Tendovaginitis treatment. Tenosynovitis of the hand - description, treatment and prevention. Medical treatment of the disease

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

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

And in the muscles that move the joint, their tendons must be in the synovial sheaths. There, due to the production of synovial fluid, the coefficient of friction is reduced to a minimum, and the muscle, contracting, freely “pulls” the tendon, producing mechanical work.

Then the muscle relaxes and its tendon, attached to the head of the bone, easily and effortlessly slides “back” in its sheath, where the tendon is “embedded” - (hence the name), due to the action of gravity and its elasticity.

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Tendovaginitis - what is it?

As usual, the ending "-itis" indicates the inflammatory nature of the process, and the term "tenosynovitis" 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 for this disease can be found:

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

This suggests that tendovaginitis is a complex inflammatory process that affects the muscle tendon and its vagina. In some cases, it is unreasonable to separate tendinitis and tendovaginitis, since the 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 exertion, damage to the neighboring nerve trunks also joins these structures.

So, tendovaginitis of the hand can be complicated by the syndrome carpal tunnel in 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?

Speaking about the possible causes of the inflammatory process in the tissues of the musculoskeletal system, the following should be mentioned:
overvoltage, microtrauma. There is a non-microbial, aseptic inflammation. It is often caused by prolonged mechanical action.

Such are 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 occurs 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 a load.

An example would be psoriasis, systemic scleroderma, and other diseases. connective tissue. As in the first case, this inflammation is aseptic, non-microbial in nature.

• microbial inflammation. Specific infectious tendovaginitis may occur due to 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. It most often appears with local migration of pathogens from arthritis, bursitis. Sometimes spilled soft tissues lead to purulent streaks in the tendon sheaths with the development of tendovaginitis after injury;

Clinical signs of tendovaginitis

tendovaginitis of the wrist joint photo

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

In the same way, it is necessary 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 become chronic.

The "classic" symptoms of tendovaginitis are manifested by the following signs:

• The synovial sheaths of the corresponding tendons swell and swell. This edema is aggravated after exercise and during movement;
• Movement becomes painful. This is especially true for aseptic and professional tendovaginitis. If we talk about bacterial processes, then pain is possible at rest. The "pulling" 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 signs such as redness and a feeling of local heat may also appear;
• As a result of swelling and pain, there is a limitation of joint function due to a decrease in 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 has a fever, weakness, lethargy, and refusal to eat. Swelling of regional lymph nodes is possible.

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

There are several varieties of the disease that occur, not “so scary”, however, they have their own characteristics and localization. These include crepitus and de Quervain's tendovaginitis.

What is special about the crepe form?

In medicine, there is a term called "crepitus". It denotes a special kind of quiet, pathological sound. After all, before one of the most important ways examination by the patient's doctor was auscultation of the lungs using a phonendoscope.

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

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

In the same way, with crepitating 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 back of the hand, the vagina of the biceps is affected. Sometimes this happens when the tendons of the foot are affected, when tendovaginitis of the ankle joint develops.

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

Tenosynovitis de Quervain (stenosing)

The second name for this process is “stenosing”, that is, narrowing tendovaginitis. It is particularly painful and is located in a special, "unfavorable" place. This place is located in the area of ​​​​the thumb. There exist such anatomical features which lead to thickening of the vaginal walls.

As a result, the cavity that is available for tendon movement becomes narrowed. As a result, there are pronounced pains when bringing the finger to the palm and opposing it to others. The zone of greatest pain is determined above the navicular bone.

Stenosing tendovaginitis is almost always aseptic and occurs as a result of intense exercise.

Tenosynovitis of the wrist joint, features

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

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

• Nocturnal and daytime complaints of paresthesia, "crawling crawling", pain in the fingers and hand, especially in the II and III fingers;
• Reduced pain and tactile sensitivity in the tenar and thumb;
• Sometimes there is hypotrophy of thenar, that is, the palmar elevation of the thumb.

In order to “provoke” median nerve ischemia, you can raise your outstretched arms above your head and hold them in this position for 1 minute. There will be pain on the affected side.

In addition, you can put a cuff to measure blood pressure, and after the disappearance of the pulse on the radial artery after 30 seconds - 1 min. pain occurs.

About general diagnostics

The diagnosis is usually made clinically, based on the patient's complaints, history, signs of inflammation, and specific signs such as crepitus. In the case of a microbial process, a puncture is performed, with bacteriological seeding 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, and an increase in ESR.

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

Treatment of tendovaginitis - drugs and methods

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.

With an anesthetic purpose, anti-inflammatory drugs are prescribed topically, orally and intramuscularly. nonsteroidal drugs. In addition, they contribute to the elimination of inflammation and swelling. Ketanov has the greatest analgesic activity, and Ketorol and Movalis have anti-inflammatory activity.

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

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

After reducing 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 drainage of wounds.

In the event that inflammation has become a chronic process, spa 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 when running infectious lesions, with purulent fusion of the tendons and the inner lining of the vagina.

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

Therefore, at the first sign acute inflammation you need to immediately give the limb a rest, and consult a doctor - a traumatologist or surgeon.

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. Possible swelling and elevation local temperature. With infectious tendovaginitis, symptoms of general intoxication are observed, non-infectious ones proceed without disturbance. general condition patient. Treatment depends on the form and variant of the course of tendovaginitis and can be both conservative and operative.

ICD-10

M67 Other synovial and tendon disorders

General information

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.

Causes of tendovaginitis

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 due to trauma. ligamentous apparatus(sprain or bruise).

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.

Pathoanatomy

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 not a large number of oily liquid. 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.

Classification

Taking into account etiological factor allocate:

• Aseptic tendovaginitis, which, in turn, can be professional, reactive and post-traumatic.
• Infectious tendovaginitis, which are divided into specific and nonspecific.

Given the nature of the inflammatory process, there are:

• Serous tendovaginitis.
• Serous-fibrinous tendovaginitis.
• Purulent tendovaginitis.

Taking into account the course, acute and chronic tendovaginitis are distinguished.

Types of tendovaginitis

Acute aseptic tendovaginitis

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. At adequate treatment 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 turns into chronic form.

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.

Acute post-traumatic tendovaginitis

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 a significant hemorrhage in the tendon sheath) perform a puncture to remove the accumulated blood. Symptoms of post-traumatic tendovaginitis completely disappear within a few weeks.

Chronic aseptic tendovaginitis

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 sensory disturbances in the I-III and 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. AT 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

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.

Acute nonspecific infectious tendovaginitis

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. AT 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, in rehabilitation period prescribed exercise therapy with gradual increase therapeutic load.

Description of the disease

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.

Characteristic pain syndrome accompanies movement or is felt during palpation of the diseased area. The 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 muscle fibers, the tendon forms a thickening in the form of a flexible tunnel, called the tendon sheath. Inner surface The vaginal bursa is covered with a synovial membrane that produces a small amount of fluid that 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.

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 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:

1. Frequent movements with tension, performed along one 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 varying degrees severity;
4. The impact of the pathogen in osteomyelitis, septic inflammation of the joint, abscess, felon;
5. Specific infections: gonorrhea, brucellosis, tuberculosis, the irritant passes through the blood or lymphatic vessels to the tendon;
6. The risk of tendovaginitis increases with rheumatism, gout, ankylosing spondylitis, systemic scleroderma;
7. Elevated blood glucose levels (diabetes mellitus);
8. Violation of protein metabolism with deposition in the tissues of amyloid (protein compound);
9. Significant excess of cholesterol in the blood;
10. Taking quinolone antibiotics (Norfloxacin, Levofloxacin, Moxifloxacin).

Forms of pathology

AT medical practice tendovaginitis is classified according to the etiology, duration of the disease and clinical signs. The inflammation can be acute and chronic. The acute form is characterized sudden appearance intense pain, the rapid development of bright 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:

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

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 represents clear liquid, in which the 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.

Disease Clinic

The symptoms of tendovaginitis are different and depend on the etiology of the pathology. Common signs 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 appears sharp pain. In the absence of effusion, crepitus is present in the tendon, which can be heard with a stethophonendoscope.

Acute non-specific form

Sudden pain in the inflamed tendon appears along with severe 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.

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The most common localization of acute non-specific form tendovaginitis - outer side hands and feet, tendons located on the fingers are less likely to become inflamed. When the hand is damaged, 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 organism 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 current 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 on a chronic course with repeated mechanical damage tendons 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. long current chronic stage in the tumor-like formation, one can feel 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 carried out on the basis of symptoms, specific pain tests, percussion and palpation methods, as well as an external examination of the patient. From instrumental research MRI is used to rule out tendon ruptures and ultrasound to detect inflammation.

Diagnostic signs of inflammation of the tendon sheath:

• Rotator cuff tendovaginitis: pain intensifies in the shoulder area with active movement of the arm to the side more than forty degrees and with free movement of the upper limb towards the chest.
• Damage to the biceps of the shoulder: 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 be jammed, and when returning to a straightened state, a characteristic click.
• Localization in the gluteal muscle: there is pain when pressed in the area 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 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 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:

• 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.
• At severe pain, non-removable NSAIDs, an introduction into the cavity is prescribed inflamed tendon glucocorticosteroids (Betamethasone, Triamcinolone). This procedure is carried out according to strict indications, as the procedure can lead to tendon rupture.
• Antibiotics (Ampicillin, Omoxicillin) are used for infectious forms inflammation to fight pathogenic microbes.
• Specific treatment may be required for lesions of the lungs with Koch's bacillus or venereal infections.

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. Special meaning is given 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 functional state sick.

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.

Prevention of tendovaginitis

It is possible to prevent the development of tendovaginitis if well-known rules are observed. healthy lifestyle life:

• Move more, be active, but avoid strenuous exercise
• Eat right for admission essential substances for optimal functioning internal organs and systems
• Watch your weight, avoid the appearance of extra pounds
• If necessary, perform movements that provoke injury, wear orthopedic appliances for prevention
• Timely treat chronic diseases and emerging infections
• Stop smoking and drinking alcohol

When the first symptoms of tendovaginitis appear, consult a doctor for diagnosis and proper treatment.

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Tendovaginitis is an inflammatory disease. It affects the tissues of the tendons and their sheaths. In another way, the sheath covering the tendon is commonly called the vagina. It consists of connective tissue and is a kind of soft tunnel. This is the main difference from tendinitis and tendinosis, in which the pathological process affects only the tendon tissues.

Origin mechanism

The disease does not develop in all tendons, but only in those in which there is a vagina. Most often, tendovaginitis of the foot, ankle, knee, and joints of the hands is diagnosed.

Chronic tendovaginitis is often found in people whose activities are associated with the performance of monotonous work. Until the tendovaginitis of the tendon has become chronic, the treatment is easy, but as the pathology progresses, this process becomes more complicated.

tendovaginitis knee joint or other articulation develops in the inner layer of the shell, which produces a special fluid needed to lubricate the tendons. The outer leaf is not involved in the process. Inside, due to inflammation, not a normal lubricating fluid is produced, but prostaglandins that cause pain, swelling and redness of the skin in this area.

Reasons for the development of the disease

Etiology of tendovaginitis hip joint or other joints is varied. The main factors that can provoke a violation are:

• Postponed tendon injuries;
• Nonspecific infections that are present in the body for a long time, but did not cause the disease;
• A specific infectious process, accompanied by the presence of an abscess in nearby bones;
• Long-term microtrauma of the tendons;
• Systemic pathologies of the body.

On a note!

Any injury reduces defensive forces joints and tendons, so you should consult a doctor.

The infection can also enter the synovium and tendon structure through the bloodstream. This route of infection is called hematogenous. Any past pathologies, after which the infectious agent remains in the body, can cause the development of tendovaginitis.

Disease can be caused by others inflammatory diseases. Sometimes the cause is rheumatism or rheumatoid arthritis.

Disease classification

The ICD-10 code for tendovaginitis is as follows: M65.2, M75.2-3, M76.0-76.7. Accurate diagnosis in medical card brought by the doctor after the examination.

Classification involves the division of the disease into types, depending on the causes, the nature of the inflammatory process and the duration of the course. Depending on the cause, the following categories of the disease are distinguished:

• infectious type;
• Aseptic.

Crepitating tendovaginitis refers to the aseptic form. Accompanied by serous-hemorrhagic inflammation, pus accumulates. According to the nature of the flow, the following forms are distinguished:

• Purulent;
• Serous;
• Serous-fibrous.

The purulent form of tendovaginitis is the most dangerous. A severe infectious process begins inside the tendon. The accumulation of pus begins.

With a serous form of inflammation of the tendon sheath, the pathological process covers the inner sheet of the synovial membrane of the tissue. A serous fluid is released.

With serous-fibrous forms, fibrin plaque is formed on the sheets of the shell. Because of this, friction of the tendons increases, which increases inflammation and unpleasant symptoms.

Tendovaginitis can be acute, subacute and chronic. The acute form lasts for one month, with subacute symptoms persisting for up to six months. Chronic tendovaginitis is a form of the disease that lasts more than 6 months.

Symptoms of tendovaginitis

The sooner a person pays attention to signs of damage to the tendon sheath, the faster the condition can improve. Symptoms depend on which tendon is involved in the inflammatory process and in what form the disease proceeds.

Features of the acute form of pathology

Acute tendovaginitis of the Achilles tendon develops against the background of the injury. Color skin over the inflamed tissues does not change, there is a slight swelling. Pain occurs only when active movements are performed. At rest, symptoms are often absent.

If the pathology begins to progress, the symptoms become brighter. The symptoms are especially noticeable in the purulent form of the disease. The following manifestations occur:

• The skin turns red;
• The local temperature rises;
• The skin is stretched from swelling and shines;
• Pain worries even at rest.

Less commonly, patients report a general deterioration in well-being, decreased appetite and weakness. Sometimes the lymph nodes are enlarged.

Features of the chronic form

Chronic course is possible with aseptic tendovaginitis. The pain is not strong, it occurs locally at the site of inflammation. If you feel this area, you can detect the onset of crepitus. There are no clear signs of illness. The nature of the symptoms depends on which tendon is involved in the process.

With stenosing tendovaginitis of the flexors of the fingers, pain occurs in the wrist joint. More often formed the field of injury. With damage to the hamstring muscle discomfort appear when walking up the stairs or after jogging. Inflammation of the synovial membrane of the tendon of the thigh occurs more often in women than in men.

Diagnostics

The doctor will tell you how and how to treat tendovaginitis only after a thorough diagnosis. As can be seen in the photo of the disease, the symptoms are clearly visible. An experienced rheumatologist, orthopedist or traumatologist can immediately make a diagnosis. You can see severe redness, swelling.

To make an accurate diagnosis, the doctor will prescribe the following diagnostic procedures:

• Complete blood count and biochemistry;

Can be carried out bacteriological culture exudate that accumulates in the foci of inflammation. Such an analysis will reveal the nature of the pathogen and select the appropriate therapy.

Interesting!

The list of necessary diagnostic procedures is determined by the doctor. Not all methods described are always necessary.

An x-ray is needed to rule out arthritis and. Some external signs similar, but after diagnostic procedure the diagnosis becomes clear.

Treatment of pathology

Treatment of tendovaginitis is carried out after an accurate diagnosis is made. Patients undergo therapy in a hospital setting. Only joint efforts will prevent the development of complications, including tendobursitis, and the progression of the disease. It is worth considering the most commonly used methods and their effectiveness.

Medical therapy

Treatment of tendovaginitis always includes the use of medicines. However, to get rid of purulent form pathology of this method is not enough.

The following medications are used:

• Anti-inflammatory and analgesic drugs (Diclofenac, Paracetamol, Nimesil);
• Hormonal painkillers (Dexamethasone);
• Antibacterial agents (cefazolin, ceftriaxone).

Puncture

Puncture is an intermediate technique between surgical treatment and drug therapy. Although it is possible to reduce symptoms by this method, complete cure cannot be achieved.

The inflamed area is punctured. Before that, an anesthetic is injected into the injection site of the needle. This allows you to stop the progression of the pathology and protect the surrounding healthy tissue.

Operation

The operation is performed in the presence of the following indications:

• Purulent inflammatory process;
• Persistent deformity of the tendons, not corrected by medication.

The operation is carried out as a matter of urgency. Preparation includes monitoring blood sugar levels, blood pressure, and blood tests. Anesthesia can be local or general. Layered incisions are made for tendovaginitis, rinsing with antiseptics is done, tissues are sutured.

Physiotherapy

Shock Wave Therapy – milestone in recovery after surgery. The impact of ultrasound, electrophoresis, UHF is carried out. Usually 7 to 14 treatments are required.

Folk remedies

Treatment of tendovaginitis with folk remedies is permissible only at the recovery stage. sharp shape should be treated medically.

After the operation, you can use an alcohol compress. Can't hit wound surface. The alcohol concentration should not exceed 20%. Improves blood microcirculation and activates the lymphatic drainage system.

Mud applications on the affected tendon and iodine mesh have a beneficial effect. Any folk recipes should be used only after a doctor's prescription.

During treatment, it is important to reduce the load. You can use compression bandages that support large joints.

Tendonitis (tendinosis) is a degenerative process in the tendon tissue.

Tenosynovitis is an inflammation of the tendon that occurs in the area covered by the synovial membrane.

Upon contact with an infectious agent or reactive changes, the synovial membrane begins to produce fluid - exudate or transudate.

Tendonitis and tendovaginitis can occur primarily or secondarily, as complications of arthritis and a number of other diseases.

Most often, inflammation of the tendons occurs as a result of injuries. The presence of serious damage is not at all necessary - microtraumas of tendons, muscles, connective tissue and blood vessels that occur during intense sports training or physical work.

With normal rest, these changes disappear. With an irregular process of training or work, damage accumulates (chronic injury), inflammation can occur in this place - tendonitis.

On the initial stages as a result of intense overload, there is swelling of the connective tissue and splitting of collagen fibers, changes in the mucous membrane. These manifestations are most pronounced in the places of attachment of the tendons to the bone. Subsequently, areas of necrosis appear in them with the deposition of calcium salts, mucous, fibrinoid or hyaline degeneration with the replacement of the central part of the tendon with a jelly-like mucous sediment (fatty degeneration).

Salt deposits usually occur in places where tendon microfractures have previously occurred. Since they are solid formations, they can further injure the surrounding tissues, contributing to the spread of the process.

With continued intense workloads cartilage tissue between the fibers of the tendon is reborn, hardens, bone growths appear - osteophytes, spikes and bone spurs. Similar changes can often occur in rheumatoid, reactive and gouty arthritis.

With tendovaginitis, as a result of inflammation, the synovial membrane begins to produce fluid - exudate or transudate. The process of its development is called exudation or transudation, respectively. Transudate is released during aseptic processes (aseptic tendovaginitis), exudate - during infectious (infectious tendovaginitis).

Transudate is a non-inflammatory fluid that begins to be produced during aseptic inflammation due to impaired blood and lymph circulation, water-salt metabolism, or increased permeability of vessel walls. It differs from exudate by a low concentration of protein (no more than 2%). The formation of a transudate may be the result, for example, of excessive physical activity, after which tissue edema occurs, followed by the production of fluid by the synovial membrane.

Aseptic tendovaginitis can be acute (acute crepitant) and chronic (chronic stenosing).

Exudate begins to be produced when an infectious agent is attached and is defense mechanism. It is a cloudy liquid containing a large amount of protein and formed elements.

Depending on the predominance of various cellular elements, it can be: serous, purulent, hemorrhagic, fibrinous or mixed.

For acute infectious processes in the exudate, neutrophilic leukocytes predominate, in chronic - monocytes and lymphocytes, in allergic - eosinophils. There may be a breakthrough of exudate from the focus with the spread of inflammation to the surrounding tissues. Thus, not only tendovaginitis can be a consequence of arthritis, but vice versa.

A large accumulation of exudate or transudate can compress surrounding tissues, impairing their function and causing pain. With proper and timely treatment, the liquid is completely absorbed, leaving no changes behind.

Causes of tendonitis and tendovaginitis

1. Excessive stress on the tendon. This is the most common cause of tendonitis and tendovaginitis. As a result of chronic microtrauma, aseptic inflammation occurs. Athletes and people involved in intensive sports are most susceptible to the disease. physical labor with a load on certain tendons (for example, typists, window cleaners and some others).
2. arthritis and bursitis. Moreover, rheumatoid, reactive, and gouty processes, ankylosing spondylitis are the causes of tendonitis. Infectious and traumatic lesions often lead to tendovaginitis.
3. Other diseases musculoskeletal system(eg, poor posture, skeletal malformations).
4. infectious processes. These include the ingress of pyogenic microflora during injuries or the spread of a purulent process from neighboring purulent foci (for example, with purulent arthritis, osteomyelitis, panaritium, and others) or specific types of inflammation (tuberculosis, syphilis, and others).
5. Other, rarer causes: toxic lesions(for example, with), penetrating wounds in the tendon and others.

Classification

Depending on the nature of the course, the disease can be:

• sharp;
• chronic.

Symptoms of the disease

Symptoms of tendonitis and tendovaginitis include:

Diagnosis begins with examination, detection of pain during active movements and palpation, swelling at the site of the tendon.

Laboratory tests do not reveal any changes, except when the tendinitis is associated with a rheumatoid or infectious process.

X-ray of the affected tendon often does not reveal any changes. They may occur on late stages when calcifications have already appeared in the affected area. If the process began as a result of arthritis or bursitis, then appropriate changes can be identified. Heel spurs are found in tendinitis and tendobursitis of the Achilles tendon or tendon of the plantar muscle. With tendinitis of the patellar ligament own ligament, signs are possible aseptic necrosis tibial tuberosity ().

It is often necessary to resort to magnetic resonance imaging and computed tomography. It reveals areas of degenerative changes, tendon ruptures that require surgical intervention. To identify stenosing tendosynovitis, these methods are not very informative.

An ultrasound examination of the tendon is additional methods, with its help it is possible to detect a contraction of the tendon or a change in its structure.

With tendonitis of the flexors and pronators of the forearm (medial epicondylitis), the pronator teres, radial and ulnar flexors of the wrist and long palmar muscle are affected. The disease results from chronic irritation of the medial epicondyle with reactive inflammation of the site of attachment of the flexor muscles.

Main cause of tendinitis of the forearm- excessive hallux valgus. Often found in some sports (golf - "golfer's elbow", tennis, baseball, table tennis, squash, gymnastics).

Forearm tendinitis symptoms:

• pain along the inner edge of the elbow, which may radiate up along the shoulder or down along the outer part of the forearm;
• pain on palpation in the area above the medial part of the epicondyle humerus and bending the brush down;
• weakness in the area of ​​\u200b\u200bthe brush (up to the point that there are difficulties in raising the cup, shaking hands);
• ulnar neuritis often occurs.

Most frequent causes of wrist extensor tendonitis(lateral epicondylitis) - playing some sports (tennis - "tennis elbow", badminton, golf, table tennis and others). The pathogenesis is based on repetitive trauma to the extensor muscles, especially the short radial extensor of the hand. Fibrosis develops in response to chronic irritation. Other muscle groups may also be involved in the process: the common extensor of the fingers, the long radial extensor and the ulnar extensor of the hand.

Symptoms of tendonitis of the wrist:

• pain along the outer edge of the elbow, which may radiate up along the shoulder or down along the outer part of the forearm;
• pain on palpation in the area above the lateral epicondyle of the humerus and on the outer part of the elbow when the bent middle finger is extended over resistance;
• weakness in the area of ​​\u200b\u200bthe brush (up to the point that there are difficulties in raising the cup, shaking hands).

X-ray of the affected joint usually does not reveal any changes. Magnetic resonance imaging is used to clarify the nature and localization of the lesion.

A predisposing factor to the occurrence of temporal tendinitis is the habit of chewing nuts, seeds or other solid foods. Also common causes diseases can be malocclusion and other diseases of the teeth and jaws.

There are unilateral and bilateral cases of temporal tendinitis.

Symptoms of temporal tendinitis

Pathology has the following manifestations:

• pain in the cheek area, which increases with chewing and talking, less often, pain can be localized in other areas of the head and neck;
• pains radiate (“give”) to the teeth, head, neck;
• soreness is especially enhanced by taking rough, solid food;
• headaches and toothaches;
• the nature and intensity of pain is individual and can vary greatly in different patients.

Due to the non-specificity of manifestations, temporal tendinitis is often mistaken for toothache, trigeminal neuralgia or occipital nerves, damage to the stylomandibular ligament (Ernest's syndrome). Therefore, most often with temporal tendonitis, patients turn to a dentist or neurologist.

Also, the symptoms of the disease can be attributed to the presence, stretching of its capsule or ligaments.

Manifestations of temporal tendinitis are reduced by stopping the use of solid foods. For the duration of treatment, conversations should be limited as much as possible.

In the treatment of the disease are used:

• facial massage;
• physiotherapy procedures on the area of ​​the temporomandibular joints;
• drugs with anti-inflammatory and analgesic effect (indomethacin, ibuprofen, nimesulide and others).

In the absence of manifestations of arthrosis in the temporomandibular joints, therapy for temporal tendinitis usually takes 7-10 days.

Acute aseptic (crepitant) tendovaginitis

Usually, crepitating tendovaginitis affects the synovial sheaths, which are located on the back surface of the hand, less often on the feet, sometimes on the intertubercular synovial sheaths of the biceps brachii muscle.

Symptoms of acute aseptic tendovaginitis:

• acute onset;
• swelling in the area of ​​the affected tendon, on palpation of which, during the movement of the thumb, a crunch is determined;
• movement of the thumb is limited and painful.

Often the process can become chronic.

Acute infectious tendovaginitis

An acute process often occurs in the sheaths of the tendons of the back surface of the hands and feet, less often in the flexors of the fingers, synovial sheaths of the fingers. Purulent inflammation usually develops on the hand.

Characteristic symptoms of acute infectious tendovaginitis

With the progression of purulent inflammation on the hand, it can spread to the forearm. With purulent tendovaginitis of the little finger of the hand, it may occur.

Most often localized in the sheaths of the tendons of the extensor and flexor fingers in the area of ​​their retainers. The most typical chronic tendovaginitis of the common synovial sheath of the flexors of the fingers located in the carpal tunnel.

Symptoms of chronic tendovaginitis of the common synovial flexor sheath:

• in the area of ​​the carpal canal, a painful tumor-like formation of a longitudinal shape and elastic consistency is determined;
• fluctuation may be noted on palpation, rice bodies are palpated;
• movement restriction.

Other forms of chronic tendovaginitis include de Quervain's disease and ulnar styloiditis.

De Quervain's disease is a stenosing tendovaginitis of the short extensor and long abductor thumb muscles, which is accompanied by thickening of the walls and narrowing of the cavity of the I canal of the dorsal carpal ligament.

Symptoms of de Quervain's disease:

• sharp painful swelling along the tendon sheath;
• pain during extension and abduction of the thumb;
• pain on palpation of the styloid process of the radius;
• pain during abduction and extension of the thumb, shifting to the forearm and shoulder;
• pain when bringing the ends together index finger and little finger.

Ulnar styloiditis - definition and symptoms

Elbow styloiditis- this is stenosing tendovaginitis of the ulnar extensor of the hand, accompanied by a narrowing of the VI channel of the dorsal ligament of the wrist.

Symptoms of the disease are manifested in pain and swelling in the region of the styloid process of the ulna.

It is also known as "jumper's knee".

Symptoms of knee tendonitis:

• pain in the area of ​​the tibial tuberosity when walking, running, going down stairs;
• pain when touching the tendon, as well as with active extension;
• in the initial stages - pain occurs during physical exertion, in the future they can disturb almost constantly;
• swelling of the tendon in the area of ​​the tuberosity of the tibia - with severe injuries.

X-rays are used to detect calcification within the tendon. For more accurate diagnosis magnetic resonance imaging is performed.

Treatment should include limiting exercise stress on the tendon. Physiotherapeutic procedures (ultrasound, cold) are also used, drug therapy(non-steroidal anti-inflammatory drugs). Corticosteroid injections are contraindicated (because they may contribute to tendon rupture). Therapeutic exercises, which include stretching the quadriceps muscles, eccentric strengthening exercises.

With significant damage in the center of the tendon, mucous degeneration develops, and severe swelling occurs. At this stage, as a rule, surgical intervention is necessary. The degenerative part of the tendon is excised, reconstructing the remaining tendon. In the patellar ligament, this degeneration occurs at the lower pole of the patella or distally at the attachment to the tibial tuberosity.

Achilles tendonitis (thalalgia)

The full name is tendinitis of the Achilles tendon and tendons of the plantar muscles (thalalgia).

Symptoms of Achilles tendonitis:

• pain when stepping on the heel and when bending the sole;
• local swelling - with concomitant Achilles bursitis and subcalcaneal bursitis.

Tendonitis of the quadriceps tendon

The process can occur at the site of attachment of the quadriceps tendon to the upper pole of the patella. Unlike tendonitis of the patellar ligament, this condition usually occurs in people who experience excessive loads on the tendon for a long time.

The symptoms are similar to those of patellar ligament tendinitis. As a result of degenerative changes, the process often ends with a tendon rupture.

This is a stretch of the tendon of the posterior tibial muscle, located along inside lower leg and inner ankle. It develops with prolonged overstrain of the muscles of the lower leg, pronation of the foot due to flat feet, tendon sprain, chronic microtrauma.

Symptoms of post-tibial tendinitis:

• pain and swelling in the tendon area, which in the initial stages stop or decrease after rest, with a far advanced process they become permanent;
• Pain can be aggravated by carrying weights, running.

Treatment includes the use orthopedic shoes with a reinforced heel and arch support, wearing insoles.

Since the posterior tibialis muscle supports the arch of the foot, the disease can lead to the development of flat feet and cause overpronation of the foot, pain in the heels and in the arch of the foot, plantar fasciitis and heel spurs.

In the early stages of tendonitis, conservative methods:

To surgical methods treatment they resort to severe degenerative changes in the tendons, stenosing tendinitis, the presence of Osgood-Schlatter disease, as well as tendon rupture. At the same time, the damaged area and scar tissue excised. After the operation, rehabilitation is carried out, which usually lasts 2-3 months. It includes therapeutic exercises with exercises for gradual stretching and strength development. Complete physical training are resolved not earlier than in 3-4 months.

The basis of the treatment of any tendonitis is the rejection of excessive physical exertion on the tendon. In chronic and recurrent processes, the appearance of complications, you should think about changing your profession or choosing another sport.

Forecast

Forecast with timely and proper treatment- favorable. In case of non-compliance physical limitations tendonitis can be complicated by tendon ruptures. With purulent tendovaginitis, persistent dysfunction of the hand or foot often remains.