of the elbow and wrist joints.
In chronic tendovaginitis, there is a decrease in mobility in the joint, increased pain during sudden movements, accompanied by a specific creaking sound, clicks when the fingers are clenched into a fist. Chronic forms of tendovaginitis most often occur in the sheaths of the flexors and extensors of the fingers.
Crepitating tendovaginitis (crepitating paratenonitis)
Crepitating tendovaginitis is one of the most common occupational diseases of the musculoskeletal system. The disease occurs due to prolonged microtraumatization of the tendons and surrounding tissues with the same type of frequently repeated movements of the hand, fingers and foot (50-60 or more per 1 min).
The extensor tendon sheaths of the right forearm are most susceptible to crepitating tendovaginitis, relatively rarely - the tendon sheaths of the anterior surface of the lower leg and the Achilles tendon.
Clinical picture
The affected area becomes swollen and painful on palpation. When the fingers are bent, there is pain and a characteristic creaking sound, resembling the crunch of snow.
The average duration of the disease is 10-15 days, there is a high probability of relapses and a chronic course.
The main method of treatment of crepitating tendovaginitis is to create rest of the diseased limb by means of a removable splint. Pharmacotherapy with non-steroidal anti-inflammatory drugs, novocaine blockades, UHF therapy is prescribed.
Prevention
When performing work with frequently repetitive movements of the same type, it is recommended to take regular 10-minute rest breaks. After a long break in work, physical activity should increase gradually; it is recommended to wear special fixing bandages (“wristbands”).
De Quervain's disease (stenosing de Quervain's tendovaginitis)
This disease is characterized by inflammation of the synovial sheath of the extensor and the long abductor muscle of the 1st finger of the hand.
Etiopathogenesis
Due to the constant physical stress on the 1st finger, which physiologically opposes the strength of the other fingers of the hand and is involved in almost all types of physical stress on the hand, the finger is constantly overstressed.
This disease is most susceptible to persons who are engaged in heavy physical labor (carpenters, loaders, masons, seamstresses, pianists). De Quervain's disease is more common in females.
Relatively rarely, the disease occurs with a local injury of the anatomical snuffbox area, even less often with rheumatoid arthritis, tuberculosis of the wrist joint, or other osteoarticular pathology.
Clinical picture
De Quervain's disease is characterized by pain and swelling in the area of the wrist joint (in the area of the projection of the styloid process and the anatomical snuffbox). With pressure on the area of the anatomical snuffbox, abduction and extension of the thumb, the pain increases significantly. When moving the 1st finger, a characteristic creak is heard, due to the movement of the tendon through the narrowed and inflamed synovial sheath. Movement in the finger becomes limited due to pain, soreness extends to the area of the wrist joint.
Diagnosis of the disease is based on the identification of characteristic clinical symptoms, the results of X-ray examination (in the area of the 1st bone-fibrous canal, calcification of varying severity is determined).
In doubtful cases, an MRI examination is used.
De Quervain's disease must be differentiated from arthrosis of the wrist joint, inflammation of the styloid process (styloiditis), migratory polyneuritis (Vanterberg's syndrome).
Conservative treatments are effective for approximately the first 6 weeks of the course of the disease. Immobilization of the 1st metacarpophalangeal joint is carried out with the help of an orthosis, pharmacotherapy with non-steroidal anti-inflammatory drugs is prescribed, with a pronounced course, glucocorticoid pharmaceuticals are introduced into the area of inflammation.
With the ineffectiveness of conservative therapy, surgical methods of treatment are resorted to.
Elbow extensor tendovaginitis of the hands (ulnar styloiditis)
The disease is much less common than de Quervain's disease, and has a more favorable course. With ulnar styloiditis, fibrotic changes occur in the tendon, in the structures of the synovial sheath, which leads to narrowing of the 6th canal of the dorsal carpal ligament.
Etiology
The disease, as a rule, is the result of prolonged microtraumatization as a result of professional activity, or with direct trauma to this anatomical region.
More often sick are females working in the sewing and weaving industries, grinders, polishers, etc. In some cases, tendovaginitis of the ulnar extensor of the hands is one of the manifestations of systemic rheumatoid disease.
Clinical picture
The disease is characterized by the occurrence of spontaneous pain in the region of the styloid process of the ulna and possible irradiation to the fingers IV–V. Abduction of the hand to the radial side with its simultaneous dorsal flexion leads to increased pain. There is swelling and thickening of the tissues above the styloid process. On palpation of the styloid process, local pain is noted.
Diagnosis and differential diagnosis
Diagnosis of the disease is based on the identification of characteristic clinical symptoms, on the history of the disease. X-ray examination is being carried out.
Elbow styloiditis must be differentiated from pain that occurs with paresthesia in the IV-V fingers of the hand in Guyon's canal syndrome.
Finger and hand flexor tendovaginitis (carpal tunnel syndrome)
The disease is much less common than tendovaginitis of the dorsal carpal ligament.
Carpal tunnel syndrome is caused by various pathological processes (inflammatory, post-traumatic, neoplasms) that occur in the canal, which leads to compression of the branches of the median nerve passing in this area, which innervates the skin of I-III and the medial side of the IV fingers.
In case of injury, the disease develops on one hand, in other episodes both hands are affected and often asymmetrically.
Involvement in the pathological process of the synovial sheaths of the flexors of the hand and fingers, the transverse ligament of the wrist leads to a decrease in the strength of the flexors of the hand and fingers, the short opposing muscle of the thumb, in more severe cases, to atrophic changes.
Clinical picture
The patient is disturbed by burning pains and a feeling of numbness of the I-III fingers of the hand, which intensify at night. At the same time, the patient wakes up and tries to squeeze his fingers, lower his hand down from the bed. The strength of the hand decreases, the sensitivity of the fingertips decreases, acrocyanosis, hyperhidrosis may occur. In more rare cases, blanching or redness of the skin of the fingers is determined.
The progression of the disease leads to a decrease in the sensitivity of the fingertips, smoothing the pattern on the skin. In more rare cases, persistent swelling of the fingers occurs with spread to the hand.
The symptomatology of the disease is characterized by variable symptoms, from recurrent pain and paresthesia to the occurrence of trophic changes at the fingertips, atrophy of the tenar muscles, complete loss of pain sensitivity, and the formation of persistent contractures that limit work capacity to varying degrees.
Differential Diagnosis
Tenosynovitis of the flexors of the fingers and hands must be differentiated from vegetative polyneuritis and polyneuropathy, Guyon's canal syndrome, sympathetic truncitis of the stellate ganglion, osteochondrosis of the cervical spine, and tendovaginitis of the dorsal ligament of the wrist.
Tenosynovitis of the superficial flexors of the fingers ("snap" or "spring finger", Knott's disease)
The disease is characterized by damage to the synovial sheath, the tendons themselves and the annular ligaments that form the canal, which leads to its narrowing and difficulty in the movement of the tendons in it.
The disease develops with prolonged microtraumatization, often professional, of the synovial sheaths and tendons passing through them, which causes the occurrence of fibrotic changes. Tenosynovitis of the superficial flexors of the fingers most often occurs in persons whose work is associated with prolonged pressure on the palm and fingers (grinders, mechanical assembly fitters, choppers). In some episodes, the cause of the disease remains unclear.
Clinical picture
The leading clinical symptom is the occurrence of pain on the palmar surface at the base of one or more fingers - usually I, II and IV. The pain increases with palpation of the bases of the fingers, with their flexion or extension.
Initially, pain disturbs the patient in the morning, it becomes necessary to “develop” movements in the fingers for some time. On palpation of the palmar surface of the metacarpophalangeal joints, rounded or oval thickenings on the tendons up to 5 mm in diameter are determined. Rapid and increased flexion and extension of the fingers is accompanied by pain, occasionally clicking can be heard. In the later stages of the disease, it is necessary to overcome the snapping of the fingers with the help of a healthy hand, while the pain spreads to the hand, forearm.
Further progression of the disease leads to fixation of the fingers - usually in an extended position - snapping becomes a transient symptom.
Differential Diagnosis
Tenosynovitis of the superficial flexors of the fingers has to be differentiated from Dupuytren's contracture, arthrogenic and post-traumatic deformities and contractures.
Tibialis posterior tendovaginitis (tarsal tunnel syndrome)
Pathological changes in the tissues of the synovial sheath lead to compression of the posterior tibial nerve, which is located in this canal, and the occurrence of vasomotor-trophic disorders.
Clinical picture
Compression of the tibial nerve is accompanied by the occurrence of burning pains and paresthesias, spreading along the inner surface of the foot and in the fingers, aggravated at night. Pain sometimes extends to the lower leg. On the inner surface, there is swelling and a hardening that is painful on palpation. On the dorsum of the foot, pain and tactile sensitivity is reduced.
Specific tendovaginitis
The disease is one of the rarest varieties of extrapulmonary tuberculosis. All age groups are equally susceptible to specific tendovaginitis. In comparison with other localizations of tuberculous lesions, the disease is considered the most favorable course in assessing the general condition of the patient. However, for the restoration of the function of the affected limb, the prognosis for advanced cases is unfavorable.
Etiopathogenesis
The mechanism of penetration of mycobacterium tuberculosis into the synovial sheaths has not been fully elucidated. There are suggestions that the infection can penetrate through wounds, injections when cutting sick animals (butchers, farmers). Others have researched, they believe that in nature there is a tuberculosis mycobacterium that synthesizes a toxin that is tropic to the synovial membranes. In addition, there is an opinion that the spread of mycobacteria occurs from the foci of tuberculosis that already exist in the body.
Fibrous exudate accumulates in the dilated synovial sheaths, containing a significant amount of rice-like bodies and/or foci of caseous decay. After the subsidence of the tuberculous process, a small amount of fibrous exudate and fibrosis of the ligamentous apparatus remain.
Most often, specific tendovaginitis occurs on the palmar, and then on the back of the hand.
Clinical picture
With specific tendovaginitis, swelling, mild soreness and a slight limitation of function are formed. Accumulations of synovial fluid in the carpal bags, when pressed, are displaced above or below the carpal canal, with a slight pain. Tendovaginitis of the ulnar carpal bursa leads to compression of the median nerve, which is accompanied by severe pain and paresis in the area of its innervation (carpal syndrome). A slight limitation of movements in the hand is due to swelling. The progression of the disease leads to the weakening and loss of some movements due to elongation or rupture of the tendons, which may occur after 2-3 years from the onset of the disease. Economical surgical interventions for specific tendovaginitis may be complicated by the formation of fistulas.
With specific tendovaginitis, the most effective method of treatment is radical surgery (removal of all damaged elements of the ligamentous apparatus) with the simultaneous use of anti-tuberculosis pharmacotherapy.
Diagnosis and differential diagnosis
Identification of caseous foci practically confirms the diagnosis of specific tendovaginitis, histomorphological, bacteriological studies are carried out with the isolation of a pure culture of the pathogen.
Specific tendovaginitis must be differentiated from rheumatoid, post-traumatic tendovaginitis.
Forecast and outcome
With timely started qualified treatment, the prognosis in relation to the ligamentous apparatus is favorable. In the vast majority of cases, the function of the hand is restored almost in full. With insufficiently radical surgical treatment, undiagnosed specific osteitis of the bones of the wrist, recurrence of the disease is possible (in approximately 10–60% of cases).
General principles for the treatment of tendovaginitis
Therapeutic measures should begin with the termination of the impact of damaging factors on the affected area (load reduction, immobilization).
Pharmacotherapy of tendovaginitis depends on the immediate cause of the disease and the complications that have arisen. Therapy with non-steroidal anti-inflammatory pharmaceuticals, antibiotics is used, compresses and ointments are prescribed. In the vast majority of cases, immobilization of the affected area is indicated.
Various thermal physiotherapeutic procedures (ozokerite-paraffin applications, UHF therapy) have a favorable effect on the course of tendovaginitis.
Forecast and prevention
With timely qualified treatment, the prognosis for tendovaginitis is favorable. Purulent tendovaginitis can cause persistent dysfunction of the hand and / or foot. In cases where physical overload resumes after acute tendovaginitis, there is a high probability of a relapse of the disease and transformation into chronic tendovaginitis.
Preventive measures should be aimed at preventing chronic overstrain and traumatization of the ligamentous apparatus, rational employment of patients with chronic forms of tendovaginitis.
Arthritis is inflammation of one or more joints.. The disease is a common cause of disability, disability. Modern medicine considers the disease to be difficult to treat.
Most often, doctors facilitate the course of the disease, for which non-steroidal or hormonal drugs are used. But in this case there is no treatment, only its appearance is created. The inflammation can continue, causing the joint to collapse.
There are several types of arthritis:
Other types of arthritis may occur after psoriasis, tuberculosis, and other illnesses.
The exact cause of the appearance is unknown to doctors, but it is believed that this is an infection, the result of an injury or an allergic reaction. It sometimes appears as a result of improper metabolism, nerve diseases, low amounts of vitamins in the body. In violation of immune functions, the disease develops, the joints are destroyed. Microorganisms enter the knee, and the immune system attacks the damaged area. With poor-quality treatment, a person can remain disabled.
Knee arthritis can appear for the following reasons:
By certain signs, it can be determined that a person has a disease. Main symptoms:
The most common cause of knee arthritis in children is frequent colds. Due to the disease, immunity decreases, which is why viruses infect some parts of the body, such as the knees. Tumors and redness appear after a long time, the pain comes, most often, only in the morning.
The disease progresses unevenly. Sometimes there are frequent exacerbations, and remission periods pass. In order for the result of treatment to be maximum, it is necessary to carry out complex therapy, even with a decrease in the number of signs of the disease.
Often, parents, thanks to such signs, suspect children of deceit, because in the evening the child feels fine, and in the morning he is not able to get out of bed. You can tell if there is a disease after the examination. The spread of the disease is determined by a biochemical blood test.
Healing from the disease should not take place until the pain disappears. The causes that led to the infection should be eliminated.
Methods suitable for the treatment of arthritis:
Medical assistance consists in the use of the following means:
The people have long invented means that will help to cope with the disease. Here are some of them:
Physiotherapy procedures can be performed only during the subsidence of pain, or after recovery, to restore the joints. Reception of drugs is combined with physiotherapy exercises. Movement helps to cope with pain, strengthens the muscles and the knee frame. The likelihood of arthritis is greatly reduced.
It is better to carry out exercises in a supine position on a flat, solid base. Exercises:
Exercises are performed 8-10 times. If pain occurs, stop.
The advantage of ointments is their availability. Each pharmacy offers several remedies for the treatment of knee arthritis. Compositions are made from plants with medicinal properties. The waste products of bees, snake venoms, etc. are suitable. Most of the ointments are natural substances. There are 4 types of treatments:
In addition to such funds, there are chondoprotectors. Substances can be used in the initial stages of the development of the disease. Available in various forms, including as ointments.
Any of these remedies should be taken only after consulting a doctor. Even ointments may have contraindications, not suitable in their composition for the treatment of arthritis. No need to joke with the disease, at the slightest sign, the necessary measures should be taken. Only then will it be possible to always be healthy, and the joints will not bother.
Tenosynovitis is an inflammation of the tissues of the tendon and the sheath that covers it (the tendon sheath). Unlike tendonitis (a simple inflammation of the tendon), tendovaginitis develops only in certain anatomical places, where the tendons are sheathed: the area of the forearm, wrist, hand, ankle joint and foot.
This is a very common disease, especially among women and workers who, by the nature of their work, are forced to perform the same type of hand movements every day. The consequences of tendovaginitis of the tendon can be very severe. If the acute form responds well and quickly to treatment, then the chronic form can lead to dysfunction of the hand, which is why you even have to change jobs.
According to ICD-10 (International Classification of Diseases 10th revision), tendovaginitis has the code M65.9.
A tendon is a dense, non-elastic connective tissue formation that connects muscles and bones or two bone structures. During muscle contractions, these structures move relative to their surrounding tissues. According to official medical data, the tendon in the area of the wrist joint makes 10,000 or more movements per day.
With tendovaginitis, the tendon and its synovial membrane become inflamed
This is a colossal load that would lead to damage to the bone of this soft tissue formation and its rupture. But in the area where the tendons are in contact with the surrounding tissues, there are special protective sheaths, sheaths. They consist of 2 synovial membranes. The inner one fits snugly against the tendon, and the outer one encapsulates it all in a kind of capsule. Between the two shells is a small amount of synovial fluid, which reduces the force of friction and shock. Thus, the tendon is perfectly protected from friction damage.
With tendovaginitis, both the tendon itself and its sheath become inflamed. The process can be due to many reasons, including infectious and aseptic. Due to swelling and accumulation of inflammatory fluid inside the tendon sheaths, all movements become difficult, become painful, and the function of the limb suffers.
If the disease is not treated, it can become chronic with the development of specific complications, and in the case of purulent inflammation, the infection can spread to neighboring tissues with the development of phlegmon and sepsis.
Depending on the causes of occurrence, all tendovaginitis can be divided into 2 large groups:
Occurs in most cases. It develops mainly in people whose profession or hobby is associated with multiple similar movements of the hands. At risk are pianists, computer typists, tailors, people working with levers, cooks, etc. In this case, the same muscles, respectively, and their tendons are involved.
Such intense work leads to the depletion of synovial fluid reserves, increased friction, microtraumatization of the connective tissue and the development of aseptic inflammation. Inside the vaginas, exudate of a serous, and sometimes hemorrhagic nature begins to accumulate. The last changes cause characteristic symptoms: swelling, smoothness of the contours of the anatomical site and pain.
Work, which is associated with constant movements of the same type, most often leads to the development of tendovaginitis
It is also called septic or purulent tendovaginitis. It is caused by the ingress of the tendon of pathological microorganisms into the sleeve. They can penetrate directly from the external environment during injuries and open wounds or be introduced with the bloodstream and lymphatic fluid from other foci of infection in the body.
Important! A very dangerous condition, since pus from the tendon sheaths can quickly spread to neighboring tissues, not only of the hands, but also of the forearm, causing the development of phlegmon. Treatment in this case is only surgical, and amputation of the limb is not excluded.
All infectious tendovaginitis can be divided into two categories:
If in the first case, standard antibiotic therapy is used for treatment, then in a specific process, targeted treatment of the infection that is complicated by the development of inflammation of the tendons is necessary.
Taking into account the clinical course, acute and chronic tendovaginitis are distinguished. Consider the characteristic features of these variants of the disease.
An acute aseptic form develops after overloading a certain part of the body (hand or foot). The flexor tendons of the forearm are most commonly affected. Swelling or slight smoothing of the contours appears in the diseased area, so not all patients pay attention to this. Skin color does not change. There is pain with active and passive movements of the hand. Its localization depends on which tendon is affected. Most often, this is the area of the thumb and wrist joint (damage to the flexor tendons of 1 and 2 fingers).
Another symptom that may indicate this problem is the appearance of a specific crunch or clicks in this area during movements (crepitant tendovaginitis).
In the acute purulent form, pronounced signs of inflammation appear. The sore finger turns red, the skin over it is hot, stretched, shiny, may have a bluish tint. Pain is present not only during movement, but also at rest. Acquires a pulsating or twitching character.
In parallel, there are signs of general malaise:
With the development of purulent complications, the general condition of the patient worsens significantly, signs of inflammation from one finger spread to the entire hand and / or forearm. Septic shock may ensue.
Develops only with aseptic lesions. It may have a primary chronic course or be a complication of the acute form of the disease in the absence of its treatment.
As a rule, such patients complain only of pain that occurs when certain movements are performed. There is also pain on palpation along the inflamed area, sometimes crepitus can be detected.
A special clinical form of the chronic variant of this disease is stenosing tendovaginitis, or de Quervain's tendovaginitis. With it, the inflamed tendon is compressed in the bone-fibrous canal, which leads to constant and rather severe pain. Nerves that run nearby can also be damaged, resulting in complications such as carpal tunnel syndrome.
De Quervain's tendovaginitis often affects women
The diagnosis of tendovaginitis is exclusively clinical. There is no method that would allow you to accurately confirm it. An experienced doctor will immediately see this pathology. But in some cases, additional examinations are required to exclude similar diseases.
Diagnostic program:
Therapeutic measures, first of all, depend on the cause of tendovaginitis and can be conservative and surgical.
The first step is to limit the load on the diseased limb. For this purpose, it is recommended to abandon the main activity for 10-14 days. To limit painful movements, the patient is recommended to wear a special orthosis, which fixes the first finger of the hand and the area of the wrist joint. In the future, it can be worn to prevent relapses when performing the necessary work.
Also, a good analgesic effect can be achieved by applying cold compresses to the inflamed area.
The basis of treatment is the use of medicines:
Conservative treatment must be supplemented with physiotherapeutic procedures (shock wave therapy, laser therapy, electrophoresis, phonophoresis, etc.). After the elimination of acute pain, therapeutic exercises are prescribed to strengthen the muscles and prevent re-inflammation. Also, the course of treatment can be supplemented with proven folk remedies.
Surgery for tendovaginitis is prescribed only for complications:
The type of surgical intervention is chosen by the surgeon, based on the specific situation. Typically, the tendon sheath is dissected and removed, the tendon is released. If necessary, it is plastic. The operation can be both open access and performed using endoscopic microsurgical technique, which does not require extensive skin incisions.
The prognosis for tendovaginitis is favorable, provided that treatment is started on time and its volume is adequate. If the process becomes chronic, there may be a violation of the function of the hand or foot, which can only be corrected by surgery.
