Tendovaginitis: what is it? symptoms and treatment

Tendovaginitis, description of the disease

What is this - tendovaginitis?

Not only muscles, tendons and ligaments can become inflamed, but also those structures that surround them. What is Tendovaginitis? It is an inflammation of the synovial membrane (vagina) of the muscle tendon.

The flexor tendons are most often affected. In the second place are extensor.

Since the synovial membrane is close to the tendon, it is often accompanied by tendonitis, the inflammation of the tendon itself.

Kinds

You should consider the types of tendovaginitis, in order to understand how it happens:

1. In the form of development they distinguish:
   • Sharp - appeared once;
   • Chronic - there are relapses, recurring symptoms of the disease.
2. On inflammatory exudate:

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

1. From the variety of microorganisms, species (infectious tendovaginitis) are isolated:

• Specific, which happens of these types:
  • Tuberculosis;
  • Brucellosis;
  • Syphilitic.
• Nonspecific - infection by coccolous infection.
• Traumatic.
• Creaking is the result of professional activity. It is expressed by swelling, soreness, creaking sounds. With repeated manifestations becomes chronic.
• Stenosing is the defeat of the tendons of the hand.
• Dystrophic - a chronic effect on the microtrauma in the affected area.
• Hands;
• Brushes;
• Forearm;
• Fingers;
• Wrists;
• Wrist joint;
• Shoulder joint;
• The elbow joint;
• Folders of fingers;
• Feet;
• Achilles tendon;
• Ankle joint;
• Knee joint;
• Tibia;
• Hips;
• Tendovaginitis de Kervena - inflammation of the ligaments of the wrist.

The main reason for the development of tendovaginitis is professional activity, which is associated with performing the same type of work with hands or feet. For example, pianists, packers, performers, athletes, tap dancing, etc.

They have a load on the same muscle groups, and with them - and on the tendons. The synovial membrane is depleted, the petals begin to rub against each other. This leads to the formation of serous and hemorrhagic exudate, which is a healing factor.

However, if the load continues, the process deteriorates, and fibrosis is formed.

Another cause is the direct injury of the tendon (its rupture, trauma, sprain, when piercing with a splinter or nail) with the subsequent penetration of microorganisms. They develop the purulent form of tenosynovitis, which is treated for a very long time.

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

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Symptoms and signs of tendon tendonitis of the tendon sheath

Let's start the examination with the general symptoms and signs of tendon tissue of the tendon of any kind:

1. Pain is constant and acute, increasing when trying to move the affected area. With suppuration, pulsation is possible.
2. Edema is pronounced and very tense, it develops very quickly.
3. Redness first places of inflammation, and then and nearby tissues. Accompanied by crepitation (crunch).
4. Hyperthermia (local high skin temperature).
5. Loss of functionality of the affected area. A person can not move an affected area, and the entire limb is usually in a relaxed state, performing lax movements.
6. Spikes and changes in contracture, which develops after some time after the onset of the disease.
7. Fever.
8. Chills.
9. Inflammation of blood vessels and lymphadenitis.

Tendovaginitis in children

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

Tendovaginitis in adults

Tendovaginitis is predominantly observed in adults, since they are engaged in such work for a long time, which gives a load on the same group of muscles.

In men, tendovaginitis develops due to the monotonous sports load and professional activity.

In women, it also manifests itself because of professional, monotonous work, and also when wearing high heels.

Diagnostics

Diagnosis of tendovaginitis is not difficult. According to the patient's feelings and general examination with the help of palpation, all the main signs of the disease are visible. Only to clarify the nature of the disease it is possible to conduct additional procedures:

• MRI.
• Blood test.
• Sowing of tendon exudate, which accumulated in the synovial membrane.
• CT.
• Radiography allows tenosynovitis to be distinguished from arthritis and osteomyelitis.
• Ligamentography.

Treatment

Treatment of tendovaginitis is carried out only under stationary conditions. At home, it leads to complications. Thus it is necessary to start treatment as early as possible, as the disease rapidly progresses, affecting neighboring healthy tissues and areas.

Than to treat tendovaginitis? With the help of those medicines prescribed by the doctor:

• Nonsteroidal anti-inflammatory drugs: Nimesulide, Diclofenac.
• Hormonal anti-inflammatory drugs: Dexamethasone.
• Antibiotics: Ceftriaxone.
• Injection of novocain for anesthesia.
• Enzyme preparations.

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

The affected limb should be immobilized with gypsum, so as not to provoke additional painful sensations. At the same time, physiotherapeutic procedures are carried out:

• Ultrasound therapy;
• SUF irradiation;
• Electrophoresis of anesthetics;
• UHF;
• Alcohol compress;
• Mud treatment (peloidotherapy);
• Ozokerite and paraffin applications;
• Massotherapy;
• Warming.

As healing recovers, plaster is removed so that the patient begins to perform light therapeutic gymnastics with a limb, and develops muscles.

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

1. Warm compresses.
2. Warming Ointments.
3. 1 tbsp. of marigold flowers to grind and mix with baby cream or petroleum jelly. Stir the mixture for several hours and apply before going to bed on the affected area.
4. 1 tbsp. chamomile and St. John's wort, pour a glass of hot water, insist 30 minutes. Use inside half a cup.
5. As a diet, you can resort to eating raw fruits and vegetables to fill the body with vitamins.

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Forecast of life

On the question of how many live with tendovaginitis, you can answer: it all depends on the course and complications of the disease.

It is better to treat the disease, then within 2 weeks there will come a recovery, which gives a positive prognosis of life.

If the treatment is not carried out, the purulent form develops, which gives such complications:

• Septic tendovaginitis, which inflames neighboring healthy areas of the tendon and vagina, spreading throughout the limbs.
• Sepsis, which requires limb amputation. Otherwise, death may occur.
• Disability due to loss of limb.
• Congestion of tendons.

To prevent the disease, it is necessary to prevent the disease:

• 1. Change the type of activity to distribute the load throughout the body.
  2. Make a rest, give the body more strength.
  3. Mask muscles before sports.
  4. Call the doctor in good time for help.

It is better to change the work that led to tendovaginitis. You can cure the disease, but it will again appear because of the negative impact of the work.

A source: http://vospalenia.ru/tendovaginit.html

Tendovaginitis - inflammation of the tendon and its membranes

Tendovaginitis- Inflammation of the tendon and surrounding shell. Unlike tendonitis, it develops in the area of ​​tendons that have a vagina - something like a soft tunnel consisting of connective tissue.

The cause of development can be nonspecific and specific infections, rheumatic diseases and repetitive movements of the same type while exercising or performing professional responsibilities. Tendovaginitis can occur acutely or chronically.

It manifests itself with pains that increase during movement. It is possible to swell and increase the local temperature. With infectious tendovaginitis, there are symptoms of general intoxication, non-infectious diseases occur without disturbing the patient's general condition.

Treatment depends on the form and variant of the course of tendovaginitis and can be both conservative and operative.

Tendovaginitis - an inflammation that develops in the tendon and tendon sheath.

Suffer tendons are covered with a connective tissue membrane in the region of the forearm, wrist and hand, as well as the ankle, foot and Achilles tendon.

Tendovaginitis can be infectious or non-infectious (aseptic), acute or chronic. Infectious tendovaginitis is usually treated promptly, the remaining forms are conservative.

During movements, the muscles contract, and the tendon shifts relative to the surrounding tissues.

In the middle and adjacent to the muscle parts of the tendon are covered with a case of connective tissue that continues on the tendon tissue directly from the surface of the muscles.

From the inside, these cases are lined with a synovial membrane that produces a small amount of oily liquid.

Due to this, during movements, the tendon easily slides inside the original channel, without encountering resistance.

With inflammation or degeneration of the tendon or tendon sheath, slipping is difficult, there are symptoms of tendovaginitis.

Causes of tendovaginitis

Aseptic tendovaginitis may appear due to constant overload and associated microtraumatic tendon and its vagina.

Such tendovaginitis occur in people of certain professions: pianists, typists, movers, etc., as well as some athletes, for example, skaters or skiers.

In a number of cases, tendovaginitis develops as a result of a ligament injury (stretching or bruising).

Nonspecific tendovaginitis occurs when the infection spreads from a nearby purulent focus. It can occur with panaritium, purulent arthritis, osteomyelitis or phlegmon.

Specific tendovaginitis can be observed in tuberculosis, brucellosis and gonorrhea, with pathogens usually falling into the tendon sheath with blood flow.

Taking into account the etiological factor, the following are distinguished:

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

Taking into account the nature of the inflammatory process, one distinguishes:

1. Serous tenosynovitis.
2. Serous-fibrinous tenosynovitis.
3. Purulent tenosynovitis.

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

Acute aseptic tenosynovitis

This form of tendovaginitis usually develops after overload (for example, intensive work for computer, during the preparation for examinations at the music school, in preparation for the competition etc.). Usually affected tendons and tendon sheaths on the back surface of the hands, less often - stop. There is also tendovaginitis in the tendon of the biceps brachii of the shoulder.

Tendovaginitis develops sharply. In the affected area there is swelling. The movements become sharply painful and are accompanied by a kind of soft, soft crunch in the area of ​​the affected tendon.

With adequate treatment, the symptoms of acute tenosynovitis completely disappear within a few days or weeks.

However, due to continuing excessive loads on the tendon already weakened by the disease, such tendovaginitis often turns into a chronic form.

Patients with tendovaginitis are recommended to limit the load on the limb, possibly with the use of orthoses. Apply cold to the affected area. With intensive pain syndrome prescribe painkillers.

Physiotherapy and shock wave therapy are also used. With tendovaginitis with persistent pain, not removed analgesics, perform therapeutic blockade with glucocorticosteroid drugs.

After elimination of the pain syndrome, therapeutic exercises are prescribed to strengthen the muscles.

Acute posttraumatic tenosynovitis

Post-traumatic tendovaginitis occurs with stretches and bruises of the region of the wrist joint. In the history - a characteristic trauma: a fall on the arm sharply bent or unbent in the wrist joint, less often the contusion of the wrist area. There is pain and swelling in the affected area.

Assign immobilization using a tight bandage, gypsum or plastic longes.

In the first day after the injury, cold is applied to the affected area, then thermal procedures are performed and UHF therapy is prescribed.

Symptoms of posttraumatic tenosynovitis completely disappear within a few weeks.

It can be primarily chronic or develop after acute aseptic or posttraumatic tenosynovitis. The cause is chronic microtraumatism followed by dystrophy of tendon sheaths. The course is recurrent.

A patient with tendovaginitis complains of pain, aggravated by movement. Swelling is usually absent. When palpation, tenderness along the tendon and a crunch or crepitation during movements is revealed.

A special form of chronic aseptic tenosynovitis is stenosing tendovaginitis, in which the tendon is partially blocked in the osteo-fibrous canal. There are several syndromes caused by stenosing tendovaginitis.

Carpal tunnel syndrome develops with narrowing of this canal, which is located on the palmar surface of the wrist joint. At the same time, the flexor tendons of the fingers and the median nerve are compressed.

The examination reveals pain along the tendon and sensitivity disorders in the area I-III and the inner surface of the IV fingers, loss of ability to precise and subtle movements and a decrease in the strength of the hand.

De Carven's disease is a stenosing tendon of the tendon of the short extensor and a long abducent muscle I fingers of the hand, which are squeezed in the bone-fibrous canal, located at the level of the subulate of the appendage. There is a violation of movement, swelling and pain in the area of ​​the "anatomical snuffbox".

The disease develops as a result of sclerotic changes in the region of the ring ligaments and is accompanied by some difficulty in extending the finger - as if at some point you need to overcome some obstacle for further movement.

During the exacerbation, tenosynovitis is carried out immobilization of the limb, physiotherapy is prescribed (phonophoresis with hydrocortisone, electrophoresis with potassium iodide and novocaine), anti-inflammatory therapy preparations. With severe pain, blockages with glucocorticosteroids are performed.

In the recovery period, patients with tendovaginitis are prescribed ozocerite in combination with dosed medical gymnastics.

In the absence of the effect of conservative therapy, dissection or excision of affected tendon sheaths is performed.

Reactive tendovaginitis

Reactive tendovaginitis develops in rheumatic diseases: Reiter's syndrome, Bechterew's disease, systemic scleroderma, rheumatism and rheumatoid arthritis. Usually acute. It is manifested by pain and minor swelling in the affected tendon.

Treatment - rest, if necessary, immobilization, anti-inflammatory drugs and pain medications.

Acute nonspecific infectious tendovaginitis

Infectious tendovaginitis can occur when drifting pyogenic microflora from a nearby foci (with purulent inflammation) or from the external environment (with trauma). It develops more often in the area of ​​tendon sheaths of the finger flexor and in this case is called the tendon felon.

Initially, the serous exudate accumulates in the cavity of the tendon vagina. Then pus is formed. Swelling and squeezing of accumulated pus cause severe pain and disrupt the blood supply of the tendon.

A patient with tendovaginitis complains of acute pain, which, when forming an abscess, becomes jerky or throbbing, depriving sleep. When examined, there is a significant swelling, hyperemia and sharp soreness in the area of ​​the affected finger.

Pain is aggravated by movement. The finger is in the forced position. Regional lymphadenitis is revealed.

Unlike other types of tendovaginitis, with infectious tendovaginitis, signs of general intoxication are revealed: fever, weakness, weakness.

If the tendonaginitis appeared in the V region of the finger, the pus can spread to the ulnar synovial bag.

When the first finger is injured, the purulent process can spread to the radial synovial bag. In both cases, a tenobursitis develops.

The spread of pus leads to a worsening of the patient's condition with a significant increase in temperature, chills and severe weakness.

There is a significant swelling and forced position of the hand. The skin of the affected area is purple-cyanotic.

The patient with tendovaginitis complains of sharp pains, which increase when trying to move.

In the early stages (before the formation of the abscess) treatment of infectious tenosynovitis is conservative: immobilization with gypsum or plastic lunget, novocain blockades, alcoholic lotions, UHF and laser therapy. When suppuration is shown, surgical treatment is the opening of the tendon vagina with its subsequent drainage. In the pre- and postoperative period, antibiotic therapy is performed.

With tenobursitis and phlegmon brush also need surgical treatment, consisting in a wide opening, washing and subsequent drainage of purulent cavities against the background of taking antibiotics.

In the long-term period after infectious tendovaginitis, stiffness of the finger can be observed due to cicatricial changes in the tendon area. In case of melting and death of the tendon, the flexural contracture of the affected finger develops.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/tendovaginitis

Tendovaginitis: Symptoms and Treatment

Tendovaginitis is an inflammatory disease that affects the tendon tissues, as well as the membranes that cover it (in medicine they are called the tendon sheath).

Such a disease from tendonitis differs in that the inflammatory process occurs exclusively in those anatomical places where the tendon is covered with a specific membrane - the ankle joint, forearm, foot, hand, wrist joint.

Tendovaginitis is a rather common pathology. More often it is diagnosed in representatives of certain professions, who during the working day are forced to perform the same type of movement with their hands or feet.

It is worth noting that such an inflammatory process can have severe consequences.

Acute tenosynovitis is easily treatable, while a chronic form of pathology can lead to impaired functioning of the fingers, wrist, wrist joint.

The tendons of the muscular structures are tightly attached to the bone structures. Above, they are covered with a shell that produces exudate, which reduces friction during the performance of certain active movements.

As the inflammation progresses, the production of specific substances - prostaglandins, which irritate the nerve endings (provoking pain syndrome), provoke edema of tissues and their hyperemia.

Etiology

Clinicians identify several main causes that may lead to the progression of tendovaginitis of the wrist joint, ankle and others:

• injuries of tendons and their membranes of varying severity;
• nonspecific infections. The development of the disease usually provokes bacteria that are already in the body. Hematogenously, they penetrate the tendon sheath, settle there and begin to actively multiply, thereby causing inflammation;
• specific infections. The cause of the progression of the disease is already a purulent or inflammatory process in the bone structures. From this focus, infectious agents easily penetrate the tendon sheaths;
• prolonged microtraction of tendons;
• existing systemic diseases.

Classification

Clinicians use a classification that is based on the etiology, the nature of the inflammation, and the duration of the pathological process.

According to the etiology:

1. infectious;
2. aseptic. This type includes crepitus tenosynovitis of the forearm, as well as reactive tendovaginitis (with systemic pathologies).

Schematic representation of tenosynovitis

By the nature of inflammation:

• purulent tenosynovitis. The most dangerous. Purulent tendovaginitis develops in the case of an infectious process. As a result of its progression, pus accumulates in the affected tendon and its shell;
• serous. For this type of pathology is characterized by inflammation of the inner layer of the membrane with the release of serous fluid;
• serous-fibrous. Simultaneously with the appearance of serous exudate, a specific fibrin gland is formed on the surface of the shell sheets. It causes increased friction of the tendon.

From the duration of the current:

1. acute - up to 30 days;
2. subacute - from a month to six;
3. chronic - more than 6 months.

Forms

• initial. In this case, there is only hyperemia of the synovial vagina. It is possible to form small infiltrates in its outer sheet. These signs are observed on the tendons of the hand, feet and fingers;
• exudative sedentary;
• chronic stenosing.

Symptomatology

Given the clinical course, clinicians identify acute and chronic pathology.

Sharp

This clinical form usually begins to progress after a systematic overload of a specific area of ​​the body (foot, hand). At the lesion site, a slight edema is formed, which patients do not immediately pay attention to.

The color of the skin does not change. Pain syndrome occurs when the hand or foot performs active movements. Its localization depends on which particular tendon was affected.

More often "attack" is exposed to the thumb of the hand and wrist joint.

With the progression of the purulent process, the symptoms of inflammation are very pronounced. The affected finger strongly reddens, the skin is taut and glitters, local hyperthermia is noted. Pain is noted not only with active movements, but also in complete peace.

Additional symptoms:

1. fever;
2. increased lymph nodes;
3. decreased appetite.

If, if these symptoms do not occur, do not treat tendovaginitis, then the patient's condition will rapidly deteriorate. Signs of inflammation from the finger go to the wrist and the forearm. Septic shock may develop.

Chronic

Chronic tenosynovitis only progresses with an aseptic lesion. At the site of the lesion, the patient marks moderate soreness. When you feel this area, you can note the appearance of crepitus. Chronic tenosynovitis occurs without a pronounced symptomatology.

Symptoms of tendovaginitis also depend on which tendon was affected by the inflammatory process. Clinics may differ slightly.

Defeat of foot

The symptoms of tendovaginitis of the foot are rather specific, therefore the pathology can be diagnosed without difficulty:

• pain syndrome with load on the foot. The pain is acute and can be of a pulsating nature (in the presence of purulent exudate);
• swelling of the foot and ankle;
• hyperemia of the skin over the vagina of the tendon;
• slight limitation of mobility of the joint;
• limited functionality of tendons;
• local increase in temperature;
• when probing the site of the lesion, one can note the appearance of pathological nodes and infiltrates;
• intoxication syndrome (more pronounced with purulent tenosynovitis of the foot).

Lesion of the wrist joint

The main symptoms of tendonitis of the wrist joint:

1. swelling in the wrist area;
2. spasm of the muscular structure of the hand;
3. pain in the joint, which tend to increase;
4. the movements of the fingers are somewhat limited;
5. when performing active movements by hand, a crunch may appear in the wrist;
6. Tendovaginitis of the wrist joint can be accompanied by numbness and tingling in the area of ​​the wrist and fingers.

Brush defeat

The clinical picture of tendodaginitis of the hand usually appears after the brush experienced a strong physical load. The main symptoms are:

• edema in the affected area. Most often swell tissues located on the back of the hand;
• In the place of localization of the tendon appears persistent hyperemia;
• stiffness in the wrist joint;
• convulsions. When the hand is stretched, the patient often feels as if the brush is brushing.

Treatment - Species

The tactics of treating tendovaginitis directly depends on the type of pathology, and also on the clinical picture.

Treatment of aseptic species:

1. impose gypsum longe on the affected tendon;
2. anti-inflammatory drugs;
3. Physiotherapeutic procedures with Novocain blockades;
4. mud applications.

Using longots with tendovaginitis

Treatment of infectious type of pathology:

• if a purulent exudate has accumulated in the synovial vagina, it is shown to perform its immediate opening and drainage of the tendon;
• superposition of gypsum lingeta;
• therapy for the background disease, which provoked tendovaginitis;
• antibiotics;
• antiseptic means;
• anti-inflammatory drugs;
• physiotherapy.

Treatment of chronic form:

1. broad-spectrum antibiotics;
2. non-steroidal anti-inflammatory drugs;
3. paraffin applications;
4. massage;
5. physiotherapy.

A source: http://SimptoMer.ru/bolezni/sustavy-kosti/1320-tendovaginit-simptomy

Tendovaginitis

Tendovaginitis is an inflammation of the inner lining of the fibrous vagina of the muscle tendon, that is, of the synovial membrane. The synovial membrane facilitates the sliding of the corresponding tendon in the osteo-fibrous canals when performing muscular work.

Picture 1. Schematic representation of tendovaginitis - inflammation of the synovial membrane of the fibrous vagina of the muscle tendon. Distinguish between acute and chronic tenovaginitis.

Acute tenosynovitisis manifested by edema of the synovial membrane and by the accumulation of fluid in the cavity of the synovial membrane.

Chronic tenosynovitisis accompanied by thickening of the synovial membrane and accumulation in the synovial cavity of effusions with a high content of fibrin. Over time, as a result of the organization of fibrinous effusion, the so-called "rice bodies" are formed, and the lumen of the tendon sheath decreases.
Depending on the nature of the inflammatory process, there are serous, serous-fibrinous, and purulent tenosynovitis.

The causes of tendovaginitis

Depending on the causes of the onset, the following groups of tendovaginitis can be distinguished:

1) independent aseptic tendovaginitis, the occurrence of which is a consequence of prolonged microtraumatism and overstrain of synovial vaginal tendons and adjacent tissues in persons of certain professions (carpenters, locksmiths, loaders, typists, pianists, hosiery, moulders brick production, workers of heavy metallurgical industry), who perform long-term movements of the same type, in which they participate limited group of muscles; In addition, such tendovaginitis can appear in athletes (skiers, skaters and others) with overtraining.2) infectious tenosynovitis:

a) specific tenosynovitis in some infectious diseases (such as gonorrhea, brucellosis, tuberculosis and so on), in which the spread of pathogens occurs more often by hematogenous pathway (with current of blood);

b) nonspecific tendovaginitis in purulent processes (purulent arthritis, panaritium, osteomyelitis), from which directly spread inflammation to the synovial vagina, as well as injuries;
3) reactive tendovaginitis, the appearance of which accompanies rheumatic diseases (rheumatism, Bekhterev's disease, rheumatoid arthritis, systemic scleroderma, Reiter's syndrome and others).

Symptoms of tendovaginitis

Foracute nonspecific tenosynovitischaracterized by an acute onset and rapid development of painful swelling in the location of the affected synovial membranes of the tendon sheaths.

Most often, acute tendovaginitis is observed in the tendon sheaths on the dorsal surface of the feet and brushes, more rarely - in the synovial vagina of the fingers and in the vagina of flexor tendons fingers brush.

If the inflammatory process becomes purulent, the body temperature rises quickly, chills appear, develops regional lymphadenitis (enlarged lymph nodes due to inflammation) and lymphangitis (inflammation of lymphatic vessels). Purulent tendovaginitis more often develops in the area of ​​the vagina of tendons of flexor flexors.

Foracute aseptic (creping) tenosynovitisis characterized by the defeat of the synovial vagina on the dorsum of the hand, not so often - the feet, even less often - the intercampagogic synovial vagina of the biceps (biceps muscles of the shoulder).

The onset of the disease is acute: a swelling is formed in the area of ​​the affected tendon, when probed, there is a crepitation (crunching). There is a restriction of the movement of the finger or tenderness when moving.

A transition to a chronic form of the disease is possible.

Forchronic tenosynovitischaracteristic of the defeat of the vagina tendons flexors and extensors of the fingers in the area of ​​their retainers.

Often there are symptoms of chronic tendovaginitis of the common synovial vagina of the flexor of the fingers - the so-called carpal tunnel syndrome, a tumor-like, painful elongated shape in the region of the wrist canal, having an elastic consistency and often taking on the shape of an hourglass, slightly shifting when driving. Sometimes you can feel the "rice bodies" or determine the fluctuation (sensation of the transfer wave, caused by the accumulation of fluid). Characteristic limitation of tendon movements.

Particularly distinguish the peculiar form of chronic tendovaginitis - the so-calledstenosing tendovaginitis, or tendovaginitis de Kervena, which is characterized by the defeat of the vagina of the tendon of the short extensor and the long distal muscle of the thumb of the hand.

The walls of the vagina with this form of tendovaginitis thicken, and the cavity of the synovial vagina, respectively, tapers.

Tendovaginitis de Kervena is manifested by pains in the location of the styloid process of the radius, which often irradiate in the first finger of the hand or in the elbow, as well as swelling.

Tuberculous tenosynovitischaracterized by the formation of dense formations ("rice bodies") along the course of the expansion of the tendon sheaths, which can be palpated (palpated).

Complications of tendovaginitis

Purulent radial tenobursitis- is, as a rule, a complication of purulent tenosynovitis of the thumb of the hand.

It develops if the purulent inflammation spreads to the entire vagina of the tendon of the long flexor of the thumb of the hand.

Characterized by severe soreness along the palmar surface of the thumb of the hand and further along the outer edge of the hand to the forearm. If the disease progresses, the purulent process can spread on the forearm.

Purulent ulnar tenobursitis- is, as a rule, a complication of purulent tendovaginitis of the little finger of the hand.

Because of the peculiarities of the anatomical structure, the inflammatory process quite often passes from the synovial vagina of the little finger on the common synovial vagina of the flexor of the hand, less often on the synovial vagina of the tendon of the long flexor of the large finger. In this case, the so-called cross phlegmon develops, which is characterized by a severe course and is often complicated by a disruption in the functioning of the hand. Characterized by severe soreness and swelling of the palmar surface of the hand, thumb and little finger, as well as a significant restriction of extension of the fingers or its complete inability.

Carpal tunnel syndrome:its occurrence and clinical manifestations are caused by compression in the carpal tunnel of the median nerve.

Characterized by sharp pain and a sense of numbness, tingling sensation, crawling crawling in the area (paresthesia) of the first, second, third fingers of the hand, and also the inner surface of the fourth finger. There is a decrease in the muscle strength of the hand, the sensitivity of the tips of these fingers is reduced.

Pain intensification occurs at night, which leads to sleep disturbance. There may be some relief when the hand is lowered and waved. Quite often there is a discoloration of the skin of the painful fingers (blueness of the tips, pallor).

Perhaps a local increase in sweating, a decrease in pain sensitivity. When you feel your wrist, swelling and soreness are determined.

With the syndrome of the Huyon canal, as a result of the ulnar nerve being compressed in the region of the pea-bones, pain and numbness occur, tingling sensations, crawling crawling in IV, V fingers, swelling in the region of the pea-shaped bone and tenderness when palpating side.

Examination and laboratory diagnostics of tenosynovitis

Diagnosis of tendovaginitis allows a characteristic localization of the pathological process and obtained during a clinical study data (cord-like form of painful compaction in typical places, impaired movement, definition of "rice bodies" at probing).

At laboratory inspection at an acute purulent tenosynovitis in the general analysis of a blood (OAK) leukocytosis is determined (increase of white blood cells over 9 x 109 / L) with an increase in the content of stab neutrophil forms (above 5%), an increase in ESR (sedimentation rate erythrocytes).

Pus is examined by bacterioscopy (examination under a microscope after a special coloring of the material) and bacteriological (isolation pure culture on nutrient media) by methods, which makes it possible to establish the nature of the pathogen and determine its sensitivity to antibiotics.

In cases where the course of acute purulent tendovaginitis is complicated by sepsis (with the spread of the pathogen from the purulent focus to the bloodstream), a study of blood for sterility is performed, which also makes it possible to establish the character of the pathogen and determine its sensitivity to antibacterial drugs.

X-ray examination is characterized by the absence of pathological changes on the part of the joints and bones, only thickening of the soft tissues in the corresponding area can be determined.

Differential diagnosis

Chronic tenosynovitis should be differentiated with Dupuytren's contracture (painless progressing flexural contracture IV and V fingers of the hand), acute infectious tendovaginitis - with acute arthritis and osteomyelitis.

Treatment of tendovaginitis

Treatment of acute tendovaginitis is divided into general and local.

General treatment for nonspecific acute infectious tendovaginitisprovides for the fight against infection, for which the use of pritovobakterialnye funds, as well as measures to strengthen the body's defenses. Whentubercular tendovaginitisanti-tuberculosis drugs (streptomycin, ftivazid, PASK and others) are used. General treatmentaseptic tenosynovitisimplies the use of non-steroidal anti-inflammatory drugs (aspirin, indomethacin, butadione).

Local treatmentin both the infectious and the aseptic tenosynovitis in the initial stage is reduced to ensuring the rest of the affected limbs (in the acute period of tenosynovitis are immobilized with gypsum lintet), the use of warming compresses. After it is possible to achieve the subsidence of acute phenomena, physiotherapeutic procedures (ultrasound, UHF, microwave therapy, ultraviolet rays, hydrocortisone and novocaine electrophoresis), physiotherapy exercises.With a purulent tendovaginitis, the vagina of the tendon and the purulent swelling are urgently opened and drained.Whentubercular tenosynovitislocal injection of streptomycin solution, as well as excision of affected synovial vaginas.

ATtreatment of chronic tendovaginitisapply the aforementioned methods of physiotherapy, as well as prescribe paraffin or ozocerite applications, massage and electrophoresis of lidase; classes of physiotherapy exercises.

If the chronic infectious process progresses, punctures of the synovial vagina and administration of antibiotics of directed action are shown.

With chronic aseptic tendovaginitis non-steroidal anti-inflammatory drugs are used, local administration of glucocorticosteroids (hydrocortisone, methipred, dexazone) is effective.

Tendovaginitis accompanying rheumatic diseases, are treated in the same way as the main disease: prescribe anti-inflammatory and basic drugs, electrophoresis of non-steroidal anti-inflammatory drugs, phonophoresis of hydrocortisone.

Prognosis for tendovaginitis

In the case of timely initiated and adequate treatment, tendovaginitis is characterized by a favorable prognosis. However, with purulent tendovaginitis, persistent violations of the function of the affected hand or foot can sometimes remain.

A source: http://www.medicalj.ru/diseases/orthopedics/1003-tendovaginit