NPSV tendovaginitis in their treatment. Acute infectious tendovaginitis. Nonspecific tendovaginitis, occurring in an acute form

What is this disease? What causes tendovaginitis and what are its symptoms?

You probably know that muscle tendons lie in the so-called tendon sheaths. Their inflammation is called tendovaginitis of the tendons or tendosynovitis. This disease can be acute or chronic, infectious or aseptic. It especially affects the hands and feet. Often the area of ​​\u200b\u200bthe forearm, wrist joint, ankle joints, Achilles tendon suffer from it.

Causes of tendovaginitis

In non-infectious tendovaginitis of the tendons, aseptic inflammation is caused by injuries or microtraumas of the synovial membrane, which occur during intense muscular work, overwork, hypothermia, and muscle strain.

In the infectious form of tendovaginitis, the cause of the disease is a nonspecific or specific infection. In the first case, its source is panaritiums, purulent arthritis, wounds, pustules or cracks in the skin, osteomyelitis.

At specific infections(tuberculosis, brucellosis, syphilis, etc.) microorganisms penetrate into the synovial vagina with blood flow from the main focus of infection.

Sometimes tendovaginitis develops as a reactive inflammation, such as in rheumatism or infectious arthritis.

Symptoms of tendovaginitis

The patient is concerned about soreness along the tendon, swelling in the area of ​​the tendon sheath, swelling and redness of the skin. With infectious tendovaginitis, there is an increase in body temperature, chills, an increase and soreness of regional lymph nodes, and a deterioration in well-being.

Symptoms of acute tendovaginitis

All acute tendovaginitis is characterized by rapid development with a pronounced pain reaction and impaired motor function.

Infectious acute tendovaginitis manifested by painful swelling in the area of ​​the tendon sheath. The tendon sheaths of the back surface of the hands or feet are more often affected, less often the fingers or flexors of the hand. Inflammation and swelling can spread to the forearm, and if localized on the foot, to the lower leg. The patient complains of malaise, chills, fever. There is an increase and soreness of nearby lymph nodes. The fingers of the affected limb are limited in mobility.

The disease may develop from serous inflammation to purulent tendovaginitis with a severe general condition. In this case, the infection spreads to the forearm with a lesion of the so-called Pirogov's fascial space. With purulent tendovaginitis, the patient has a fever, general intoxication, severe pain at the site of inflammation, swollen lymph nodes.

Aseptic acute tendovaginitis also develops rapidly, but there is no fever, chills with it. Most often it affects the tendon of the long adductor of the thumb and its short extensor. This form of the disease is also called crepitant tendovaginitis due to the characteristic crunching that occurs with it during the movement of the fingers. It is often associated with the professional activities of people doing work involving some one muscle group. With such tendovaginitis of the hand, patients are worried about pain in the lower outer area radius radiating to the thumb and forearm.

It is believed that tendovaginitis of the foot is less common. The tendons of the long common extensor of the fingers and the anterior tibial muscle are most often affected. With this tendovaginitis, the symptoms are similar to those described above. They range from mild swelling, clumsiness and mild crepitus to significant swelling along the course of the tendons and swelling of the foot and lower leg.

Symptoms of chronic tendovaginitis

All chronic tendovaginitis develops with untimely or improper treatment acute. Often they occur in people whose work is associated with a prolonged load on one muscle group (typists, pianists, seamstresses, etc.).

A typical picture of chronic crepitating tendovaginitis happens when it is localized in the area of ​​\u200b\u200bthe common sheath of the flexors of the fingers, located in the carpal tunnel. At the same time, a painful swelling of an elastic consistency is visible in the wrist area. The movements of the affected tendons are limited, the skin is swollen and reddened.

Upon transition to chronic form tendovaginitis of the hand with a lesion of the sheath of the tendon of the long adductor of the thumb and its short extensor, stenosing tendovaginitis of de Crevin develops. At the lower outer edge of the radius, an oblong, dense and painless tumor is formed. Thumb movements are painful.

Another form of stenosing tendovaginitis occurs when the annular ligament of the flexors of the fingers is affected. I, III, IV fingers are most often affected. The extension and flexion of the fingers are disturbed, clicks appear during their movements.

Transition tendovaginitis of the foot in the chronic form is associated more often with ineffective treatment. Foot movements become painful and difficult. Palpation is determined by the compaction and thickening of the tendon.

With tendovaginitis caused by tuberculosis infection, characteristic formations called rice bodies are felt along the affected tendon sheaths.

For various forms tendovaginitis symptoms are quite characteristic. Thanks to this, an experienced doctor can make a correct diagnosis already during the examination. In some cases, X-rays are additionally performed and clinical researches to differentiate acute or chronic tendovaginitis from arthritis or osteomyelitis

Treatment of tendovaginitis

Let's talk about how to treat tendovaginitis of various forms. All methods of therapy used in this case can be divided into general and local. With tendovaginitis, treatment in the acute period begins with immobilization of the limb. When the acute period is over, local physiotherapeutic and warming procedures are carried out: paraffin, ozocerite applications, electrophoresis with dimexide, UHF, treatment with Rosenthal paste. With crepitating tendovaginitis, this gives an effect.

General therapy includes antibacterial and anti-inflammatory drugs, painkillers and vitamins.

Depending on the type of tendovaginitis, the treatment has its own characteristics. With specific tendovaginitis, it is carried out in accordance with the etiology of the disease. Treatment of nonspecific infectious tendovaginitis is often surgical. It is important to consult a doctor as soon as possible at the first symptoms of the disease. The question of how to treat tendovaginitis in each case should be decided by a specialist.

Treatment of acute tendovaginitis

The affected limb must be kept as quiet as possible. For this purpose, a plaster splint is applied for a period of up to 10 days. Novocaine is administered locally, in some cases hydrocortisone and hyaluronidase. After the acute symptoms subside, heat (compresses, paraffin, ointments) and physiotherapy procedures are prescribed.

For nonspecific infectious tendovaginitis, antibacterial drugs, vitamins, restorative therapy, painkillers. If necessary, surgical treatment is applied.

What if you can't see a doctor right away? First of all, it is necessary to provide rest to the sick limb with the help of a splint. To do this, you can use a ruler, cardboard, a small board as it. It must be applied so that at least two joints are fixed.

When the acute period has passed, the pain has decreased, and you have removed the splint, apply treatment with warm compresses and ointments.

Can tendovaginitis treat folk remedies or not? In order not to overlook the infectious form of the disease, be sure to first consult with a specialist. After all infectious form diseases can turn into purulent inflammation and end surgical operation. In some cases, for example, with folk remedies, it is used successfully.

Treatment with folk remedies

There are situations when the question arises of how to treat tendovaginitis without the use of drugs. In case of drug intolerance or allergy to antibacterial drugs, one has to turn to medicinal plants. ethnoscience recommends when tendovaginitis treatment with folk remedies in the form of infusions of herbs, decoctions, ointments, compresses.

Here are some recipes:

Recipe number 1. Treatment of tendovaginitis with calendula ointment

To prepare the ointment, equal amounts of dry calendula flowers and baby cream, mix well. The ointment is applied to the affected surface and, covered with a bandage, left overnight. It has anti-inflammatory and antimicrobial effects.

Recipe number 2. Treatment of tendovaginitis with wormwood tincture

Take two tablespoons of dry herb wormwood, insist for half an hour, adding 200 ml of boiling water. Then the infusion is filtered and allowed to drink a tablespoon before meals 2-3 times during the day. It has anti-inflammatory and tonic effect.

Recipe number 3. Treatment of tendovaginitis with the help of compresses and lotions with infusion of shepherd's purse herb.

The infusion is prepared by taking a tablespoon of herbs for 200 ml of boiling water. Infuse in a thermos or in a water bath for 2 hours. Filter and apply as a local treatment in the form of compresses for the night or lotions.

Recipe number 4. Treatment of tendovaginitis with wormwood and lard ointment

An ointment is prepared by taking 100 g of internal lard 30 g dry wormwood. Everything is boiled over low heat, cooled, applied to sore spot.

Recipe number 5. Compresses with medical or bear bile for the treatment of tendovaginitis

Bile is heated in a water bath and a compress is made with it in the usual way on a sore spot. Keep it through the night. Bile has a resolving and anti-inflammatory effect. At tendovaginitis crepitus treatment with the help of such compresses gives a good result.

To prevent the disease, try to avoid overwork during work, injuries and sprains of the tendons. During the treatment of wounds and cracks on the skin of the extremities, preventing the development of felons. At the first sign of tendovaginitis, try to consult a specialist doctor to avoid possible purulent complications. Good health to you!

tendovaginitis(tendovaginitis; tendo- tendon + vagina vagina, syn. tendosynovitis)- inflammation of the synovial sheaths of the tendon.

Terms " tendovaginitis”, “tendevit”, “tenosynovitis”, “ligamentitis” are often used as synonyms, since often all closely adjacent tissues are affected - the tendon, its synovial sheath and ligamentous canal. The disease manifests itself tendovaginitis pain when active movement any muscle or group of muscles, swelling along the tendon sheath, crunching during movement. Most often when tendovaginitis tendon sheaths of the extensors of the forearm, fingers, hand, lower leg, foot and Achilles tendon are affected.

Causes of tendovaginitis

tendovaginitis can be both an independent disease (primary tendovagit), and secondary - as a complication of any process of a specific or infectious nature.

Infectious tendovaginitis occurs as a result of the penetration of infection into the tendon sheaths with wounds and microtraumas, purulent inflammations surrounding tissues. Infectious tendovaginitis(nonspecific purulent tendovaginitis or specific - tuberculosis, brucellosis) is quite rare.

The most common non-infectious (aseptic) tendovaginitis- crepitus, stenosing.

The cause of non-infectious (aseptic) tendovaginitis most often are excessive loads on the tendons. Frequently repeated movements cause microtrauma, as a result of which the tendovaginitis. This is usually associated with the patient's professional activities or sports activities, so this tendovaginitis called professional. There is also a post-traumatic tendovaginitis, which is also most often observed in athletes, although domestic trauma may well lead to its appearance.

tendovaginitis may also have a degenerative character - in the event that it is associated with circulatory disorders of adjacent tissues (for example, with varicose disease). cause of degenerative tendovaginitis is a violation of the blood supply to the periarticular tissues, leading to degenerative changes in the synovium of the tendon sheath.

Symptoms of tendovaginitis

By clinical signs differentiate between acute and chronic tendovaginitis.

Symptoms of acute tendovaginitis.

With acute tendovaginitis there is a sharp swelling and a rush of blood to the synovial membrane, there is painful swelling in the area of ​​the affected tendon sheaths. Finger movements in acute tendovaginitis limited, painful, accompanied by a crunch. There is a restriction of movements, sometimes with this form tendovaginitis there is a persistent reduction (contracture) of the fingers.

An acute process is more often observed 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. Such inflammation often becomes chronic.

In acute infectious tendovaginitis swelling and swelling may extend to the forearm or lower leg. With the development of purulent inflammation, a high temperature rises, chills, nearby inflammation The lymph nodes and vessels, a serous or purulent inflammatory fluid appears in the synovial cavity, while the place of entry into the tendon is compressed blood vessels, its nutrition is disturbed, resulting in necrosis of the tendon.

Symptoms of chronic tendovaginitis

Chronic tendovaginitis most often it is an occupational disease and affects, first of all, the hands (the area of ​​the wrist, the elbow joint). Symptoms of chronic tendovaginitis are: soreness with active movement, poor joint mobility, crunching or distinct clicking when squeezing the hand or moving the wrist. Chronic tendovaginitis are observed most often in the sheaths of the tendons of the extensor and flexor fingers. Yes, at tendovaginitis of the common synovial sheath of the flexors of the fingers, located in the wrist area (carpal tunnel syndrome), a painful tumor-like formation of an elongated elastic consistency is determined, often having the shape hourglass that move as they move.

Treatment of tendovaginitis

The main thing at tendovaginitis- Seek medical attention in a timely manner proper treatment. Effective help in the fight against it unpleasant illness can provide a therapeutic anti-inflammatory patch NANOPLAST forte.

Treatment of acute tendovaginitis

Acute treatmenttendovaginitis divided into general and local.

With an infectious tendovaginitis First of all, it is necessary to stop the development infectious process, for which various antibacterial agents are used, as well as drugs that strengthen defensive forces organism. For acute non-infectious tendovaginitis using non-steroidal anti-inflammatory drugs. With a purulent process, an urgent opening and drainage of the tendon sheath is performed to remove purulent exudate. It is necessary to ensure rest and fixation of the limb.

After the subsidence of acute phenomena with tendovaginitis warming compresses, physiotherapy procedures (microwave therapy, ultrasound, UHF, ultraviolet rays) and physiotherapy exercises are prescribed.

At this stage treatment of tendovaginitis effective use of modern innovative drug- therapeutic analgesic anti-inflammatory patch NANOPLAST forte.

Course application of NANOPLAST forte with treatment of tendovaginitis allows you to reduce the dosage of anti-inflammatory and painkillers, provide deep heating of the affected area, reduce inflammation and speed up recovery.

Chronic tendovaginitis

During exacerbation of chronic tendovaginitis First of all, rest and warming up are recommended. If necessary, prescribe anti-inflammatory and analgesic drugs.

Efficient and convenient treatment of chronictendovaginitis course application of the therapeutic anti-inflammatory patch NANOPLAST forte. soft warmth and curative effect magnetic field relieve inflammation and swelling tendovaginitis, improve blood circulation in the affected area, contribute to the restoration of damaged tissues.

Tenosynovitis of the forearm is an inflammatory disease that affects the tendon and its surrounding sheath. Pathology develops only in tendons with synovial sheaths resembling soft connective tissue pockets. The most common cause of tendovaginitis in the forearm is professional or sports microtrauma. Much less often, the tendon is damaged as a result of progression autoimmune disease or infection with pathogenic microorganisms.

The leading symptoms of the pathology of the forearm are pain, aggravated by rotation of the shoulder, flexion or extension of the arm. To establish the cause of clinical manifestations, a number of instrumental and biochemical studies are carried out. In therapy, only conservative methods are usually used. This is a course of NSAIDs, analgesics, muscle relaxants, antibiotics. Patients are shown physiotherapy, massage, exercise therapy.

The reasons

The tendons of the forearm are connective tissue structures; unlike ligaments, they are inelastic. With any movement of the muscles of the upper arm, the tendon is displaced, but not stretched. Therefore, injuries of this part of the musculoskeletal system are rarely diagnosed. Muscles and tendons are united by a special dense case of connective tissues lined inside with a synovial membrane. It produces a thick viscous liquid, which has shock-absorbing properties. It facilitates the sliding of the tendon inside the case, ensures its smooth displacement relative to nearby tissues. With the development of tendovaginitis, inflammatory edema is formed, the amount of synovial fluid decreases. Any displacement of the tendon causes severe, sharp pain.

The most common cause of tendovaginitis is microtrauma. At risk are tennis players, basketball players, volleyball players, skiers, painters, loaders, typists. During the day, they make frequent, monotonous hand movements, in which the tendon of the forearm is involved. Gradually, the integrity of his individual fibers is violated. And in case of significant damage, it starts inflammatory process various variability. The following pathologies become the cause of tendovaginitis:

• degenerative-dystrophic diseases (deforming osteoarthrosis, cervical osteochondrosis), accompanied by inflammation of the periarticular soft tissues;
• arthritis: infectious, metabolic, autoimmune, reactive, traumatic, dystrophic;
• diabetes mellitus, thyrotoxicosis and other endocrine diseases;
• congenital or acquired dysplasia of the shoulder joints;
• previous injuries of the shoulder or arm, after which scars remained on the connective tissue structures.

Often, the inflammatory process develops due to the penetration of pathogenic microorganisms, more often pathogenic bacteria, into the tendon. Tendovaginitis can occur a few days after a respiratory, intestinal, less often urogenital infection. Pathogenic bacteria penetrate into the tendon sheath, begin to multiply intensively there. In the process of life, they release into the surrounding space toxic substances that provoke inflammation and general intoxication of the body.

Tendovaginitis occurs when both nonspecific (staphylococcus, streptococcus) and specific (pale treponema, gonococcus, mycobacterium tuberculosis) infectious agents are affected. The tendon of the forearm may become inflamed after deep cuts or wounds in which bacteria enter it from the surface of the skin.

Classification

When choosing a method of treatment, doctors take into account the form of the diagnosed tendovaginitis of the forearm. The most severe is a purulent pathology that develops as a result of tissue infection. It is characterized by the accumulation of purulent exudate in the tendon vagina, provoking a rapid aggravation of symptoms and the spread of the inflammatory process to healthy areas. Serous tendovaginitis of the forearm is also isolated, in which the inner layer of the membrane is affected and a clear protein-serous serum is released. Less common is a serous-fibrous disease that occurs against the background of the formation of a specific plaque and accumulation serous exudate. The methods of therapy used also depend on the form of pathology:

• initial. There is hyperemia (overflow of blood vessels) of the synovial vagina, accumulation of perivascular infiltrate, usually localized in the outer shell;
• exudative-serous. A small amount of effusion is found in the tendon sheath, and the clinical picture is supplemented by the formation of a small round swelling in the inflamed part of the tendon;
• stenosing. Sclerotic changes occur: the structures of individual layers are smoothed out, the channel of the synovial sheath is partially or completely narrowed.

Tendovaginitis of the forearm can be aseptic or infectious, chronic or acute. Allocate primary diseases that develop after injury to the tendon. Secondary tendovaginitis occurs due to pathology already present in the body: arthritis, arthrosis, venereal, respiratory, intestinal infections.

The main cause of tendovaginitis is microtrauma.

Clinical picture

In the acute course of tendovaginitis, severe pain occurs, which increases when trying to raise the shoulder or make a movement with the arm. But traumatologists note that it is not painful or other sensations that make patients quickly seek medical attention. medical care. The main complaint is weakness in the hand, which makes any work impossible. Also, the following symptoms are characteristic of tendovaginitis of the forearm:

• weak aching, drawing pains in nighttime;
• swelling of the upper arm, sometimes extending to the forearm;
• redness of the skin, local fever;
• crunching, crackling in the inflamed tendon when moving.

Infectious tendovaginitis is accompanied by clinical manifestations general intoxication of the body. The temperature rises, the lymph nodes become inflamed, digestion and peristalsis are upset, headaches, chills, cold perspiration occur. To eliminate these symptoms, antibiotic therapy is required.

Diagnostics

An experienced doctor will suggest the development of tendovaginitis of the forearm during the initial examination of the patient and based on his complaints. A history may indicate pathology - previous injuries, diabetes mellitus, arthritis, arthrosis, dysfunction of the thyroid gland. An X-ray examination is usually performed to determine the degree of inflammation and complications that have arisen. If radiography is not informative, CT or MRI is indicated. The results of these diagnostic measures identify the stage of pathology. Other connective tissue structures involved in the inflammatory process are also found.

Bacterial seeding.

Be sure to conduct a bacteriological study to exclude the infectious etiology of tendovaginitis. A biological sample taken from a patient is sown in a nutrient medium. After a few days, colonies of microorganisms form on its surface. Laboratory diagnostics allows you to identify the species of microbes, their sensitivity to antibiotics.

Treatment

Methods of treatment and severity of symptoms of tendovaginitis of the shoulder joint are closely interrelated. When acute pain and severe swelling, patients are shown wearing a fixing bandage, using a rigid or semi-rigid orthosis. This avoids unwanted stresses on inflamed tendon and compression by edema of sensitive nerve endings. Immobilization also promotes rapid regeneration of damaged tendon tissues. In the first days of treatment, traumatologists recommend applying a bag filled with ice cubes to the upper arm. He's being wrapped thick cloth to prevent frostbite. The duration of one cold procedure is no more than 15 minutes.

Fixing bandage.

To reduce the severity of pain and inflammation, drugs from various clinical and pharmacological groups can be used:

• - Ketoprofen, Nimesulide, Diclofenac, Meloxicam, Celecoxib, Ketorolac, Ibuprofen. Stop inflammatory processes, eliminate pain, promote the resorption of edema. Effectively cope with high fever, fever, chills;

• glucocorticosteroids (synthetic hormones) - Prednisolone, Hydrocortisone, Dexamethasone, Kenalog, Flosteron, Triamcinolone. In the form of tablets for tendovaginitis of the forearm, they are rarely used. Their introduction is practiced directly into the inflamed tendon.

For unexpressed pain, analgesics are used (Paracetamol, Efferalgan) or ointments with NSAIDs - Fastum, Voltaren, Artrozilen, Ketonal, Nurofen. External agents are rubbed into the area of ​​pain and inflammation 1-3 times a day for 7-10 days. After stopping the inflammatory process, the doctor may prescribe (Capsikam, Viprosal, Finalgon). The active ingredients of the preparations have a locally irritating, distracting, analgesic and stimulating tendon regeneration effect.

Compresses with Dimexide, electrophoresis with analgesics, NSAIDs, Lidaza, phonophoresis with hydrocortisone are used to resolve inflammatory edema and prevent the accumulation of exudate. Patients are prescribed 5-10 sessions of laser therapy, magnetotherapy, UHF therapy.

In the treatment of infectious tendovaginitis, antibiotics are used, to which the microorganisms that provoked them are sensitive. Most often, treatment regimens include Clarithromycin, Azithromycin from the macrolide group, Cefazolin, Cefotaxime from the cephalosporin series, semi-synthetic protected penicillins Augmentin, Amoxiclav. Sulfonamides are also used, and, if necessary, immunomodulators or immunostimulants.

After antibiotic therapy, patients are recommended a course of eubiotics to restore intestinal biocenosis. The treatment of tendovaginitis, provoked by specific infectious agents, is carried out by a phthisiatrician, urologist, venereologist.

Folk remedies

Prescription products traditional healers are effective in the rehabilitation period. After the main treatment, warming up the damaged tendon is practiced for its accelerated healing. Drawstring linen bags filled with hot sea ​​salt or flaxseeds. For warming, rubbing prepared at home is also used:

• a dark glass container is filled to the top, without tamping, with freshly picked leaves of burdock, plantain, sour, dandelion flowers, calendula, chamomile, finely chopped horseradish roots;
• carefully pour vodka without additives or 96% ethyl alcohol diluted with an equal volume of water along the wall;
• put for a month in a warm, dark place, periodically shaken.

Alcohol tincture of herbs.

The resulting tincture is rubbed on the forearm 1-3 times a day. Biologically active substances that have passed into the alcohol solution have an analgesic, anti-inflammatory and blood circulation-improving effect.

In the absence of medical intervention, the pathology gradually takes on a chronic form of the course. Painful sensations occur during physical exertion, after hypothermia or during sharp decline immunity. The biceps and deltoid muscles begin to weaken and atrophy, reducing functional activity arms. Fibroplastic tendomyositis develops, in which irreversible fibrous degeneration of the tendon occurs. To avoid such a negative development of events will allow seeking medical help when the first pathological signs appear.

At acute form tendovaginitis, a strong swelling of the synovial membrane appears, as a result of a rush of blood to the sore spot. At the site of the lesion of the tendons, a swelling appears, which, when pressed or moving, gives off severe pain. In the acute course of the disease, the movements of the fingers are limited, there is a characteristic creaking sound when pressed (crepitus), pain. The limitation of movements in the acute form of tendovaginitis can be expressed in a strong reduction of the fingers in an unnatural position.

As a rule, in an acute process, the tendons are affected only from the opposite palm or foot of the side, tendovaginitis is much less common in the acute form of the fingers. Usually this kind of inflammatory process flows into a chronic form. In acute tendovaginitis, the forearm or lower leg may also swell. If a purulent form of the disease begins to develop, then the patient's condition worsens with fever (chills, temperature, inflammation of the lymph nodes, blood vessels). In the synovial cavity, a serous or purulent filling is formed, which compresses the place connecting the blood vessel to the tendon. As a result, tissue nutrition is disrupted and in the future it can cause necrosis.

Chronic tendovaginitis is often caused by the performance of professional duties and appears as a result of frequent and severe stress on the tendons and certain muscle groups, and the disease can also result from ineffective or incorrect treatment of the acute form of tendovaginitis. The elbow joints and wrists are primarily affected. Chronic tendovaginitis is manifested by weak joint mobility, pain during sudden movements, a characteristic creaking sound or clicking when you try to squeeze your hand. Usually, the chronic form of tendovaginitis occurs in the sheath of the tendons responsible for flexion and extension of the fingers.

Crepitating tendovaginitis

Crepitating tendovaginitis is one of the most common occupational diseases. As a rule, the disease develops against the background of regular trauma to the tendons, muscles, and adjacent tissue due to the often repetitive monotonous movements of the fingers or feet.

The disease in most cases affects the extensor surface of the forearm (usually the right one), less often occurs on the Achilles tendon, the anterior surface of the lower leg.

The disease is accompanied by swelling over the site of the lesion, soreness and a creaking sound, similar to the crunch of snow. As a rule, the duration of the disease does not exceed 12-15 days, crepitating tendovaginitis can reappear and often flows into the chronic stage.

Stenosing tendovaginitis

Stenosing tendovaginitis is an inflammation of the tendon-ligamentous apparatus of the hand. The most common cause of the development of the disease is an occupational injury. The disease proceeds rather slowly, at first appear pain in the region of the metacarpophalangeal joints. It is difficult to bend the finger, often this movement is accompanied by a creaking sound (crepitus). You can also feel a dense formation along the tendons.

Purulent tendovaginitis

Purulent tendovaginitis usually develops as a primary disease, due to penetration through microtrauma and damage to bacteria. Less often, secondary tendovaginitis with the formation of purulent masses is observed - as a rule, the tendon is affected as a result of the transition of purulent inflammation from adjacent tissues, for example, with phlegmon.

Bacteria are usually the causative agents of the purulent process in the tendon. coli, streptococci, staphylococci, extremely rarely other types of bacteria. When bacteria enter the wall of the tendon sheath, swelling appears, suppuration appears, which prevents tissue nutrition, resulting in necrosis of the tendon.

At secondary disease, usually purulent inflammation begins in adjacent tissues, and only after that spread to the wall of the tendon sheath. As a rule, with purulent inflammation, the patient is worried about fever with high fever and general weakness. With advanced forms of purulent tendovaginitis, the risk of developing sepsis (blood poisoning) increases.

Aseptic tendovaginitis

Aseptic tendovaginitis has non-infectious character, the disease occurs quite often, mainly in people who, by the nature of their professional activities, must perform monotonous movements for a long time, usually only one muscle group is involved in such work, and as a result, due to overstrain, various microtraumas of the tendons and adjacent tissues, an inflammatory process begins.

Tenosynovitis of the hand is often found in musicians, volleyball players, etc. Skiers, skaters and other professional athletes are more susceptible to foot damage. The aseptic form of tendovaginitis, which has developed into a chronic stage, can force a person to change his profession.

The development of aseptic tendovaginitis in an acute form can be caused by trauma, it is often found in young athletes. Usually a person does not notice how he got injured, because during training he may not even pay attention to a slight crunch in his wrist or foot. At the initial stage of the disease, the pain may not be strong, but it increases with time.

Acute tendovaginitis

Tendovaginitis in acute form usually occurs as a result of infection. In the acute course of the disease, there is severe pain in the affected tendon, swelling over the affected area, high fever (lymph nodes often become inflamed). An acute process usually develops on the back of the foot or palm. Quite often, the swelling extends to the lower leg or forearm.

With tendovaginitis in an acute form, movements are constrained, sometimes there is complete immobility. The patient's condition worsens over time: the temperature rises, chills appear, pain increases.

Chronic tendovaginitis

Chronic tendovaginitis usually does not greatly affect the general condition of the patient. As a rule, in chronic tendovaginitis, the tendon sheaths of the extensor and flexor fingers suffer, and swelling appears, oscillatory movements are felt when probing, and the mobility of the tendons is limited.

The disease begins with the appearance of pain in the affected area (usually in the region of the styloid process). A painful swelling appears along the course of the tendons, movements of the fingers are hampered by pain, stiffness, while the pain can radiate to the shoulder or forearm.

Hand tendovaginitis

Tenosynovitis of the hands is a fairly common disease, since it is on the hands that maximum load, they are most susceptible to injury, hypothermia, which provokes the disease. Typically, tendovaginitis of the hands affects people whose work is associated with frequently repetitive movements that load only a certain muscle group, as a result of which the tendons are injured and the inflammatory process begins.

Musicians often suffer from tendovaginitis of the hands, it is known that some famous musicians were forced to give up their favorite pastime and become composers because of pain.

Tenosynovitis of the hand

As already mentioned, the hands are the most vulnerable organ. Frequent hypothermia, minor injuries, excessive loads lead to inflammation of the tendon sheaths. Tenosynovitis of the hands is the most common pathological process, from which musicians, stenographers, typists, etc. suffer. In most cases, the disease is non-infectious in nature, and is associated with professional activities. A little less often, tendovaginitis of the hand develops as a result of infection.

Tenosynovitis of the forearm

The forearm (most often the dorsal side) is usually affected by crepitant tendovaginitis. As a rule, the disease progresses rapidly. In most cases, the disease begins with aches, increased fatigue hands, in some cases there is a burning sensation, numbness, tingling. Many patients, even after the onset of such symptoms, continue their usual work and after a while (usually after a few days, in the late afternoon) severe pain appears in the forearm and hand, while movements of the arm or hand increase discomfort in the arm. Tendovaginitis in this case is associated with increased load and fatigue of the muscles of the hand due to monotonous long movements.

In addition, the disease can develop as a result of bruises or injuries of the forearm.

If the bruised hand is not spared, then this can quickly lead to swelling, severe pain, in addition to this, a creaking sound may appear. Usually a person independently notices the appearance of swelling on the forearm, while the appearance of a creaking sound is not paid attention to.

But not even swelling, the appearance of a crunch or severe pain force a person to seek help from a specialist. Usually, when contacting a doctor, the patient complains of the inability to fully work due to weakness of the arm, increasing pain during movement. With creeping tendovaginitis, the swelling has an oval shape (resembles a sausage) and is concentrated on the back of the forearm, along the tendons.

Tenosynovitis of the finger

Finger tendovaginitis at the initial stage of development is difficult to recognize. The specialist makes a diagnosis on the basis of examination, palpation, anamnesis. There are several characteristic features, by which it is possible to determine the development of tendovaginitis:

• swelling of the finger, swelling on the back of the hand;
• pain when pressing with a probe along the tendons;
• severe pain when trying to move a finger.

All these signs can appear both individually and all together at the same time (with tendovaginitis in a purulent form).

A purulent infection can spread quickly, and excruciating pain appears, due to which a person cannot sleep and work normally, the patient keeps his finger in a half-bent position. The swelling extends to the back of the hand, when you try to straighten your finger, you feel sharp pain. Against the background of inflammation, the temperature may rise, the lymph nodes become inflamed, the person assumes a position in which he unconsciously tries to protect the sore hand.

Diagnosis of the disease can be helped by radiography, which reveals a thickening in the tendon with clear (rarely wavy) contours.

Tenosynovitis of the wrist

Tendovaginitis harness develops on the dorsal ligament. The disease affects the tendon that is responsible for straightening the thumb. A typical symptom is pain over the wrist at the base of the thumb. Over time, the pain increases with movement and calms down a little when the arm is relaxed and rested.

Tenosynovitis of the wrist

Tendovaginitis of the wrist joint is manifested, as in other cases, by pain during the movement of the wrist, thumb. With this disease, the tendon responsible for the thumb is affected, and often the affected tendon thickens. Often pain from the wrist is given to the forearm and even the shoulder.

The most common cause of tendovaginitis in the carpal tunnel is tiresome repetitive hand movements, often accompanied by injuries and injuries. An infection can also cause inflammation of the tendons.

Women are more susceptible to tendovaginitis of the wrist, and there is a connection between the disease and excess weight.

It is noted that women of short stature are more prone to developing tendovaginitis. Also, heredity plays a significant role in the development of the disease.

A characteristic feature of tendovaginitis of the wrist joint is that the disease is expressed not only by severe pain, but also by numbness or tingling, which is associated with compression of the median nerve. Many patients are concerned about "naughty" hands, numbness. A tingling sensation appears on the surface of the hand, usually in the area of ​​\u200b\u200bthe index, middle and thumb, in rare cases tingling occurs in the ring finger. Often the tingling is accompanied by a burning pain that can radiate to the forearm. With tendovaginitis of the wrist, the pain becomes worse at night, while the person may experience temporary relief after rubbing or shaking the hand.

Tenosynovitis of the shoulder joint

Tenosynovitis of the shoulder joint manifests itself dull pain in the shoulder area. When probing, pain appears. Most often, damage to the shoulder joint occurs in carpenters, blacksmiths, ironers, grinders, etc. The disease usually lasts 2-3 weeks, proceeds in a subacute phase. With tendovaginitis, the pain has a burning character, with muscle tension (during work), the pain can intensify many times, swelling often appears, a creaking sound.

Elbow Tenosynovitis

tendovaginitis elbow joint is quite rare. Basically, the disease develops as a result of injury or damage. As in other cases of the development of tendovaginitis, the disease proceeds with pronounced soreness in the area of ​​the affected joints, swelling, and creaking. Usually, at rest, the joint does not bring the patient special discomfort, however, when moving, the pain can be quite sharp and severe, which leads to forced immobilization.

Finger flexor tendovaginitis

Tenosynovitis of the flexors of the fingers is expressed in the defeat of the tendon-ligamentous apparatus of the hand. In this case, there is an infringement of the tendons, which are responsible for flexion and extension of the fingers. The disease occurs most often in women. Usually the development of the disease is related to professional activities associated with manual labor. AT childhood You can notice the disease at the age of 1 to 3 years. It is the thumb that is most often affected, although there is an infringement of the tendons on the other fingers.

Tenosynovitis of the foot

Tendovaginitis of the foot manifests itself in the form of pain along the tendons, with movement of the foot the pain intensifies. Along with the pain, redness and swelling appear. With infectious tendovaginitis, a temperature appears, a deterioration in general well-being.

Achilles Tenosynovitis

Tenosynovitis of the Achilles tendon develops mainly after increased loads on the Achilles tendon or calf muscles. Especially often the disease affects cyclists, both professional and amateur, long-distance runners, etc. A sign of the disease is a thickening of the Achilles tendon, pain when moving the foot, swelling, and when probing the tendon, you can feel a characteristic creaking.

Tenosynovitis of the ankle joint

Tendovaginitis of the ankle joint develops mainly in those who experience frequent and heavy loads on the legs. Often, tendovaginitis develops in military personnel, after making long transitions. Also, athletes (skaters, skiers), ballet dancers, etc. often suffer from ankle tendovaginitis. In addition to professional tendovaginitis, the development of the disease occurs after prolonged hard work.

Except external factors, tendovaginitis may develop due to congenital anomaly feet (clubfoot, flat feet).

Tenosynovitis of the knee

As in other cases, tendovaginitis knee joint develops as a result of prolonged physical stress on the joint, anatomically incorrect structure of the body, in violation of posture, and also as a result of infection.

The disease, as a rule, affects people whose lifestyle is associated with increased physical exertion or who, by the nature of their professional activities, are forced to stay in one position for a long time (often in an uncomfortable position). Knee tendovaginitis is widespread among basketball players, volleyball players, etc., since frequent jumping leads to knee injury.

The classic symptoms of the development of tendovaginitis is the appearance of pain in the affected area, which over time (with the development of the inflamed process) becomes stronger. Pain may increase from physical activity, depending on the weather. In addition to pain, there is a limitation in the movement of the limb, when probing, pain appears, sometimes creaking, you can also feel the formed tendon nodule. The affected area is red and swollen.

Shin tendovaginitis

Symptoms of tendovaginitis do not appear immediately, but a few days after the inflammation process has begun. Tenosynovitis of the lower leg develops, as in other cases, with an increased load on the lower leg or infection, as well as in the case of abnormal development of the foot. On x-ray, you can see a seal in the place of the affected tendon.

Tenosynovitis of the thigh

Quite often, tendovaginitis of the thigh is caused by various injuries, overloads of the tendons and muscles. Women are more susceptible to the disease than men. The disease occurs as a result of overloading the legs, after a long or unusual walk, running, after carrying heavy loads. In some cases, the disease develops as a result of damage.

Tendovaginitis de Quervain

Tendovaginitis de Quervain proceeds with severe inflammation ligaments of the wrist, which is characterized by inflammation, pain, limited movement. Many years ago, this disease was called "washerwomen's disease", because it affected mainly women who were forced to wash their hands daily. a large number of underwear, but after 1895 it was named after the surgeon Fritz de Quervain, who first described the symptoms.

De Quervain's tendovaginitis is characterized by soreness of the tendons on the back of the wrist, with inflammation, the walls of the tendon sheath thicken, which can cause a narrowing of the canal. Inflammation can cause the tendons to stick together. In women, the disease develops eight times more often than in men, as a rule, women older than 30 years suffer.

Inflammation can be triggered by some damage to the first canal of the dorsal ligament, for example, after various injuries to the radius. The disease can be caused frequent inflammations, injuries, muscle strain (especially caused by hard work involving one muscle group). However, for the most part, set exact reasons disease is not possible.

Tenosynovitis is manifested by pain along the radial nerve, which can be aggravated by tension or movement (most often when trying to forcefully grasp something). A painful swelling appears over the first canal of the dorsal carpal ligament.

Tenosynovitis is an acute or chronic inflammation of the fibrous (synovial) sheath of the tendon of the muscle, which is often combined with inflammation of the tendon itself.

Etiopathogenesis

Tendovaginitis can develop as an independent disease, and as a result of a complication of the infectious process.

The disease can be acute or chronic. Depending on the etiology, infectious and aseptic tendovaginitis are distinguished, including rheumatic and allergic diseases.

Most often, aseptic tendovaginitis occurs, which is caused by prolonged and / or heavy physical exertion on the ligamentous apparatus, often repeated movements of the same type as a result of professional activity or hypothermia. Aseptic inflammation synovial sheaths of long and thick tendons are more susceptible. Due to higher muscle activity upper limbs tendovaginitis in this area occur most often.

Traumatization skin(bruises, skin cuts in the area of ​​the tendon sheaths) can also cause purulent or aseptic tendovaginitis.

In addition, tendovaginitis can be one of the manifestations of rheumatoid or specific arthritis, gout, Bechterew's disease, Reiter's syndrome, osteomyelitis, tendovaginitis that occurs with sepsis, some allergic and infectious diseases(tuberculosis, gonorrhea, brucellosis).

As a result of a violation of regional blood and lymph circulation (for example, with varicose veins of the lower extremities), degenerative tendovaginitis may develop.

There are the following anatomical and histological forms of tendovaginitis, which in some cases characterize the sequential development of the pathological process:

1. The mild, simple, or initial form is characterized by the appearance of only hyperemia of the predominantly fibrous layer of the synovial sheath. With this form, local areas of damage appear in the endothelial layer, perivascular infiltrates are sometimes determined in the adventitial layer, violations of the boundaries and structure of the layers do not develop.

1. The exudative-serous form of tendovaginitis is characterized by the accumulation in the synovial vagina of a moderate amount of cloudy yellowish synovial fluid. A small rounded swelling forms around the tendon. Most often, this variant develops in case of layering of the infection.

1. The chronic stenosing form of tendovaginitis is characterized by the occurrence of sclerotic changes in the synovial sheaths, which is accompanied by the disappearance of structural boundaries between the layers and the formation of stenosis, which makes it difficult to slide the tendon.

In addition, morphological changes in the synovial sheath are dependent on specific properties damaging factors that provoked the occurrence of tendovaginitis: the presence of microflora causes the predominance of inflammation elements, in the absence of microflora, degenerative processes predominate.

General clinical picture

Acute tendovaginitis is accompanied by severe pain, greatly aggravated by active and passive movements. The area of ​​the affected tendon becomes swollen and painful on palpation. The swelling may spread to the entire forearm or lower leg. In some cases, palpation may cause crepitus, an unnaturally pronounced flexion of the fingers. When you try to straighten your fingers, severe pain occurs.

Most often, the pathological process develops in the tendons of the back surface of the hands and feet. Relatively rarely seen acute inflammation tendons of the fingers, which usually transforms into a chronic form.

With a purulent form of tendovaginitis, general intoxication symptoms occur (fever, an increase in body temperature), regional lymphadenitis develops. The accumulation of inflammatory serous or purulent exudate can lead to compression of the blood vessels that feed the tendon, and its subsequent necrosis.

Chronic forms of tendovaginitis, as a rule, occur when certain types labor activity (playing the piano, playing tennis), which is accompanied by frequent and / or pronounced stress on the tendons of certain muscle groups. Also, the chronic form of tendovaginitis can occur with incorrect treatment. acute period diseases. Most often, chronic tendovaginitis occurs in the area of ​​the elbow and wrist joints.

In chronic tendovaginitis, there is a decrease in mobility in the joint, increased pain during sudden movements, accompanied by a specific creaking sound, clicks when the fingers are clenched into a fist. Chronic forms of tendovaginitis most often occur in the sheaths of the flexors and extensors of the fingers.

Crepitating tendovaginitis (crepitating paratenonitis)

Crepitating tendovaginitis is one of the most common occupational disease musculoskeletal system. The disease occurs due to prolonged microtraumatization of the tendons and surrounding tissues with the same type of frequently repeated movements of the hand, fingers, and foot (50–60 or more in 1 min).

Tendon sheaths of the right forearm extensor tendons are most susceptible to crepitating tendovaginitis, relatively rarely - tendon sheaths of the anterior surface of the lower leg and Achilles tendon.

Clinical picture

The affected area becomes swollen and painful on palpation. When the fingers are bent, there is pain and a characteristic creaking sound, resembling the crunch of snow.

The average duration of the disease is 10-15 days, there is a high probability of relapses and a chronic course.

The main method of treatment of crepitating tendovaginitis is to create rest of the diseased limb by means of a removable splint. Pharmacotherapy with non-steroidal anti-inflammatory drugs is prescribed, novocaine blockades, UHF therapy.

Prevention

When performing work with frequently repetitive movements of the same type, it is recommended to take regular 10-minute rest breaks. After a long break in work, physical activity should increase gradually; it is recommended to wear special fixing bandages (“wristbands”).

De Quervain's disease (stenosing de Quervain's tendovaginitis)

This disease is characterized by inflammation of the synovial sheath of the extensor and the long abductor muscle of the 1st finger of the hand.

Etiopathogenesis

Due to the constant physical stress on the 1st finger, which physiologically resists the strength of the other fingers of the hand and participates in almost all types of physical stress on the hand, the finger is constantly overstrained.

This disease is most susceptible to people who are engaged in heavy physical labor(carpenters, loaders, masons, seamstresses, pianists). De Quervain's disease is more common in females.

Relatively rarely, the disease occurs with a local injury to the area of ​​the anatomical snuffbox, even less often with rheumatoid arthritis, tuberculosis of the wrist joint or other osteoarticular pathology.

Clinical picture

De Quervain's disease is characterized by pain and swelling in the area of ​​the wrist joint (in the area of ​​the projection of the styloid process and the anatomical snuffbox). With pressure on the area of ​​​​the anatomical snuffbox, abduction and extension of the thumb, the pain increases significantly. When moving the 1st finger, a characteristic creak is heard, due to the movement of the tendon through the narrowed and inflamed synovial sheath. Movement in the finger becomes limited due to pain, soreness extends to the area of ​​the wrist joint.

Diagnosis of the disease is based on the identification of characteristic clinical symptoms, results x-ray examination(in the area of ​​the 1st bone-fibrous canal, calcification of varying severity is determined).

AT doubtful cases MRI examination is used.

De Quervain's disease must be differentiated from arthrosis of the wrist joint, inflammation of the styloid process (styloiditis), migratory polyneuritis (Vanterberg's syndrome).

Conservative treatments are effective for approximately the first 6 weeks of the course of the disease. Immobilization of the 1st metacarpophalangeal joint is carried out with the help of an orthosis, pharmacotherapy with non-steroidal anti-inflammatory drugs is prescribed, with a pronounced course, glucocorticoid pharmaceuticals are introduced into the area of ​​inflammation.

With inefficiency conservative therapy resort to surgical treatment.

Elbow extensor tendovaginitis of the hands (ulnar styloiditis)

The disease is much less common than de Quervain's disease and differs more favorable course. With ulnar styloiditis, fibrotic changes occur in the tendon, in the structures of the synovial sheath, which leads to narrowing of the 6th canal of the dorsal carpal ligament.

Etiology

The disease, as a rule, is the result of prolonged microtraumatization as a result of professional activity, or with direct trauma to this anatomical region.

More often sick are females working in the sewing and weaving industries, grinders, polishers, etc. In some cases, tendovaginitis of the ulnar extensor of the hands is one of the manifestations of systemic rheumatoid disease.

Clinical picture

The disease is characterized by the occurrence of spontaneous pain in the region of the styloid process of the ulna and possible irradiation to the fingers IV–V. Abduction of the hand to the radial side with its simultaneous dorsal flexion leads to increased pain. There is swelling and thickening of the tissues above the styloid process. On palpation of the styloid process, local pain is noted.

Diagnosis and differential diagnosis

Diagnosis of the disease is based on the identification of characteristic clinical symptoms, on the history of the disease. X-ray examination is being carried out.

Elbow styloiditis must be differentiated from pain that occurs with paresthesia in the IV-V fingers of the hand in Guyon's canal syndrome.

Finger and hand flexor tendovaginitis (carpal tunnel syndrome)

The disease is much less common than tendovaginitis of the dorsal carpal ligament.

Carpal tunnel syndrome is caused by various pathological processes (inflammatory, post-traumatic, neoplasms) that occur in the canal, which leads to compression of the branches of the median nerve passing in this area, which innervates the skin of I-III and the medial side of the IV fingers.

In case of injury, the disease develops on one hand, in other episodes both hands are affected and often asymmetrically.

Involvement in the pathological process of the synovial sheaths of the flexors of the hand and fingers, the transverse ligament of the wrist leads to a decrease in the strength of the flexors of the hand and fingers, the short opposing muscle of the thumb, in more severe cases, to atrophic changes.

Clinical picture

The patient is disturbed by burning pains and a feeling of numbness of the I-III fingers of the hand, which intensify at night. At the same time, the patient wakes up and tries to squeeze his fingers, lower his hand down from the bed. The strength of the hand decreases, the sensitivity of the fingertips decreases, acrocyanosis, hyperhidrosis may occur. In more rare cases, blanching or redness of the skin of the fingers is determined.

The progression of the disease leads to a decrease in the sensitivity of the fingertips, smoothing the pattern on the skin. In more rare cases, persistent swelling of the fingers occurs with spread to the hand.

The symptomatology of the disease is characterized by variable symptoms, from recurrent pain and paresthesia to the occurrence of trophic changes at the fingertips, atrophy of the tenar muscles, complete loss pain sensitivity, the formation of persistent contractures, which to varying degrees limit the ability to work.

Differential Diagnosis

Tenosynovitis of the flexors of the fingers and hand must be differentiated from autonomic polyneuritis and polyneuropathy, Guyon's canal syndrome, sympathetic truncitis stellate node, osteochondrosis cervical spine, from tendovaginitis of the dorsal ligament of the wrist.

Tenosynovitis of the superficial flexors of the fingers ("snap" or "spring finger", Knott's disease)

The disease is characterized by damage to the synovial sheath, the tendons themselves and the annular ligaments that form the canal, which leads to its narrowing and difficulty in the movement of the tendons in it.

The disease develops with prolonged microtraumatization, often professional, of the synovial sheaths and tendons passing through them, which causes the occurrence of fibrotic changes. Tenosynovitis of the superficial flexors of the fingers most often occurs in persons whose work is associated with prolonged pressure on the palm and fingers (grinders, mechanical assembly fitters, chippers). In some episodes, the cause of the disease remains unclear.

Clinical picture

Leading clinical symptom is the occurrence of pain on the palmar surface at the base of one or more fingers - as rule I,II and IV. The pain increases with palpation of the bases of the fingers, with their flexion or extension.

Initially, pain disturbs the patient in the morning, it becomes necessary to “develop” movements in the fingers for some time. On palpation of the palmar surface of the metacarpophalangeal joints, rounded or oval thickenings on the tendons up to 5 mm in diameter are determined. Rapid and increased flexion and extension of the fingers is accompanied by pain, occasionally clicking can be heard. In the later stages of the disease, it is necessary to overcome the snapping of the fingers with the help of a healthy hand, while the pain spreads to the hand, forearm.

Further progression of the disease leads to fixation of the fingers - usually in an extended position - snapping becomes a transient symptom.

Differential Diagnosis

Tenosynovitis of the superficial flexors of the fingers has to be differentiated from Dupuytren's contracture, arthrogenic and post-traumatic deformities and contractures.

Tibialis posterior tendovaginitis (tarsal tunnel syndrome)

Pathological changes in the tissues of the synovial sheath lead to compression of the posterior tibial nerve, which is located in this canal, and the occurrence of vasomotor-trophic disorders.

Clinical picture

Compression of the tibial nerve is accompanied by the occurrence of burning pains and paresthesias, spreading along the inner surface of the foot and in the fingers, aggravated at night. Pain sometimes spread to the lower leg. On the inner surface, there is swelling and a hardening that is painful on palpation. On the dorsum of the foot, pain and tactile sensitivity is reduced.

Specific tendovaginitis

The disease is one of the rarest varieties extrapulmonary tuberculosis. All age groups are equally susceptible to specific tendovaginitis. In comparison with other localizations of tuberculous lesions, the disease is considered the most favorable course when assessing general condition patient. However, for the restoration of the function of the affected limb, the prognosis for advanced cases is unfavorable.

Etiopathogenesis

The mechanism of penetration of mycobacterium tuberculosis into the synovial sheaths has not been fully elucidated. There are suggestions that the infection can penetrate through wounds, injections when cutting sick animals (butchers, farmers). Others have researched, they believe that in nature there is a tuberculosis mycobacterium that synthesizes a toxin that is tropic to the synovial membranes. In addition, there is an opinion that the spread of mycobacteria occurs from the foci of tuberculosis that already exist in the body.

Fibrous exudate accumulates in the dilated synovial sheaths, containing a significant amount of rice-like bodies and/or foci of caseous decay. After the subsidence of the tuberculous process, a small amount of fibrous exudate and fibrosis of the ligamentous apparatus remain.

Most often, specific tendovaginitis occurs on the palmar, and then on the back of the hand.

Clinical picture

With specific tendovaginitis, swelling, mild soreness and a slight limitation of function are formed. Accumulations of synovial fluid in the carpal bags, when pressed, are displaced above or below the carpal canal, with a slight pain. Tendovaginitis of the ulnar carpal bursa leads to compression of the median nerve, which is accompanied by severe pain and paresis in the area of ​​its innervation ( carpal syndrome). A slight limitation of movements in the hand is due to swelling. The progression of the disease leads to the weakening and loss of some movements due to elongation or rupture of the tendons, which may occur after 2-3 years from the onset of the disease. Economical surgical interventions for specific tendovaginitis may be complicated by the formation of fistulas.

With specific tendovaginitis, the most effective method treatment is radical surgical intervention(removal of all damaged elements of the ligamentous apparatus) with the simultaneous use of anti-tuberculosis pharmacotherapy.

Diagnosis and differential diagnosis

Identification of caseous foci practically confirms the diagnosis of specific tendovaginitis, histomorphological, bacteriological research with the isolation of a pure culture of the pathogen.

Specific tendovaginitis must be differentiated from rheumatoid, post-traumatic tendovaginitis.

Forecast and outcome

With timely started qualified treatment, the prognosis in relation to the ligamentous apparatus is favorable. In the vast majority of cases, the function of the hand is restored almost in full. With insufficiently radical surgical treatment, undiagnosed specific osteitis of the bones of the wrist, recurrence of the disease is possible (in approximately 10–60% of cases).

General principles for the treatment of tendovaginitis

Therapeutic measures should begin with the termination of the impact of damaging factors on the affected area (load reduction, immobilization).

Pharmacotherapy of tendovaginitis depends on the immediate cause of the disease and the complications that have arisen. Therapy with non-steroidal anti-inflammatory pharmaceuticals, antibiotics is used, compresses and ointments are prescribed. In the vast majority of cases, immobilization of the affected area is indicated.

Favorable effect on the course of tendovaginitis have various thermal physiotherapy procedures (ozokerito- paraffin applications, UHF therapy).

Forecast and prevention

With timely qualified treatment, the prognosis for tendovaginitis is favorable. Purulent tendovaginitis can cause persistent dysfunction of the hand and / or foot. In cases where, after suffering acute tendovaginitis, physical overload is resumed, there is high probability recurrence of the disease and transformation into chronic tendovaginitis.

Preventive measures should be aimed at preventing chronic overexertion and traumatization of the ligamentous apparatus, rational employment of patients with chronic forms of tendovaginitis.

Tendovaginitis is an inflammation internal surfaces shells from connective tissue surrounding tendons like a tunnel, the so-called. tendon sheaths, scientific medicine it is also called Deckervain's syndrome.

The inflammatory process is expressed by the appearance of pain and crunching during movement, swelling at the site of the affected tendon.

The most susceptible to tendovaginitis are the tendons of the hand, foot, wrist joint, ankle joint, Achilles tendons, extensors of the forearm.

Acute tendovaginitis, its features

Along with the chronic form of tendovaginitis, there is an acute form.

In the acute course of the disease, swelling occurs at the site of the affected tendon. This is due to severe swelling in the area of ​​\u200b\u200bthe membrane and blood flow to it. The movements are extremely difficult, accompanied by pain and a soft, quiet crunch, the affected area swells.

If acute tendovaginitis is of an infectious origin, then swelling can spread from the foot to the lower leg and from the hand to the entire forearm. Purulent inflammation causes fever, inflammation of the lymph nodes, in the worst case, it can even lead to necrosis of the tendon.

At adequate treatment exacerbation can be removed in a few days.

Causes of the disease

Tendovaginitis is divided into aseptic and infectious, depending on what causes provoked its occurrence.

Infectious tendovaginitis is a complication against the background of the underlying disease. It is provoked by the ingress of infectious agents into the tendon sheaths in case of injuries, microtraumas, purulent inflammations. It happens specific, for example, with tuberculosis, in this case, the pathogens penetrate the tendon with the blood stream. Nonspecific tendovaginitis is caused by the ingress of infectious microflora into the tendon from a nearby purulent focus, for example, with osteomyelitis or purulent arthritis.

Non-infectious, or aseptic tendovaginitis, occurs much more often than infectious, as a result of increased loads on the tendons, microtraumas of the synovial membrane of the tendon due to constantly repetitive movements, muscle strains and overloads.

In people working at a computer, and musicians, the hands are most susceptible to disease, in runners and skiers - feet, loaders - forearms. Tendovaginitis can manifest itself as a consequence of a ligament injury; sometimes as a complication of rheumatic diseases.

Symptoms of tendovaginitis

• Severe pain during acute course tendovaginitis

• Pinching of the fingers (contracture) is also seen in acute tendovaginitis.

• Unexpressed pain in the hands, fingers, feet and forearms with chronic course diseases and limitations of joint mobility

• Cracking and creaking in the inflamed tendon

• Redness and swelling in the area of ​​inflammation

• Cramps in a limb with an inflamed tendon

• Weakness of the affected limb

With infectious tendovaginitis, the following symptoms are added

• Strong pain syndrome, increasing under load
• Feverish state
• Symptoms of intoxication
• Inflammation of the lymph nodes

Treatment of tendovaginitis

Methods and methods of treatment are diverse, their choice depends on the type of tendovaginitis and the form of its course.

In the acute form of aseptic tendovaginitis inflammatory process relieved by taking anti-inflammatory drugs, such as aspirin. They can use novocaine blockades as a means of pain relief, and dimexide compresses.

The affected tendon is placed in a plaster splint and provides complete immobility. After removal acute process treatment is continued by physiotherapy: ultrasound, microwaves. Use homemade mud applications with iodine.

In the treatment of infectious tendovaginitis, in addition to treating the underlying disease, it is necessary to use antibacterial agents and antiseptics with a general spectrum of action, as well as vitamins and immunostimulants. In the case of a purulent course, surgical intervention is performed and drainage of the tendon sheath is carried out.

An exacerbation of chronic tendovaginitis is treated with anti-inflammatory drugs, for example, hydrocortisone, heat, and rest is provided to the affected tendon. Antibiotic therapy, paraffin baths and massage of the affected limb are also prescribed, therapeutic exercises and physiotherapy (electrophoresis, UHF, ultrasound).

A wonderful way to prevent or alleviate tendovaginitis is self-massage. It is necessary to massage the area located just above the affected tendon, in which stroking and kneading alternate with squeezing.

At home, ointments and decoctions of medicinal herbs also come to the rescue.

Treatment of tendovaginitis with folk remedies

• Calendula ointment will have an antimicrobial and anti-inflammatory effect. It is made by mixing dried calendula flowers with baby cream. At night, apply ointment and cover with a bandage. Treat in this way mainly the elbow joint.

• Tendovaginitis of the knee joint is treated with ointment from pork interior fat and wormwood. 100 g of fat and 30 g of wormwood are boiled over low heat. Refrigerate and use overnight.

• Pain can be reduced by a cool lotion from a liquid solution of healing clay.

• Ointment against tendovaginitis chicken protein and taken on a tablespoon of flour and alcohol. The components, after mixing, are applied to the bandage and applied to the affected area overnight. Treatment continues for two weeks.

• As an anti-inflammatory and tonic, wormwood tincture is recommended: 2 tablespoons of dry chopped grass insist half an hour on a glass of boiling water. Take two tablespoons half an hour before meals three times a day.

• To relieve inflammation before going to bed, take calendula tincture diluted in water: a teaspoon of tincture in a glass of water.

If conservative methods could not help, then the tendon sheath is excised.

With proper treatment, tendovaginitis has a favorable prognosis. If the disease is started, then it may take up to two months to cure it, from an acute course it can turn into a chronic form. Purulent tendovaginitis can leave behind a violation of the functioning of the affected hands and feet.

As a prevention of the disease, regular breaks in work for 5 minutes per hour, gymnastics for the fingers have proven themselves well. You should also prevent overwork of the tendons, their injuries and sprains.

How to determine your tendovaginitis, what causes and how to treat the doctor will tell you - video

How to determine if you have tendovaginitis in less than 1 minute? Because of what this disease occurs and how to treat - all this is in the program to live healthy.