Tenosynovitis of 1 toe. Tenosynovitis. Causes, symptoms, types, treatment and rehabilitation. What is it - tendovaginitis

Now it's time to get acquainted with some "sequel". It will be about a disease such as tendovaginitis.

To clearly visualize the muscles and joints that are in motion, one can imagine the hydraulic levers of a working bulldozer. There is hydraulic oil in the lever and it does work under pressure.

And in the muscles that set the joint in motion, their tendons should be in the synovial sheaths. There, due to the production of synovial fluid, the friction coefficient is reduced to a minimum, and the muscle, contracting, unhindered "pulls up" the tendon, performing mechanical work.

Then the muscle relaxes and its tendon, attached to the head of the bone, easily and effortlessly slides "back" into its vagina, where the tendon is "nested" - (hence the name), due to the action of gravity and its elasticity.

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Tenosynovitis - what is it?

As usual, the ending "-it" indicates the inflammatory nature of the process, and the term "tendovaginitis" unambiguously determines that inflammation of the walls of the tendon sheath has occurred. Since there is a constant connection around the muscles, ligaments and synovial fluid that is produced in the tendon sheath, the following names of this disease can be found:

• tenosynovitis;
• tendinitis (in the case of a pronounced inflammatory component related to the tendon);
• ligamentitis (in the same case).

This suggests that tenosynovitis is a complex inflammatory process which affects the muscle tendon and its vagina. In some cases, it is unreasonable to separate tendonitis and tendovaginitis, since involvement of one component in inflammation is manifested, due to anatomical and functional proximity, and the involvement of another component in inflammation.

• In some cases, with high physical activity these structures are joined by a lesion and the adjacent nerve trunks.

For example, tenosynovitis of the hand can be complicated by carpal tunnel syndrome in the case of compression of the median nerve between the bones of the wrist and the transverse carpal ligament, which is the “roof” of this narrow groove.

When does the disease develop?

Talking about possible reasons inflammatory process in the tissues of the musculoskeletal system, the following should be named:
overvoltage, microtrauma. Non-microbial, aseptic inflammation occurs. It is often caused by prolonged mechanical stress.

Such are the professional tendovaginitis in musicians, joiners and carpenters, typists, athletes, grinders, milkmaids and all those who constantly reproduce the same type of movement. The higher the amplitude in them and the load, the greater the chance of inflammation;

• Reactive inflammation. The process arises due to the appearance of an autoimmune component, which, unlike a mechanical one, can occur in various joints and tendon sheaths of the body, and may not be associated with stress.

Examples include psoriasis, systemic scleroderma, and other connective tissue diseases. As in the first case, this inflammation is aseptic, non-microbial in nature.

• Microbial inflammation. Specific infectious tenosynovitis can occur as a result of dissemination of the pathogen by the hematogenous route (with brucellosis, gonococcal and chlamydial infections, with Lyme disease or tuberculosis).
• In the event that the pathogen is not some kind of "special" guest, but is part of the pyogenic flora, then nonspecific tendovaginitis occurs. He, most often, appears during the local migration of pathogens from arthritis, bursitis. Sometimes spilled soft tissue leads to purulent leaks into the tendon sheaths with the development of tendovaginitis after wounds;

Clinical signs of tendovaginitis

wrist joint tenosynovitis photo

It is important to know that regardless of the etiology, or the cause of the development of the disease, aseptic arthritis is almost always serous, or serous-fibrinous, microbial arthritis is most often purulent. But some specific infection, such as tuberculosis, can also proceed without the presence of pus.

Likewise, you need to take into account the timing of the course of the disease. In the event that the inflammation and its signs cannot be eliminated within one, maximum two months, then a diagnosis of chronic tendovaginitis can be made, since the inflammation has acquired a chronic course.

"Classic" symptoms of tendovaginitis are manifested by the following signs:

• The synovial sheaths of the corresponding tendons become swollen and swollen. This swelling increases with exercise and movement;
• The movements become painful. This is especially true for aseptic and professional tendovaginitis. If we talk about bacterial processes, then pain is possible at rest. The "twitching" nature of the pain indicates suppuration;
• In the event that tendovaginitis develops in the tendons and their sheaths, which are located near the surface of the skin, then there may also appear signs such as redness and a feeling of local heat;
• As a result of edema and pain, joint function is limited by reducing the volume of active movements.

In the event that we are talking about a secondary purulent process, then a general reaction is not excluded: a person's temperature rises, weakness, lethargy, and refusal of food appear. Swelling of regional lymph nodes is possible.

In the event that their barrier function is violated, the pathogens will "break through" into the bloodstream, and sepsis will ensue. And with sepsis, secondary purulent "metastatic foci" appear in other organs and tissues. This can lead to septic shock and death.

There are several types of the disease, which are not "so scary", however, they have their own characteristics and localization. These include de Quervain's crepitus and tenosynovitis.

What is special about the crepitant form?

In medicine, there is a term called crepitus. It denotes a special kind of quiet, pathological sound. After all, earlier one of the most important ways of examining a patient by a doctor was auscultation of the lungs with the help of a phonendoscope.

The sound of crepitus was like the soft chafing of a bun of hair. You can all easily repeat this sound if you “rub” yourself by the strand of hair located near your own ear.

• Initially, this term was used to refer to the sound of the accumulation of viscous exudate in the alveoli. When they break apart, a similar sound occurs.

Likewise, with crepitant tendovagititis, a specific "crunching" occurs, which is not the sound of cartilage, but simply a consequence of the destruction of such thick deposits that are in the tendon sheath when it is felt.

Most often, this phenomenon occurs when the rear of the hand, biceps vagina is damaged. Sometimes this occurs when the tendons of the foot are affected, when tendovaginitis of the ankle joint develops.

A similar lesion occurs with tuberculous lesion, which is characterized by the appearance of dense "rice-like" crepitant inclusions.

De Quervain's tendovaginitis (stenosing)

The second name of this process is "stenosing", that is, a narrowing tenosynovitis. It is particularly painful and located in a special, "unfavorable" place. This place is located in the area of ​​the thumb of the hand. There are such anatomical features that lead to a thickening of the walls of the vagina.

As a result, the cavity that is available for the movement of the tendon becomes narrowed. As a result, severe pain occurs when bringing the finger to the palm and opposing it to others. The zone of greatest pain is defined above the scaphoid bone.

Stenosing tenosynovitis is almost always aseptic and results from intense exercise.

Tendovaginitis of the wrist joint, features

The wrist joint is the most loaded (from a professional point of view). In the event that tunnel syndrome also joins, then signs of neurological disorders appear. Therefore, the treatment of tendovaginitis of the wrist joint necessarily implies temporary disability, and in the case of a proven case of an occupational disease, the employee will be entitled to compensation.

So, in addition to the above-described signs of inflammation, when the median nerve is involved in the pathological process, symptoms such as:

• Nocturnal and daytime complaints of paresthesias, "creeping", pains in the fingers and hands, especially in the second and third fingers;
• Reduced pain and tactile sensitivity in the thenar and thumb;
• Sometimes there is thenar hypotrophy, that is, the palmar eminence of the thumb.

In order to "provoke" ischemia of the median nerve, you can raise your outstretched arms above your head and hold them in this position for 1 minute. Pain will arise on the affected side.

Alternatively, you can put on the cuff for measurement blood pressure, and after the disappearance of the pulse on the radial artery after 30 sec - 1 min. pain occurs.

About general diagnostics

Usually, the diagnosis is made clinically, based on patient complaints, history, signs of inflammation, and specific signs such as crepitus. In the case of a microbial process, a puncture is performed, with a bacteriological inoculation of the discharge.

Also, in the inflammatory process, and even more so in acute infectious tendovaginitis, as well as in arthritis and bursitis, leukocytosis occurs in the blood, a shift of the leukocyte formula to the left, an increase in ESR.

In the immune process, the criteria for the corresponding disease are applied (systemic varieties of psoriasis, ankylosing spondylitis, rheumatoid arthritis, ELISA, setting specific reactions). Certain help can be provided by ultrasound of joints, periarticular tissues, as well as MRI - high-resolution diagnostics.

Treatment of tendovaginitis - drugs and techniques

Treatment of both acute and chronic tendovaginitis begins with the creation of functional rest of the limb. For this, immobilization is used, for example, with a splint.

For anesthetic purposes, anti-inflammatory nonsteroidal drugs are prescribed locally, internally and intramuscularly. In addition, they contribute to the elimination of inflammation and edema. The greatest analgesic activity is possessed by "Ketanov", and anti-inflammatory - "Ketorol", "Movalis".

Naturally, antibiotic therapy is the basis for the treatment of microbial, infectious tendovaginitis. In the case of a tuberculous process, specific anti-tuberculosis antibiotics are used.

Local treatment of tendovaginitis is aimed at relieving inflammation and relieving swelling. Therefore, in the first days, when acute pain appears, it is forbidden to heat the affected area so as not to cause increased edema. You can use anti-inflammatory ointments and gels, as well as preparations containing bee and snake venom (in the absence of allergies).

After reducing the pain, it is possible to use physiotherapeutic methods: magnetotherapy, electrophoresis of hormones and vitamins, exercise therapy. In the case of diffuse purulent inflammation, surgical methods of treatment are used, with washing and draining the wounds.

In the event that the inflammation has acquired a chronic process, sanatorium treatment is indicated, the introduction of drugs such as "Diprospan", "Kenalog" into the corresponding synovial muscle sheaths.

Forecast

In the case of an acute and aseptic process, the prognosis is usually favorable. The most severe tendovaginitis occurs with advanced infectious lesions, with purulent fusion of the tendons and the inner lining of the vagina.

This leads to scarring, decreased muscle movement, and inevitably leads to muscle atrophy and the development of ankylosis in the corresponding joint.

Therefore, at the first signs of acute inflammation, you must immediately rest the limbs, and consult a doctor - a traumatologist or surgeon.

Can be a serious cause for concern. If a finger is sick and swollen, many will not pay attention to it special attention thinking that everything will pass in a few days. But it is precisely this attitude towards one's own ailments that often leads to the development of complications that are already fatal.

What is tenosynovitis?

Not only muscles, tendons and ligaments can become inflamed, but so can those. What is tendovaginitis? This is an inflammation of the synovial membrane (vagina) of the muscle tendon. Flexor tendons are most commonly affected. In second place are the extensor. Since the synovium is close to the tendon, tendonitis, an inflammation of the tendon itself, often develops along with it.

Views

You should consider the types of tendovaginitis in order to understand what it is:

1. According to the form of development, they are distinguished:
   • Sharp - appeared once;
   • Chronic - there are relapses, recurring symptoms of the disease.
2. For inflammatory exudate:

• Aseptic, which is divided into the following types:
  • Serous;
  • Hemorrhagic;
  • Fibrinous.
• Septic, which itself manifests itself in a purulent form.

1. Types of microorganisms (infectious tendovaginitis) are distinguished from a variety of microorganisms:

• Specific, which is of the following types:
  • Tuberculous;
  • Brucellosis;
  • Syphilitic.
• Nonspecific - infection with a coccal nature.
• Traumatic.

1. Separate types:

• Crepitant is the result of professional activity. It is expressed by swelling, soreness, creaking sounds. With repeated manifestations, it becomes chronic.
• Stenosing - damage to the tendons of the hand.
• Dystrophic - a chronic effect on microtrauma in the affected area.

1. By location:

• Brushes;
• Forearms;
• Finger;
• Wrists;
• Wrist joint;
• Shoulder joint;
• Elbow joint;
• Finger flexors;
• Feet;
• Ankle joint;
• Knee joint;
• Shins;
• Hips;
• De Quervain's tendovaginitis is an inflammation of the wrist ligaments.

Causes

The main reason for the development of tendovaginitis is professional activity, which is associated with the performance of the same type of work with hands or feet. For example, pianists, packers, vaulters, athletes, tap dancers, etc. They have a load on the same muscle groups, and with them - on the tendons. The synovium is depleted, the petals begin to rub against each other. This leads to the formation of serous and hemorrhagic exudate, which is a healing factor. However, if the load continues, then the process deteriorates, and fibrosis is formed.

Another reason is the direct injury of the tendon (its rupture, trauma, stretching, etc. when pierced by a splinter or nail), followed by the penetration of microorganisms. It is they who develop the purulent form of tendovaginitis, which heals for a very long time.

Special attention should be paid to manicure and pedicure procedures, which can cause the development of infectious tenosynovitis. Infection under the finger leads to, and he already develops tendovaginitis.

Spread of infection through blood from other infected organs is the most common case of infectious tendovaginitis. It often develops with tuberculosis, brucellosis, syphilis, osteomyelitis, liver abscess, lung gangrene, etc.

Symptoms and signs of tendovaginitis of the tendon sheath

Let's start with the general symptoms and signs of tendovaginitis of the tendon sheath of any kind:

• The pain is constant and acute, aggravated by attempts to move the affected area. With suppuration, pulsation is possible.
• The edema is pronounced and very tense, it develops very quickly.
• Redness first of the site of inflammation, and then of the nearby tissues. It is accompanied by crepitus (crunch).
• Hyperthermia (local heat skin).
• Loss of functionality of the affected area. A person cannot move the affected area, and the entire limb is usually in a relaxed state, performing sluggish movements.
• Adhesions and changes in contracture that develop some time after the onset of the disease.
• Fever.
• Chills.
• Vascular inflammation and lymphadenitis.

Tendovaginitis in children

In children, tendovaginitis is practically not manifested. Only because of damage to the tendon with the subsequent introduction of infection, the child can develop this disease.

Tenosynovitis in adults

Tenosynovitis is mainly observed in adults, since they are the ones who spend a lot of time doing such work that puts a load on the same muscle group. In men, tendovaginitis develops due to monotonous sports loads and professional activities. In women, it also manifests itself due to professional repetitive work, as well as when wearing high heels.

Diagnostics

Diagnosis of tendovaginitis is not difficult. According to the self-perception of the patient and during a general examination with the help of palpation, all the main signs of the disease are visible. Only to clarify the nature of the disease is it possible to carry out additional procedures:

• Blood test.
• Sowing the tendon exudate that has accumulated in the synovium.
• Radiography allows tenosynovitis to be distinguished from arthritis and osteomyelitis.
• Ligamentography.

Treatment

Treatment of tendovaginitis is carried out only in stationary conditions. At home, it leads to the development of complications. In this case, treatment should be started as early as possible, since the disease progresses rapidly, affecting adjacent healthy tissues and areas.

How to treat tenosynovitis? With the help of those medicines prescribed by the doctor:

• Non-steroidal anti-inflammatory drugs: Nimesulide, Diclofenac.
• Hormonal anti-inflammatory medications: Dexamethasone.
• Antibiotics: Ceftriaxone.
• Novocaine injections for pain relief.
• Enzyme preparations.

Surgical operations for tendovaginitis are carried out in the case of the formation of a purulent form or the formation of adhesions, leading to deformation of the structures.

The affected limb should be immobilized with plaster cast so as not to provoke additional pain. Physiotherapy procedures are carried out in parallel:

• Ultrasound therapy;
• SF irradiation;
• Electrophoresis of anesthetics;
• Alcohol compress;
• Mud therapy (peloid therapy);
• Ozokerite and paraffin applications;
• Massotherapy;
• Warming up.

As the patient recovers, the plaster is removed so that the patient can begin to perform light therapeutic exercises with the limb, develop muscles.

At home, you can use ointments bought at the pharmacy, as well as the compresses themselves prepared at the stage of recovery:

• Warm compresses.
• Warming ointments.
• 1 tbsp chop calendula flowers and mix with baby cream or petroleum jelly. Insist the mixture for several hours and apply before going to bed on the affected area.
• 1 tbsp chamomile and St. John's wort pour a glass of hot water, leave for 30 minutes. Consume half a glass inside.
• As a diet, you can resort to eating raw fruits and vegetables in order to fill the body with vitamins.

Life forecast

The question of how long they live with tendovaginitis can be answered: it all depends on the course and complications of the disease. It is better to treat the disease, then within 2 weeks recovery will come, which gives a positive life prognosis. If treatment is not carried out, a purulent form develops, which gives the following complications:

• Septic tenosynovitis, in which the adjacent healthy areas of the tendon and vagina become inflamed, spreading throughout the limb.
• Sepsis, in which limb amputation is necessary. Otherwise, death is possible.
• Disability due to the loss of a limb.
• Fusion of tendons.

To prevent the disease, you need to carry out the prevention of the disease:

1. Change the activity to distribute the load throughout the body.
2. To rest, give the body to gain strength.
3. Warm up your muscles before exercising.
4. Seek medical attention in a timely manner.

Better to change the job that led to tenosynovitis. The disease can be cured, but it will reappear due to negative impact work.

Tendovaginitis of the tendons and their membranes (photo) is accompanied by impaired functioning of the affected limb. Lack of timely treatment can lead to irreversible changes in tissues, which threatens the development of serious complications and even amputation.

Photo. Tendovaginitis of the hand

Why does tendovaginitis occur?

The main cause of the disease is the constant overload of the tendons, accompanied by the appearance of microcracks. It is observed in skaters, skiers and other athletes, whose classes follow the same scenario. This is due to the constant execution of the same movements, as a result of which the load is unevenly distributed. The disease is recorded in pianists and machinists as a result of constant tension in the tendons of the fingers and hands.

Tendovaginitis of the tendons occurs after the postponed injury of the ligamentous apparatus - bruise or sprain. The development of an aseptic form of the disease (as a complication of rheumatic diseases of the joints) is not excluded.

Other reasons for the development of tendovaginitis are the penetration of bacteria from nearby foci of infection, which include felon, phlegmon of soft tissues and other diseases. Specific infections are capable of provoking the inflammatory process - tuberculosis, gonorrhea, brucellosis. In this case, the pathogen penetrates the tendon sheaths with the blood flow.

Depending on what caused the onset of the disease, aseptic and infectious tendovaginitis are distinguished. The clinical manifestations of pathology depend on this.

Signs of the disease

Symptoms of acute tendovaginitis are characterized by severe pain, due to which a person cannot perform elementary movements. The range of motion in the fingers is limited, with pressure, crepitus occurs.

Most often, the tendons of the back of the hand and foot are affected, much less often the fingers. Acute inflammation can be accompanied by swelling and tenderness in the lower leg or forearm. An effusion forms in the synovial cavity, which leads to a deterioration in the blood supply and nutrition to the tendon.

The chronic form of the disease has a sluggish character, which does not greatly affect the mobility of the fingers. The tendon sheaths of the extensors and flexors of the fingers are mainly affected, leading to stiffness and impairment of range of motion. There is swelling and slight soreness, discomfort is not localized in one place, but is given to the shoulder or forearm.

The main options for the course of the disease:

1. Crepitating tenosynovitis. It is included in the group of occupational diseases in which a person performs monotonous repetitive finger movements. Most often, the extensor surface of the forearm, the Achilles tendon and the anterior surface of the lower leg are affected. Symptoms of crepitant tendovaginitis include swelling and tenderness of the tissues over the affected tendons. The main sign is the appearance of a squeak, reminiscent of the sound of snow under a person's feet on a frosty day. The disease often becomes chronic.
2. Stenosing tenosynovitis. It is characterized mainly by the defeat of the ligamentous apparatus of the hand, which develops as a result of traumatic injury. As a result of sluggish stenosing tendovaginitis, the tendons thicken, which can be detected by palpation. Flexion of the thumb is impaired, and crepitus is often present.
3. Purulent tenosynovitis. It develops with the penetration of pathogenic and opportunistic microorganisms from chronic foci of infection with blood flow. It is accompanied by the formation of purulent masses, which leads to a deterioration in the nutrition of the surrounding tissues. The most formidable complication is tendon necrosis. With acute purulent tenosynovitis, all signs of an inflammatory process are present - an increase in local and general body temperature, weakness, sweating. Blood poisoning and the development of sepsis are not excluded.

Drug treatment of the disease

Timely seeking specialized help will allow you to cope with the disease in a conservative way. The sooner you start treatment, the more chances you have to prevent progression. pathological process and the development of irreversible changes in tissues.

Immobilization plays an important role in the successful treatment of the patient, since the affected tendon needs complete rest. In no case should the slightest movement be allowed to avoid friction between the sheets of the synovial vagina. To do this, use a splint or special clips.

It is forbidden to apply an elastic bandage, this threatens the formation of adhesions.

An individual therapeutic scheme is developed for each patient. The doctor must take into account the patient's complaints, the results of the examination and additional studies carried out, as well as the cause of the disease.

The treatment of tendovaginitis is based on the use of the following groups of drugs:

1. Non-steroidal anti-inflammatory drugs. It is used externally in the area of ​​the affected tendon. In parallel, NSAIDs are prescribed in the form of tablets or solution for injection. The complex effect will allow you to achieve the maximum analgesic, anti-inflammatory, anti-edema and antipyretic results. In this group of drugs - Nimesulide, Diclofenac, Ibuprofen, Paracetamol, Meloxicam, Movalis, etc.
2. Glucocorticosteroids. Indicated in the absence of a positive result from NSAIDs, since they are characterized by immunosuppressive, desensitizing, analgesic and powerful anti-inflammatory effects. Use hormonal drugs you need to be careful, observing the prescribed dosage, in order to prevent the development of complications. Cancellation of funds is carried out gradually, over several days. Dexamethasone is mainly used to treat tendovaginitis.
3. Antibacterial drugs. Prescribed for specific and nonspecific tendovaginitis. In the treatment of the disease, antibiotics of a wide spectrum of action are used. The duration of treatment is determined individually, depending on the presence of positive dynamics. In no case should you stop the course if you feel better, fat threatens to relapse. In the absence of therapeutic results, the attending physician may decide on the need to change the antibiotic.

Puncture and operation

Severe cases of the disease should be treated with puncture or surgery.

Puncture makes it possible to remove the resulting effusion, pus and other elements, sanitize the cavity of the synovial vagina and introduce an antibacterial agent. The procedure is done for acute, rapidly progressive tendovaginitis. However, there are certain contraindications to the manipulation. These include allergic reaction on anesthetics, hemophilia, thrombocytopenia, pustular or infectious skin lesions in the area of ​​puncture.

Surgical treatment of tendovaginitis is indicated when a purulent process or persistent adhesive deformity of the tendons occurs. The operation is performed under local or general anesthesia, depending on the extent of the forthcoming surgical intervention. The doctor removes pus and excises necrotic tissue, sanitizes the cavity and revises the presence of fistulas and purulent pockets to prevent relapse. In case of muscle damage, the defect is repaired.

The goal of elective surgery is to restore the altered synovial vagina, as well as to dissect the external and internal adhesions that interfere with active movements. Unfortunately, the operation gives only a temporary effect, so after 3-5 years the patient's condition may worsen again.

Physiotherapy treatment

Physiotherapy can enhance the effect of medications and accelerate the recovery of patients.

In the acute period of tenosynovitis, it is allowed to use the following procedures:

1. Ultrasound. Reduces the sensitivity of nerve fibers, relieves spasm of smooth and skeletal muscles. It has an anti-inflammatory effect, activates blood circulation and promotes the early restoration of damaged tissues.
2. SUV irradiation in erythemal doses. Effectively warms up tissues and stimulates metabolic processes. An additional advantage of this physiotherapeutic method of treating tendovaginitis is its analgesic ability due to an increase in the excitability threshold of nerve receptors.
3. Electrophoresis. By using direct current anesthetics and other drugs penetrate deep into the epidermis, providing a therapeutic effect directly in the focus of inflammation.
4. UHF. It has anti-inflammatory and regenerating effects. Helps to soften adhesions and scars.
5. Alcohol compress. Strengthens blood circulation at the site of application. Removes edema, activates lymph flow. It has a local irritating effect.

The duration of the physiotherapy course is 10-15 sessions, each 15-20 minutes long. The procedures are carried out daily or every other day, depending on the patient's condition.

In the treatment of chronic tendovaginitis, other physiotherapeutic methods are also used: mud therapy, applications of ozokerite and paraffin, therapeutic massage.

If there are signs of tendon inflammation, you should immediately seek medical help... This will remove the clinical manifestations of the disease, improve the patient's well-being and prevent the development of complications.

Tenosynovitis develops after repeated minor injuries, infectious pathologies and reactive diseases. Inflammation of the inner lining of the tendon sheath is manifested by pain during movement, swelling of the tendon and a sharp restriction of movement in the affected limb. Treatment consists in adherence to bed rest, heat exposure in the chronic form and application of cold in the acute phase of the pathology. Pain and inflammation with tendovaginitis is relieved with the help of NSAIDs and corticosteroids, during the rehabilitation period, exercise therapy is prescribed with a gradual increase in the therapeutic load.

Description of the disease

Inflammation of the synovium lining the fibrous sheath of the tendon is called tendovaginitis. The pathology develops as a result of tendon degeneration after active movements, infections, or autoimmune abnormalities.

Characteristic pain syndrome accompanies movements or is felt when palpating the affected area. Chronic course is dangerous by replacing 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 the muscle fibers, the tendon forms a thickening in the form of a flexible tunnel called the tendon sheath. Inner surface The bursa vaginalis is covered with a synovial membrane that produces a small amount of fluid that allows the tendon to move gently during movement.

During repeated microdamage or exposure to an infectious stimulus, an inflammatory response to the process of cell damage appears. 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 ​​\ u200b \ u200bthe junction of the connecting cord and muscle fibers, pain and difficulty in further movement occur.

A third of cases of diagnostics of tendovaginitis were recorded with a lesion of the muscles involved in flexion of the upper or lower limbs... Most often, the tendons of the muscles of the shoulder, hand, elbow, fingers, popliteal region, Achilles tendon are inflamed.

Causes of tendovaginitis

Inflammatory tendovaginitis most often develops in elderly people, when tendon trophic disorders appear. Against the background of dystrophic changes, microtrauma, regularly repeated with the same type of movements, or severe damage as a result of a single injury, causes primary inflammation.

Cases of diagnosis of tendovaginitis in young people can be triggered by the following factors:

1. Frequent movements with tension, performed along the same trajectory for a long time while performing professional duties for loaders, builders, pianists, secretaries and other specialties;
2. Exercises of sports disciplines: skiers, hockey players, figure skaters, tennis players;
3. Injuries of varying severity;
4. The impact of the pathogen in osteomyelitis, septic inflammation of the joint, abscess, panaritium;
5. Specific infections: gonorrhea, brucellosis, tuberculosis, the irritant travels to the tendon through the blood or lymphatic vessels;
6. The risk of tenosynovitis increases with rheumatism, gout, ankylosing spondylitis, systemic scleroderma;
7. Increased blood glucose levels (diabetes mellitus);
8. Violation of protein metabolism with deposition in tissues of amyloid (protein compound);
9. Significant excess of blood cholesterol;
10. Taking quinolone antibiotics (Norfloxacin, Levofloxacin, Moxifloxacin).

Forms of pathology

In medical practice, tendovaginitis is classified according to 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 bright clinical picture... Chronic course is a sluggish inflammatory process without pronounced symptoms with alternating stages of remission and relapse.

Due to the origin of tendovaginitis, there are:

1. Infectious forms, which are divided into: specific, as a result of specific infections (tuberculosis, gonorrhea); nonspecific, appearing in the body due to purulent infections.
2. Aseptic, developed without the intervention of pathogenic microorganisms: professional in athletes and workers whose work is associated with the same type of physical activity; reactive, caused by autoimmune pathologies.

The nature of the inflammatory lesion of tendovaginitis affects the composition of the effusion that can accumulate in the articular sheath. According to this type, it is possible to distinguish serous, serous-fibrous and purulent form of tendovaginitis. The acute course is often associated with serous exudate, which is clear liquid, in which an infectious factor is not detected.

Purulent forms of tendovaginitis signal the addition of an infection, which 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 membrane of the tendon.

Clinic of the disease

The symptomatology of tendovaginitis is different and depends on the etiology of the pathology. Common signs include pain of muscle movement with the involvement of a diseased tendon, swelling is observed when effusion accumulates in the tendon sheath, stiffness in the movements of a diseased limb, if you press on an inflamed place, a sharp pain appears. In the absence of effusion, crepitation is present in the tendon, which can be heard with a stethophonendoscope.

Acute nonspecific form

Sudden pain in the inflamed tendon appears along with pronounced swelling of the tendon sheath, which is easily detected by palpation with the hand. Gradually, the edema spreads to nearby tissues, excluding the whole limb from the process of movement.

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The most common localization of an acute nonspecific form of tendovaginitis is outer side hands and feet, less often tendons located on the fingers become inflamed. With damage to the hand, the swelling passes to the forearm and shoulder, with inflammation on the feet, the lower leg and femur suffer.

Purulent forms of tendovaginitis sharply worsen the condition, causing general intoxication of the body against the background of a feverish state. The manifestations of inflammation intensify, hyperemia appears over the diseased area, the pain is of a pulsating character.

Acute aseptic form

The main difference between the aseptic form of tendovaginitis is the absence of exudate and the appearance of the sound of crepitus in the sore spot. This course often develops on the hands and in the area of ​​the shoulder joint. Sudden start with acute pain accompanied by edema in the inflamed tendon, upon palpation of which a crisp sound is clearly heard. The fingers lose their mobility, movements are accompanied by severe soreness. A chronic process may follow the aseptic form.

Chronic form

Inflammation of tendovaginitis takes on 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 from opposite sides, a push is felt, indicating the accumulation of fluid in the tendon canal.

Diagnosis of the disease

The diagnosis of "Tendovaginitis" is made on the basis of symptoms, specific pain tests, methods of percussion and palpation, as well as an external examination of the patient. From instrumental research, MRI is used to exclude tendon ruptures and ultrasound to detect inflammation.

Diagnostic signs of tendon sheath inflammation:

• Rotator cuff tendovaginitis: pain increases in the shoulder area with active movement of the arm to the side for more than forty degrees and with free movement of the upper limb towards the chest.
• Lesion of the biceps brachii: increased pain is observed with flexion movements or turn of the forearm inside up.
• Inflammation of the flexor tendons of the fingers: the disease proceeds in a latent form without obvious clinical signs, pain is felt in the palm area, when the fingers are extended, the joint may become jammed, and when returning to the straightened state, a characteristic click.
• Localization in the gluteus muscle: there is pain when pressed in the region of the greater trochanter, there is a change in gait (lameness).

Treatment of tendovaginitis

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 the inflamed surface, this can be done with frozen food, a hot water bottle with cold water or a hypothermic Snowball bag, which can be purchased at the pharmacy. The chronic course is treated with warming procedures in the form of therapeutic compresses or ointments.

Drug therapy for tendovaginitis, which your doctor prescribes, is selected taking into account the clinic of the disease by the attending doctor:

• Non-steroidal anti-inflammatory drugs (Ketaprfen, Diclofenac, Ibuprofen), prescribed in high dosages for a long time.
• Colchicine or Indomethacin is used if the pathology is provoked by gout.
• With severe pain that cannot be relieved by NSAIDs, glucocorticosteroids (Betamethasone, Triamcinolone) are administered into the cavity of the inflamed tendon. Such a procedure is carried out according to strict indications, since the procedure can lead to tendon rupture.
• Antibiotics (Ampicillin, Omoxicillin) are used for infectious forms of inflammation to fight pathogenic microbes.
• Specific treatment may be required if the lungs are affected by Koch's bacillus or sexually transmitted infections.

Surgical treatment of tendovaginitis may be required for persistent pain and limited movement, more often in shoulder joint... During the operation, 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 complemented by a course of massage, UHF, ultrasound treatment. Particular attention is paid to swimming and performing a special set of exercises in water, which is compiled by a medical specialist, taking into account the stage of the disease and the functional state of the patient.

Physiotherapy exercises are 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. The correct dosage of the intensity of movements determines the speed of recovery of the affected tissues. Excessive effort can nullify all previous treatments.

Prevention of tenosynovitis

It is possible to prevent the development of tendovaginitis by observing the well-known rules of a healthy lifestyle:

• Move more, lead an active lifestyle, but avoid heavy loads
• Eat right for the supply of essential nutrients for optimal functioning of internal organs and systems
• Monitor your weight, prevent the appearance of extra pounds
• If it is necessary to perform movements that provoke injury, wear orthopedic devices for prevention
• Timely treat chronic diseases and emerging infections
• Quit smoking and drinking alcohol

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 ...

It's no secret that muscle tendons are located in tendon sheaths. If the inflammatory process extends to these formations (tendon sheaths), then it is called tenosynovitis or tenosynovitis. Tenosynovitis can be acute or chronic... According to the etiological (causal) factor, the disease can be aseptic and infectious. Most often, the place of localization of the pathological process is the hands and feet, forearms, ankles.

Causes diseases of tendovaginitis

Nonspecific aseptic tendovaginitis occurs due to minor injuries to the synovial membrane, formed during prolonged muscle stress, fatigue, muscle strains, prolonged exposure to low temperatures.

The occurrence of infectious tendovaginitis is associated with specific and nonspecific infections. Purulent arthritis, infected wounds, can act as a source of nonspecific infection. A specific infectious process is characterized by the ingress of various pathogens into the tendon sheath infectious diseases(brucellosis,). Also, the cause of tendovaginitis can be a reactive type of inflammation in rheumatism or infectious arthritis.

Clinical signs tenosynovitis a

The main symptoms of the disease are swelling of the tendon sheath, soreness of the tendons, hyperemia and swelling of the skin. If we are talking about infectious tendovaginitis, there is an increase in body temperature, swollen lymph nodes, chills, weakness.

Treatment tenosynovitis a

Treatments for tendovaginitis can be divided into general and local purposes. In the acute course of the disease, the limb must be fixed (immobilized). After that, various physiotherapy methods are prescribed.(warming compresses with paraffin, ozokerite are used, electrophoresis is performed using dimexide solution). For the treatment of chronic tendovaginitis, UHF therapy and the use of Rosenthal's paste are effective.

Medication treatment consists in the use of antibacterial and anti-inflammatory drugs... In addition, pain relievers and vitamin preparations are used.

When choosing a method of therapy, you need to take into account the peculiarities of the course of tendovaginitis. Treatment of specific tendovaginitis is carried out taking into account the characteristics of the underlying pathology. Therapy of nonspecific tendovaginitis is quite often performed by a surgical method. The stage of the inflammatory process in tendovaginitis affects the success of the treatment of the disease. Therefore, the chances of a complete recovery in patients who seek help from a specialist when the first symptoms of the disease appear will be significantly higher than in patients with an advanced form of tendovaginitis.

It is necessary to understand that with a timely visit to the doctor, the risk of complications and the possibility of the transition of tenosynovitis from an acute form to a chronic one decreases.

VIDEO

Treatment of tendovaginitis with traditional medicine

Tendon sheath inflammation therapy folk remedies is an excellent addition to the main treatment of the disease. Before starting self-treatment, you need to consult a medical specialist in order to clarify the diagnosis and predicting possible complications with this method of treatment.

Therapy for tendovaginitis with bile and Rosenthal's paste

First recipe. Rosenthal's paste successfully copes with the task of curing crepitant tendovaginitis. This drug consists of iodine, wine alcohol, paraffin, chloroform. The heated paste must be applied to the site of inflammation, it hardens, then a cotton bandage is applied on top.

Second recipe. The tissue must be soaked in medical bile. The fabric should be thick and soft. Next, the bile-soaked tissue is applied to the painful area. Then this section is wrapped with a warm cloth and compressor paper. After a day, the procedure must be repeated up to 10 times.

Treatment tenosynovitis and homemade ointments

First recipe. In this case, an ointment is prepared from herbs and calendula flowers. The above plant raw materials are crushed to a powdery state and mixed with the required amount of a base (one tablespoon) consisting of petroleum jelly or baby cream... The ointment is applied in the form of compresses or used to lubricate the site of inflammation.

Second recipe. An ointment is also made, which includes the protein of a chicken egg, flour (in the amount of one tablespoon) and a tablespoon of alcohol. Next, all the components of the ointment are mixed and applied to cotton fabric, which should be cut into a strip (like a bandage). This tissue, which is impregnated with the above ointment composition, must be applied to the focus of inflammation. The course of treatment is a couple of weeks. The treatment procedure should be repeated once a day in the evening.

Treatment of tendovaginitis with wormwood ointment and tincture

First recipe. Wormwood tincture has a tonic and anti-inflammatory effect. To prepare the tincture, you need to take two tablespoons of wormwood herb, pour 200 milliliters of boiling water over the raw material and leave for 30 minutes. The tincture is ready. Next, you need to strain it through a filter material. Consume two tablespoons of the tincture 2-3 times a day 30 minutes before meals.

Second recipe. Taking two components: 100 grams of pork fat and 30 grams of dried wormwood herb, you can prepare a medicinal ointment for tendovaginitis. These components must be mixed and the mixture boiled over low heat, then cooled and applied to the affected area.

Therapy of tendovaginitis through infusions and tinctures of medicinal plants

Recipe 1. The use of an infusion consisting of chamomile (calendula), St. John's wort. This infusion has an anti-inflammatory effect. To make the medicine, you need to take 1 tablespoon of St. John's wort and chamomile. Then the plant material is poured with boiling water (in the volume of one glass - 200 milliliters). Infusion is carried out for 30 minutes, then the infusion is filtered and applied in half a glass per reception 2-3 times a day for 1-2 weeks.

Recipe 2. A good anti-inflammatory effect in tendovaginitis occurs as a result of the use of a diluted tincture of calendula. One teaspoon of calendula tincture is diluted in a glass of boiled water.

Recipe 3. Applying an infusion made from the herb of shepherd's purse, in the form of compresses. To get the infusion, you need to pour 200 milliliters of boiling water over one tablespoon of the dried herb of shepherd's purse and leave for several hours. Next, the infusion should be filtered. After that, you can install compresses.

Chronic tenosynovitis

Often, the chronic form of this disease occurs as a complication of acute inflammation of the tendon sheath. In this case, special attention of specialists is required. If tendovaginitis was diagnosed in the early stages of development and its treatment was correct, then the prognosis of the disease will be favorable. Important in the elimination of clinical signs of chronic tendovaginitis has a timely appeal of the patient to a specialist.

Forms, symptoms, localization of chronic inflammation of the tendon sheath

The localization of inflammation in the chronic form of tendovaginitis is the tendon sheaths, which are involved in flexion and extension of the fingers in the place of their retainers. The most common clinical signs of the disease appear in the common synovial vagina of the fingers. located in the carpal tunnel. In this place, an elastic tumor with an oblong shape is felt. By palpating, fluctuation can be detected. Tendons are painful and have limited mobility.

Stenosing tenosynovitis is a form of the disease. In this case, the tendon sheaths of the short extensor muscle and the abductor muscle of the thumb are affected. As a result, the lumen of the synovial cavity decreases.

The first symptom of chronic tendovaginitis is soreness in the area of ​​the styloid process of the radius. By palpating the tendon sheath, a tumor is found, its palpation causes an acute pain in the patient. When abducting and flexing the thumb, pain appears, radiating to the forearm and shoulder.

Clinical signs of stenosing tendovaginitis are similar to symptoms stenosing ligamentitis. With stenosing inflammation of the ligaments, the inflammatory process spreads to the entire ligamentous apparatus of the hand. The disease occurs as a result of injuries, overexertion, infectious diseases.

The site of localization of inflammation is the area of ​​collateral ligaments of the interphalangeal and metacarpophalangeal wrist joints. Movement and palpation of these joints cause pain, and the site of inflammation is characterized by swelling, redness, and swelling. The disease can cause necrosis of some part of the ligamentous apparatus., which is accompanied by a decrease in the sliding of the tendon and difficulty in moving the finger.

Tenosynovitis in tuberculosis is diagnosed by palpation. The so-called "rice bodies" of dense consistency are found in the tendon sheaths.

Chronic tenosynovitis treatment

Therapy of the chronic form of inflammation of the tendon sheath is carried out using physiotherapy methods, applying paraffin compresses, and taking mud baths. Patients are prescribed electrophoresis with lidase, massage. To restore the functions of the joints, exercise therapy is recommended.

If there is an increase in the pathological process, then it is necessary to make a puncture of the synovial vagina. In this case, antibacterial and non-steroidal anti-inflammatory drugs are prescribed. In addition, hydrocortisone and novocaine are injected into the area of ​​inflammation.

If chronic tenosynovitis does not respond particularly well to therapy, then positive dynamics in the treatment of the disease is achieved with the help of X-ray therapy sessions. However, their number should be no more than two. In order to expand the lumen of the tendon sheath with stenosing tendovaginitis, it is advisable to dissect its specific area.

Purulent tendovaginitis can be accompanied by complications: persistent changes in the functions of the feet or hands.