1De Carven's disease: symptoms, diagnosis, treatment
- 1.1Description of the disease
- 1.2What causes the development of pathology?
- 1.3Who is at risk?
- 1.4What signs are accompanied by pathology?
- 1.5Establishing diagnosis
- 1.6Conservative therapy
- 1.7When is surgery required?
- 1.8Possible complications
- 1.9Preventive measures
2De Cervan's disease
- 2.1Causes of de Kerven's disease
- 2.2Symptoms of the disease
- 2.3Treatment of de Cervan's disease
- 2.4What kind of doctor should I contact?
3De Carven's Disease: Symptoms and Treatment
4De Carven's disease: symptoms, causes, treatment of tenosynovitis of the hand
- 4.1Why is it developing
- 4.2Symptoms of de Carven's disease
- 4.3Treatment of de Cervan's disease
5The main ways to treat de Cervan's disease
- 5.1Conservative methods of treatment
- 5.2Radical treatment of de Cervin syndrome
- 5.3Application of traditional medicine methods
- 6Characteristic symptoms and effective treatment of de Cervin's disease
De Carven's disease: symptoms, diagnosis, treatment
De Carven's disease is a pathology characterized by inflammation of the tendons on the thumb. The disease manifests itself gradually, differs by a rather slow development. Sometimes before going to the doctor it takes several weeks or even months.
Description of the disease
De Carven's disease (chronic tenosynovitis or stenosing ligamentitis) is a pathology that is characterized by the gradual narrowing of the canal where the tendons of the thumb pass.
The disease is accompanied by inflammation of the so-called tendinous vaginas. The disease occurs due to the constant stress on the brush, often in connection with the performance of professional activities.
Because of the pain in patients, the ability to perform certain movements with the participation of absolutely the entire brush is reduced.
Periodic contraction of the muscles of the forearm makes it possible to flex / unbend fingers. For these movements, the tendons of the flexor muscles (approach the fingers via the palmar surface) and the extensor muscles (pass through the back of the hand) are responsible.
The transverse ligaments ensure the retention of the tendons in the required position. The back ligament is localized on the same side of the hand. Each group of tendons in the latter is in a separate channel.
The thumb is actively involved in the daily life of a person. His tendons take on the greatest strain. The disease of de Kerven provokes a consistent inflammation of the ligaments, their thickening and swelling.
As a result, the channel becomes excessively small, symptoms of an ailment occur, the functioning of the entire brush is disrupted.
What causes the development of pathology?
The exact causes of this disease remain unexplored until the end. It is assumed that the constant repetitive activity of brushes (playing golf, gardening, caring for a child) can exacerbate this condition. Therefore, sometimes the disease is called "mother's wrist."
Also, experts identify a number of factors that contribute to the development of pathology, namely:
- Injuries and mechanical damage to the brush.
- Diseases of the joints of inflammatory nature (arthritis, arthrosis).
- Constant load on the area of the wrist joint.
- Hormonal reorganization of the body (often in the menopause period).
- Anatomical features of the musculoskeletal system.
Who is at risk?
The highest risk of this pathology in people aged 30 and up to about 50 years. The disease of de Kerven is more often diagnosed in the fair sex during pregnancy and care of the newborn.
What signs are accompanied by pathology?
The main symptom of this ailment is pain in the zone of wrist joint from the side of the thumb. When you turn the brush, discomfort can increase. Pain often rests in the forearm and neck area.
A distinctive sign of the disease is a symptom of Finkelstein. The man, clutching his hand into a fist, puts his thumb inside. If the next attempt to take your hand to the side is accompanied by a sharp pain, you can confirm de Kerven (disease).
When palpating the joint, there is a slight swelling, tenderness from the affected side.
The main mistake of many patients is not recourse to qualified help, but ordinary immobilization of the brush. For these purposes tight bandages, special wristbands are used..
In this case, the onset of an illness is the cause of disability. Patients can not perform even the most usual household chores (peeling potatoes, washing, unbuttoning buttons, etc.)..
De Quervin's disease should not be ignored. Symptoms of the pathology, manifested for several days in a row, should alert and become an excuse to immediately call a doctor.
At the consultation, the specialist performs a physical examination of the affected area, can ask a number of clarifying questions (when there are pains, their possible causes). To confirm the diagnosis, the doctor conducts several tests.
- Strained abduction. The specialist pushes the thumb on the back of the hand so as to bring it to the palm of your hand. On an absolutely healthy hand, the finger should resist pressure. In the case of pathology, soreness appears when touched.
- Ability to hold objects. The patient should take each hand in the subject. If you pull it lightly, a healthy hand will hold the object with more force, which can not be said about the patient.
- X-ray examination can also confirm de Quervain's disease. Photo (snapshot) of brushes allows to reveal presence of thickening of soft tissues, changes of periosteum.
First of all, patients are recommended to stop the previously performed activities with mandatory immobilization of the affected area.
The immobilization of the brush must be carried out in such a way that the thumb is permanently bent in relation to the index and middle finger. For these purposes, the best solution is to use a cast bandage, which is superimposed to the middle of the forearm.
Such immobilization only prevents the joint from possible traumatization. In addition, appropriate conservative therapy should be conducted.
Inflammatory changes in ligaments underlie a pathology such as de Cervin's disease.
Treatment implies the use of physiotherapeutic procedures (paraffin, ultrasound with hydrocortisone).
In addition, anti-inflammatory drugs ("Ibuprofen "Naproxen"), steroid injections ("Hydrocortisone") are prescribed.
When is surgery required?
Surgical intervention is recommended when conservative therapy is ineffective or there is a two-way lesion.
The operation is performed under stationary conditions using a local anesthetic version. Before the beginning of direct anesthesia, the doctor marks the most painful area with a special marker.
Then novocaine is introduced, and a cross-section is made over the so-called styloid process, which passes through this point. A dull crochet gently devotes subcutaneous tissue along with the veins, exposing the back ligament.
The doctor dissects it and partially removes it. Often, with a prolonged course of the disease, there are fusion of the tendon with the tendon sheath. In this case, all available adhesions are excised. The wound is sewn up, a bandage dressing is applied..
Sutures are removed after about 10 days, the work capacity is finally restored to 15 days..
It is necessary to take into account that de Kervena (disease) is usually caused by a pathological process in the zone of the ring-shaped ligament.
If, after direct surgical intervention, the patient continues to overload the hand, the likelihood of recurrence increases several times.
That's why patients are recommended to reduce activity, and sometimes even completely change the type of professional activity.
What will happen if you do not treat de Cervin's disease? Hands over time are increasingly involved in the pathological process, and a person loses his habitual ability to work.
That is why it is so important if you have primary symptoms that indicate an ailment, seek qualified help from a qualified specialist.
In the case of surgical intervention, there is still a small probability of occurrence of such complications as the formation of a painful scar and violation of the movements of the thumb.
How to prevent the development of the disease? First of all, doctors recommend that all those who are at risk, reduce the physical strain associated with grasping movements of the brush.
In addition, do not start the disease of the joints of inflammatory nature. In case of trauma or mechanical damage to the hand, it is important to seek help from a doctor and take a course of therapy.
Only by following all the above recommendations can the development of pathology be prevented.
In this article, we described what symptoms are accompanied by de Kerven's disease. Operation in this pathology is recommended in 80% of cases. However, timely begun conservative treatment can eliminate the ailment and minimize the development of complications.
We hope that all the information provided will be useful for you.
A source: http://.ru/article/187772/bolezn-de-kervena-simptomyi-diagnostika-lechenie
De Cervan's disease
De Cervan's diseasecharacterized by an inflammation of the outflowing ligament of the thumb. The pathology was first described in 1895. the Swiss surgeon de Kerven.
Doctors state that most often the disease occurs in those who perform a monotonous long-term work with a load on the thumb (seamstresses, pianists, milkmaids, blacksmiths, masseurs, builders, plastering).
Also diagnosed pathology and athletes who are engaged in badminton, tennis, skiing. Most often, the disease occurs in women.
Causes of de Kerven's disease
To date, doctors have found that in most cases the origin of the disease is associated with acute trauma or chronic traumatism of the tendon passing through the first canal on the back ligament wrists.
Note that acute injuries as a cause of de Cervin's disease are rare.
According to observations, only five percent of patients had sprains, bruises and other injuries, which led to the development of pathology.
The remaining ninety-five percent fall on a prolonged mechanical squeezing effect on the canal.
This effect occurs because of the specific nature of the work performed by the hand, in which the main emphasis is on the thumb. As doctors note, the thumb is involved in four of the six types of brushing, so the load on it falls more often than on other fingers.
It is only natural that such stresses can not but cause changes on the tendons, therefore, the work related to the reduction-withdrawal of the thumb, its tension, pressure in the end result leads to an increase in pressure on the wall of the first channel from the inside, as a result of which it narrows, and the tendon itself rubs against wall channel. Primary pressure on the channel wall causes its inflammation, then when the load stops, the channel recovers and scarifies, after - stenosis.
Long-term medical observations convincingly prove that the disease is primarily of a professional nature.
Even in the middle of the twentieth century, European doctors conducted surveys of workers in some professional groups (pianists, washers, furriers, stonecutters), and revealed in all the subjects some deviations in the first channel of the dorsal ligament wrists..
It should be noted that the change in the intensity of work, too, provokes de Quervin's disease. Studies conducted in twenty years, further strengthened the statement in the etiology of de Cervin's disease..
Also, scientists note that the disease can occur among young mothers who often wear their children for their armpits.
Consequently, the hand of the mother, and especially the thumb, experiences unnatural tension.
Seven percent of women suffer from the so-called "grandmother's ligament" - they also work with grandchildren and put their hands to the same strain as young mothers.
The disease of de Kerven sometimes goes in combination with other pathologies - myositis of forearm extensors, epicondylitis of the shoulder, etc., but the direct connection of the onset of the disease with these pathologies of the physician is not have established. It is believed that they are also the consequences of occupational traumatism.
Symptoms of the disease
The main symptoms for which de Cervin's disease is diagnosed are:
- pain in the wrist joint area from the side of the thumb;
- increased pain in the rotation of the hand, pain can radradirovat in the forearm, neck, etc .;
- check on the symptom of Finkelstein - the patient is asked to clamp a thumb in the fist and make a fist in the direction of the thumb. If there is a sharp pain, the symptom is positive;
- swelling from the affected side, soreness when pressed.
On the basis of these symptoms, the doctor can practically diagnose with absolute certainty. However, in case of doubt in diagnosis, an additional radiographic examination can be performed.
Even in the last century, doctors who dealt with this issue, stopped their attention to the state of soft tissues. On the roentgenogram, a thickening of the soft tissues near the first canal of the rear ligament is clearly visible.
Therefore, to rely only on bone changes will be wrong.
After all, changes in the area of the bone and periosteum on the X-ray are visible if the disease lasted more than six months, while soft tissue changes are already noted in the very beginning of the course of the disease - often soft tissue can increase two or three times compared with a healthy hand, so neglect this symptom in diagnosis it is impossible. Additionally, it can be noted that with the increase in soft tissues, shadows from muscles, tendons and subcutaneous fat are also not delineated.
After a visual inspection and radiographic examination, the question arises of differential diagnosis.
The disease has similar symptoms with rheumatoid infection, nonspecific polyarthritis, deforming arthrosis of the wrist joint, creping paratenonitis, neuralgia of the branch of the radial nerve.
In most cases, it may not be necessary, but if necessary, it is necessary to take into account the following factors that point to de Kerven's disease:
- prevalence of diseases in women, which is due to the narrowness of the first canal of the dorsal ligament;
- the appearance of the disease most often at the age of fifty to sixty years, but recently the disease de Kervena significantly younger - women are at the age of forty, men - at the age of thirty eight years;
- the development of the disease on the right hand, which is due to the performance of working actions is exactly this hand, less often - on the left hand, if the person is left-handed.
Treatment of de Cervan's disease
De Quervain's disease is treated both conservatively and surgically.
Treatment of the disease should begin with the elimination of the factor that caused it. Next, immobilize the affected ligament in such a way that the finger is bent, is opposite to the second and third fingers.
The brush should be in the position of a slight rear extension. Due to the correct application of the plaster bandage, not only the first finger is immobilized, but the brush itself can not move to the side.
This position of the hand is fixed with a plaster cast from the fingertips to the middle of the forearm. This measure, although it is salutary for the tendon, but treatment as such it can not be called. At that time (two to three weeks), while the hand is in plaster, adequate treatment should be carried out..
There are cases. When the dressing was applied for a month or more, however, there is no evidence in medicine of the occurrence of relapses after prolonged wearing of gypsum..
Observations show that not all surgeons in polyclinics impose plaster bandages. In most cases, the patient's arm is immobilized by improvised tires, so that the necessary position of the finger is broken, and it is pressed against the brush.
This does not prevent traumatization, and the pressure that is created on the radius, constantly forces the patient to relax the bandage.
This, in the end, leads to the fact that the brush does not immobilize the deadline and after the removal of the bandage the risk of re-occurrence of the disease is very large.
Since the inflammatory process is at the heart of the disease, physiotherapeutic procedures, novocain blockades, the use of anti-inflammatory drugs give good results.
Novokainovye blockades,% solution of five to six ml are carried out under the back of the wrist along the channel. Such injections not only give an analgesic effect, but also contribute to the removal of inflammation of the endothelial ligament layer.
Novocain blockades are recommended to be performed during the entire period of conservative treatment with interruptions of several days. Some surgeons consider it effective to add penicillin to novocaine. The result of such therapy does not make you wait.
Most patients report a decrease in pain after the first injection.
To date, conservative therapy is markedly improved.
Surgeons note that the treatment of de Kerven's disease is effective not only for Novocain blockades, but also for the administration of hydrocortisone in a volume of 25 mg.
The combination of novocaine, penicillin and hydrocortisone is considered the most effective method of treating the disease.
After the gypsum is removed, the hand should be in a gentle position for about a month..
Talk about the surgical treatment of the disease occurs when conservative therapy does not give results. Note that the operation in this case is a routine manipulation, performed on an outpatient basis under local anesthesia..
As a result of the operation, the ligamentous canal is dissected and the tendons are released from squeezing.
With properly conducted surgery, complications do not occur, but sometimes there may be pain in the scar area and with the movement of the thumb.
After treatment of the disease, doctors are not advised to hurry to go to work because of too frequent relapses. It is best if the patient does not perform the basic work for another month, but only some of its elements, in order to gradually adapt to the production process.
What kind of doctor should I contact?
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A source: http://www.knigamedika.ru/kost/myagkietkani/bolezn-de-kervena.html
De Carven's Disease: Symptoms and Treatment
Extension and retraction of the thumb of the hand is carried out by reducing the muscles of the forearm, which are attached to its base by means of tendons. They pass in the bone-connective tissue channel of the wrist.
De Carven's disease (stenosing tenosynovitis) is the result of tendon damage with the development of an inflammatory process that causes their swelling.
Because of the swelling, these tendons increase in volume, which makes it difficult to move in the canal and intensifies the pain.
The exact cause of this pathology is still unknown. Predisposing factors provoking the development of tendovaginitis
- professional activities (milkmaids, masseurs, seamstresses), certain sports (badminton, tennis) associated with the same type of thumb movements and increased strain on his tendons;
- hormonal changes in the body of a woman during and after pregnancy - this provoking factor is the reason that in women stenosing tendovaginitis develops an order of magnitude more often than in women men;
- hereditary predisposition, in which the tendons of the thumb are more sensitive even to small loads;
- suffered bruising in the past;
- chronic inflammatory diseases associated with autoimmune damage (rheumatoid arthritis).
Clinical manifestations of stenosing tendovaginitis develop gradually over a long period of time (years) with the appearance of characteristic symptoms:
- pain in the area of passage of his tendons in the carpal tunnel ("anatomical snuffbox"), which can be aching, permanent and intensified when trying to withdraw or unbend a finger;
- periodic sharp exacerbation of pain at night with awkward movements in a dream in the form of a characteristic lumbago that causes a person to wake up;
- irradiation of pain in the forearm, up to the elbow joint, and in the tip of the thumb;
- redness (flushing) and swelling of the skin in the area of the "anatomical snuffbox
- sensation of crunch when moving in the thumb;
- violations of extension of the finger, which are associated with a significant swelling of its tendons (dysfunction);
- a symptom of Finkelstein - a significant increase in pain during an attempt to unbend a thumb that is held in a bent position by the other fingers of the hand.
The severity and combination of symptoms depends on the intensity of the inflammation.
Suspected development of tendovaginitis can be based on the characteristic clinical symptoms.
To clarify the diagnosis, clarify the intensity of inflammation and pathological changes in the tendons additional instrumental diagnostics is carried out - radiography, tomography, ultrasound examination.
Given that this pathology is characterized by a chronic course, with gradual progression and violation functions of thumb extension, therapeutic measures are complex and include several approaches:
- conservative drug therapy;
- physiotherapy and rehabilitation;
The main goal of conservative drug therapy is the reduction of inflammation, thereby reducing the severity of tendon edema and pain syndrome. For this, non-steroidal anti-inflammatory drugs (diclofenac, rheumoxicam, meloxicam) are used in several dosage forms:
- Ointments - are applied to the area of inflammation with little pain or in addition to the use of other medicinal forms.
- Tablets - taken internally with an average degree of pain syndrome.
- Injections - a sterile solution is administered intramuscularly or intravenously with a significant intensity of pain and inflammation.
With severe pain syndrome and impaired motor function of the thumb, injections of hormonal anti-inflammatory drugs directly into the tendon area are also used.
Physiotherapy and rehabilitation means rest at the time of acute inflammation (immobilization with a tire), followed by a gradual increase in the volume of movements and load on the thumb.
Surgical treatment involves the operation of plasty of the tendon with the removal of the fibrin deposit on it and the improvement of its movement in the canal.
In addition, folk remedies are used, which includes medicinal plants - tincture of chamomile, sage, St. John's wort. When ingested, they have an anti-inflammatory effect.
The most important condition for successful therapy is to limit the load on the tendon of the hand and forearm, so often people with this disease have to change the gender of their professional activities.
A source: http://LechenieSpiny.ru/content/bolezn-de-kervena-simptomy-i-lechenie
De Carven's disease: symptoms, causes, treatment of tenosynovitis of the hand
Inflammation of the ligament of the thumb of the hand in medicine is called de Kerven's disease or tenosynovitis. For the first time the disease, its symptoms and causes were described in 1895 by a Swiss medic de Querven.
The main reason for the development of pathology is the monotonous movements of the hand, because most often it is observed in seamstresses, typists, musicians, masons, as well as athletes, tennis players, skiers. Women suffer from these diseases more often than men, the syndrome can be considered on a gender basis.
Why is it developing
The disease develops for two main reasons:
- injury to the hand;
- a permanent minor injury to the tendon, which resembles the back of the wrist, when the same movement is repeatedly performed for a long time.
It was noted that stretching, bruising and other mechanical effects on the hands and tendon in only 5% of all cases lead to the development of the disease. And in ninety-five percent of the disease is formed due to the regular pinching of the canal, along which the tendon passes.
This phenomenon is typical when performing work, when the main load falls on the thumb of the hand. In total, there are six types of brush grip, in four of them a thumb is involved. Therefore, the load on it is higher than the rest, which can not but affect the condition of the tendon..
If the thumb performs flexion, extension and retraction movements for a long period of time, the internal pressure on the walls of the channel through which the tendon passes increases. As a result, the channel becomes narrower, with the movement of the tendon against its walls..
Due to constant friction, inflammation of the tendon begins. If the pressure is normalized and the friction stops, the tissues will be restored. They form a scar, then stenosis develops.
Many years of medical practice and research confirm that the causes of pathology are directly related to the patient's professional activity.
About a hundred years ago, studies were conducted in which groups of such workers as furriers, laundresses, milkmaids, masons and pianists took part.
Almost each of them to some extent observed violations of the first channel on the back of the wrist.
It is noteworthy that if the intensity of the load changes, this also provokes the disease.
Experiments carried out repeatedly with groups of the same people after two decades have confirmed this.
Quite often de Cervain's disease is observed in young mothers, who often lift the child's armpits - the thumb is deflected and is in great tension. In older women, a similar phenomenon is called "ligamentitis grandmothers." They perform the same movements when playing with their grandchildren and taking care of them.
In some cases, the syndrome is accompanied by other articular pathologies - epicondylitis of the elbow, myositis of the extensor brachial ligaments. The direct relationship between these articular pathologies is not confirmed from a medical point of view.
Symptoms of de Carven's disease
The following symptoms can signal the development of de Kerven's disease:
- Painful sensations in the hand, in the area of the base of the thumb, especially after physical work;
- Puffiness from the affected side of the hand;
- Increased pain when pressed and palpated to the affected area;
- With rotational movements and twists of the brush, pain can be delivered to the shoulder, elbow, neck, etc.
Also a test is conducted on the symptom of Finkelstein.
The patient should clamp a thumb in the fist, and then make a fist in the direction of the thumb (see p. a photo).
If there is a sharp pain, the syndrome is confirmed. The symptom of Finkelstein is the main indicator used by physicians in the diagnosis of the disease.
If the doctor is not completely sure, an X-ray or ultrasound can be performed additionally..
First of all attention is drawn to the condition of the soft tissues surrounding the suspicious channel..
If there is de Cervin's disease, they are noticeably thickened - this is another characteristic symptom.
Relying in this case only on changes in bone and connective tissues can not.
Disturbances are visible on the X-ray photo, only when the syndrome has been developing for more than six months.
While soft tissue increases almost immediately after the onset of the disease - sometimes 2-3 times, if you compare a healthy and a painful brush.
Also on the photo, the boundaries of the shadows between the muscles, tendons and the subcutaneous fat layer are not noticeable. This is another important symptom that can not be overlooked.
Symptoms of the disease are often very similar to the symptoms of other diseases - deforming arthrosis of the hand, unspecified arthritis, rheumatoid infection, neuralgia of the radial nerve, etc. Because often it is required to conduct differential diagnosis to accurately establish the disease de Cerven.
Symptoms that indicate in this case the syndrome:
- In women, this pathology is more common than in men.
- Suffer mostly patients aged 50-60 years.
- It affects, as a rule, the tendon of the right hand, since it is with this hand that most people perform their daily work. If the person is left-handed, the channel from the back of the wrist of the left hand will be changed.
The treatment of the illness is long, it is often difficult to change the professional activity or to refuse to perform everyday household duties.
Treatment of de Cervan's disease
The de Cervin disease can be treated both conservatively and surgically. To eliminate the syndrome, it is first necessary to eliminate the factor that caused its development. Then you need to give the brush a certain position and fix it in it.
It is important to completely eliminate the load on the damaged bundle.
To do this, the thumb should be bent and moved to a position opposite to the index and middle fingers.
The brush should be slightly bent in the back side. If the dressing is applied correctly, not only the finger, but also the brush will be immobilized.
Then, a tire is inserted from the gypsum from the fingertips to the middle of the forearm. In this position, the hand must remain at least two weeks.
This does not mean that the treatment is over..
While the hand is in a cast, medical treatment is performed to completely eliminate the symptoms of the disease..
Important: not all surgeons prefer to impose gypsum tires. Often in clinics are just tight armbands.
But in this case the thumb is not in the position that is necessary, the probability of re-traumatization is not ruled out.
On the radius of the arm is excessive pressure when wearing a bandage, and patients often indulge in it themselves. All this leads to the fact that complete immobilization of the joint is not achieved, and after the removal of the bandage a relapse is possible.
Strong pain syndrome is removed with novocain blockades. ,% solution of novocaine is injected into the back of the wrist along the canal.
Treatment with novocaine is also indicated for inflammation of the endothelial ligament layer.
Such blockades are allowed to be made during the entire period while treatment is being conducted, pausing for several days.
Sometimes there are novocain blockades with the addition of penicillin. Such treatment is justified, patients feel considerable relief after the first injection.
Then the result will not be long in coming. The complex treatment necessarily includes physiotherapy..
Treating the disease with folk remedies as an independent is not welcome and the expected result does not, as it only eliminates the symptoms for a while, but not the cause of the disease. Ideally, use it as an addition to physiotherapy or drug therapy, when Kervin's disease is in an acute stage..
Surgical treatment is used when the syndrome recurs, and conservative treatment has not helped.
The operation does not require hospitalization, it is performed under local anesthesia. The surgeon dissects the skin on the wrist and tendon canal.
Thus, the tendon is immediately released from excessive pressure.
If the operation was performed correctly, the syndrome does not recur. To side effects after scarring can be attributed to the limitation of mobility when flexing the thumb, for some time there may be minor pain.
Regardless of whether the treatment was conservative or surgical, the affected limb even after removing the tire, complete scarring and recovery should be still month. To go to work during this period is not recommended.
But even after the expiration of a month, you can not immediately return to intensive primary activities, otherwise de Kerven's disease will develop again. Loads should at first be gentle and increase gradually.
A source: http://sustav.info/bolezni/drugie/bolezn-de-kervena.html
The main ways to treat de Cervan's disease
Traumatologists and orthopedists often face a diagnosis of de Kerven's disease. This is the defeat of the tendon of the thumb of the hand. There is a narrowing of the channel. Vaginal tendons become inflamed.
The pathology arises because of the increased burden on the 1st finger. She often appears at pianists, housekeepers, milkmaids, painters, seamstresses, etc. In the people this violation is referred to as the "mother's wrist."
The signs of the disease are the pain of the thumb area, the limitation of mobility and swelling. The onset of symptoms is an indication for the beginning of therapy.
"Finger of the mother" is eliminated with the help of conservative and radical treatment. To improve the condition of the tendon and to remove inflammation, traditional medicine is used.
The earlier to begin therapy, the less likely a relapse.
Conservative methods of treatment
Therapy is prescribed after a comprehensive examination of the patient. Conservative treatment is performed only at the initial stage of the pathological process.
To avoid surgery, a person should see a doctor no later than 6 weeks after the onset of the disease. Therapy is carried out on an outpatient basis in a polyclinic.
To improve the condition of the hand and relieve inflammation, the doctor prescribes:
- Admission of non-steroidal anti-inflammatory drugs. They relieve pain, remove swelling. The most commonly prescribed are Ibuprofen, Naproxen, Ketoprofen, Flurbiprofen, Diclofenac, Ketorolac, etc. NSAIDs are drunk on a short course under the supervision of a doctor, since they negatively affect the digestive tract. With ulcers of the stomach and duodenum preparations of this group are contraindicated.
- Immobilization. On the thumb is applied a plaster or plastic tire. The patient walks with her for a month. After removing the limiter, it is recommended to wear a special band for the 1st finger. During this time, edema subsides, inflammation decreases.
- Injection of steroidal anti-inflammatory drugs. The medicine is injected into the site of inflammation. Effective are Dexamethasone, Kenalog, Cortisone, Diprospan, Hydrocortisone.
- Physiotherapeutic procedures. Ozokerite is applied to the affected hand. Good help phonophoresis with hydrocortisone. All procedures are performed in the clinic under the supervision of a specialist.
- Massage with anesthetic ointments. Due to the mechanical action on the wrist and thumb, the canal in which the tendon passes is expanded and becomes elastic. At the expense of massage the pain syndrome decreases. The procedure should be performed only by a professional, otherwise complications may occur.
The de Cervin syndrome is susceptible to conservative treatment only in 50% of cases.
The use of pharmaceuticals and immobilization of the hand slow the progression of the pathological process.
In order for the disease not to bother, it is necessary to abandon the type of activity that triggered the violation. You also need to revise the diet.
Harmful products adversely affect the condition of the canal and tendons. With de Cervin's disease it is recommended to drink plenty of fluids. Dehydration leads to an increase in the friction of the tendon against the canal wall.
Radical treatment of de Cervin syndrome
At a late stage of the pathology, conservative therapy is powerless. In this case, with de Kerven's syndrome, treatment should be radical. Pain and inflammation are removed by surgery. The operation is performed under local anesthesia in a hospital.
Anesthetic drug based on novocain is introduced into the area of the wrist joint.
The surgeon makes an oblique or transverse incision, passing through the most painful point.
Subcutaneous tissue, the superficial branch of the radial nerve and the veins are removed to the outside with a blunt hook. The doctor exposes the back ligament and partially excludes it..
If necessary, during the operation, spikes are removed. After this, the surgeon layer-by-layer sutures the wound and produces an antibacterial bandage..
Sutures are removed after 10 days. To reduce muscular load, the hand is placed in a bandage bandage.
The full capacity of the brush is restored 2 weeks after the operation.
Within 3 weeks after surgery, a person can feel crawling in the area of the large, index and middle fingers. The hand sometimes grows numb.
This is due to the squeezing of the superficial branch of the radial nerve or anesthesia.
When the hand is completely restored, the discomfort and unpleasant sensations will pass by themselves.
With the help of surgical intervention de Kerven's pathology is treated completely. However, the likelihood of recurrence is not ruled out.
Application of traditional medicine methods
Unconventional therapy complements conservative or surgical treatment. Traditional medicine should not replace the help of professional doctors. With the help of non-traditional prescriptions, you can reduce inflammation and stop pain. At home, the following apply:
- Ointment from calendula. Dry flowers plants are mixed with baby cream. The agent is applied under the bandage at night to the affected area. Ointment has antimicrobial and anti-inflammatory effects.
- Ointment of pork fat and wormwood. The inner fat and dry plant are cooked on low heat, then cooled. The drug is applied before bedtime under the bandage. Remains of fat in the morning are washed off with cool water.
- Compresses from a shepherd's bag. Dry grass is poured with boiling water and languishes in a water bath for 2 hours. The product is applied as a compress at night.
- Lotions from therapeutic clay. The mixture is sold at the pharmacy. Lotions should be cool.
- Compresses with bear bile. The product is heated in a water bath. The bandage is wetted in warm bile and is applied to the affected area of the arm.
- Lotions from the decoction of arnica. The plant is filled with boiling water, it is infused for 2 hours. Bandage is wetted in a cool broth and applied to a painful area. Gadgets are put on the night, removed in the morning.
Treatment with folk remedies should be coordinated with an orthopedic or traumatologist.
Only the doctor knows what is allowed to apply, and which method can do harm. Unconventional therapy is an excellent alternative to tablets and injections.
However, you can completely get rid of the pathology solely through surgery.
The disease is treated by orthopedists, traumatologists and surgeons.
A source: https://OrtoCure.ru/svyazki-i-myshtsy/bolezn-de-kervena.html
Characteristic symptoms and effective treatment of de Cervin's disease
Diseases of periarticular tissues
Stenosing tendovaginitis or de Kerven's disease is stenosis of the vagina, through which the tendons of the thumb of the hand pass. Tenosynovitis is characterized by inflammation of the tendon of the extensor and the abducent muscle of the first finger of the upper limb.
The cause of this disease is the systematic load of the ligaments of the thumb. As a result, micro-trauma, edema and inflammation develop.
In the channels there is a synovial fluid that protects the ligaments from friction during the movement of the muscle..
Due to the friction of swollen tendons on the narrow bone-fibrous canal, in which they lie along with nerves and blood vessels, inflammation of the synovial vagina occurs..
Its narrowing increases the friction between it and the tendons. This leads to even more traumatization of the membranes and stimulation of the development of stenosis of the canal. The disease becomes chronic. The compression of the neuromuscular bundle contributes to the disruption of the basic functions of the hand.
Traumatologists believe that the pathology in question is of a professional nature. People who work with the same type of work with their hands suffer more often.
The risk group includes tailors, musicians, milkmaids, masseurs, sportsmen (tennis players).
To the development of the pathological process can result in thumb injuries, rheumatoid arthritis and purulent diseases of surrounding tissues.
The penetration of pyogenic microbes causes infectious tendovaginitis.
Hormonal changes in the body of a woman (during pregnancy, lactation, menopause) are the main causes of the development of tenosynovitis.
From de Kerven's disease women are more likely to suffer than men. The main symptom of the ailment is pain in the wrist joint with irradiation in the thumb or elbow.
At the beginning of the disease, the pain appears when the thumb is extended and pulled aside, with sharp movements of the hand. With the progression of tendovaginitis, the pain syndrome increases..
There may be discomfort in the dream and with occasional uncontrolled movements. First, a slight swelling in the area of the first finger is detected, then it spreads to the wrist and forearm..
At the same time, the movements of the first finger and the hand of the affected hand are limited. The ability to hold objects with the thumb and forefinger is broken.
During the examination, the doctor compares 2 brushes. This allows you to identify minor, but absolute manifestations of the disease.
When palpation of the affected area, the compaction of the synovial vagina and the smoothing of the anatomical snuff-box are noted.
When pressed, there is a moderate soreness. The skin is not changed, there is no hyperemia.
To diagnose tenosynovitis, the Finkelstein test is used. The patient is asked to squeeze the hand into a fist, while placing the thumb inward, and move aside the elbow.
At this time, you can hear a characteristic click. It is due to the fact that the inflamed tendons rub against the canal walls.
If the movement is accompanied by severe pain, the sample is considered positive.
The diagnosis is confirmed on the basis of anamnesis and examination. More often additional research is not required.
In doubtful cases, radiographs in direct projection or magnetic resonance imaging (MRI) of the wrist joint are used to exclude arthritis or other inflammatory diseases..
X-ray images show swelling and thickening of soft tissues in the region of the I channel of extensors..
The main goal of conservative treatment is to reduce the likelihood of inflammation, swelling of tendons and pain. To do this, use non-steroidal anti-inflammatory drugs (Diclofenac, Meloxicam) in various forms:
- ointment - is applied to the inflammatory site with minor pain or in combination with other medicinal forms;
- tablets - taken internally with moderate pain;
- injections - the solution is administered intravenously or intramuscularly with significant pain and inflammation.
With tenosynovitis, a complex treatment is prescribed in outpatient settings:
- 1. The exclusion from the lifestyle of an annoying factor is a change in the profession or a restriction on the load on the brush.
- 2. Immobilization of limbs - the imposition of plastic or gypsum tires for up to 4-6 weeks. The thumb is fixed in a bent position, and the hand should be unbent in the back of the hand. In this way, the damaged tendon is fixed and the main cause - friction - is eliminated.
- 3. Use of anti-inflammatory drugs.
In severe pain syndrome, injections of corticosteroid drugs are prescribed. Reception of steroid medicines should be supervised by the doctor as there are contraindications in application. In case of infection, antibacterial therapy is prescribed.
You can eliminate the symptoms of the illness with physiotherapeutic procedures (Paraffin, phonophoresis with hydrocortisone). In this case, the introduction of drugs into the deep layers of the skin with the help of ultrasound.
In addition, UHF, therapeutic exercises and massage are prescribed.
If the use of corticosteroid anti-inflammatory drugs is contraindicated, folk remedies are treated (after consulting a doctor). For this purpose, ointments, tinctures, herbs and compresses are prepared. You can treat with:
- 1. Calendula. To make an ointment, you need to grind dry flowers, then mix them with baby cream. Calendula has an anti-inflammatory and antimicrobial effect.
- 2. Wormwood - 100 g of dry herbs pour 200 ml of boiled water. Insist half an hour, then strain. Take inside before eating for 1 tbsp. l. It is prescribed as an immunostimulating and anti-inflammatory agent. Also, the infusion is used in the form of applications.
- 3. Bile-based compresses - the substance is pre-heated and then superimposed on the affected area.
- 4. Lotion from therapeutic clay. They quickly eliminate pain.
Surgical treatment is used if conservative therapy is ineffective or a late stage of the disease is observed.
The operation is performed in a hospital or outpatient (under local anesthesia). Operative intervention is to achieve decompression of the tendons and the neurovascular bundle.
This method reduces the pain and inflammation of the synovial membranes.
Before you enter anesthesia, the surgeon marks the most painful place. After anesthesia, tissue is cut. The back wall of the ligament is exposed by a blunt crochet.
The tendon is opened, decompression and partial excision occur. After reaching free movement of ligaments in the canal, the wound is sewn layer by layer. Sutures are removed in the polyclinic for 5-7 days.
After 2 weeks, the patient can return to work.
After surgery, there is a possibility of scar formation and impaired motor function of the thumb.
In the postoperative period, numbness (after anesthesia) or a feeling of discomfort in the area of the first two fingers can be preserved. This is due to damage to the superficial nerve.
Symptoms occur depending on the degree of damage to the radial nerve. This period lasts 1-3 weeks..
The launched disease increases the risk of disability and inefficiency of conservative treatment. After successful therapy, it is recommended to undergo a course of rehabilitation..
It is advisable to wear an orthosis (special bandage), with which the hand assumes the correct position. It is necessary to minimize the load on the wrist and joint.
If after treatment stay in the usual mode of life and work, loading the damaged limb, relapses of the disease with more severe course are possible.
A source: http://spina-health.ru/bolezn-de-kervena/