Tendovaginitis which doctor to contact. Tenosynovitis of the flexor tendon of the finger treatment. Clinical features of tendovaginitis of various localizations

Tendovaginitis is an inflammation of the inner lining of the fibrous sheath of the tendon of the muscle, that is, the synovial membrane. The synovial membrane facilitates the sliding of the corresponding tendon in the bone-fibrous canals during muscular work.

Figure 1. Schematic representation of tendovaginitis - inflammation of the synovial membrane of the fibrous sheath of the tendon of the muscle.

There are acute and chronic tendovaginitis.
Acute tendovaginitis manifested by edema of the synovial membrane and accumulation of fluid in the cavity of the synovial membrane.
Chronic tendovaginitis accompanied by thickening of the synovial membrane and accumulation in the synovial cavity of effusion 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 narrows.
Depending on the nature of the inflammatory process, serous, serous-fibrinous, and also purulent tendovaginitis are distinguished.

Causes of tendovaginitis

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

1) independent aseptic tendovaginitis, the occurrence of which is the result of prolonged microtraumatization and overstrain of the synovial sheaths of the tendons and adjacent tissues in persons of certain professions (carpenters, locksmiths, loaders, typists, pianists, hosiery, brick molders, workers in the heavy metallurgical industry) performing for a long time the same type of movement, in which a limited group of muscles takes part; in addition, such tendovaginitis can appear in athletes (skiers, skaters and others) during overtraining.
2) infectious tendovaginitis:
a) specific tendovaginitis in some infectious diseases (such as gonorrhea, brucellosis, tuberculosis, and so on), in which the spread of pathogens often occurs by the hematogenous route (with blood flow);
b) non-specific tendovaginitis in purulent processes (purulent arthritis, panaritium, osteomyelitis), from which inflammation directly spreads to the synovial vagina, as well as with injuries;
3) reactive tendovaginitis, the appearance of which accompanies rheumatic diseases (rheumatism, ankylosing spondylitis, rheumatoid arthritis, systemic scleroderma, Reiter's syndrome and others).

Symptoms of tendovaginitis

For acute nonspecific tendovaginitis characterized by an acute onset and rapid development of painful swelling at the location of the affected synovial membranes of the tendon sheaths. Most often, acute tendovaginitis is observed in the tendon sheaths on the dorsum of the feet and hands, more rarely in the synovial sheaths of the fingers and in the sheaths of the flexor tendons of the fingers. Swelling and soreness, as a rule, spread from the foot to the lower leg and from the hand to the forearm. There is a restriction of movements, the development of flexion contracture of the fingers is possible. If the inflammatory process becomes purulent, the body temperature quickly rises, chills appear, regional lymphadenitis develops (enlargement of the lymph nodes due to inflammation) and lymphangitis (inflammation of the lymphatic vessels). Purulent tendovaginitis often develops in the sheath area of ​​the flexor tendons of the hand.

For acute aseptic (crepitating) tendovaginitis characteristic is the defeat of the synovial sheaths on the dorsum of the hand, not so often - of the foot, even more rarely - of the intertubercular synovial sheath of the biceps (biceps brachii). The onset of the disease is acute: a swelling forms in the area of ​​the affected tendon, when palpated, crepitus (crunching) is felt. There is a restriction of the movement of the finger or pain when moving. A transition to a chronic form of the disease is possible.

For chronic tendovaginitis characteristic is the defeat of the sheaths of the tendons of the flexors and extensors of the fingers in the area of ​​​​their retainers. Often there are symptoms of chronic tendovaginitis of the common synovial sheath of the flexors of the fingers - the so-called carpal tunnel syndrome, in which a tumor-like painful formation of an elongated shape in the area of ​​​​the carpal tunnel is determined, which has an elastic consistency and often takes the shape of an hourglass, slightly shifting with movement. Sometimes you can feel the “rice bodies” or determine the fluctuation (the sensation of a transmission wave due to the accumulation of fluid). Limitation of tendon movements is characteristic.

Particularly distinguish a peculiar form of chronic tendovaginitis - the so-called stenosing tendovaginitis, or de Quervain's tendovaginitis, which is characterized by damage to the sheath of the tendons of the short extensor and the long abductor muscle of the thumb. The walls of the vagina with this form of tendovaginitis thicken, and the cavity of the synovial vagina, respectively, narrows. De Quervain's tendovaginitis is manifested by pain at the location of the styloid process of the radius, which often radiates to the first finger of the hand or to the elbow, as well as swelling. Increased pain occurs if the patient presses the first finger to the palmar surface and bends the rest of the fingers over it; if at the same time the patient withdraws the hand to the elbow side, the pain is sharp. In the course of the vagina, palpation is determined by an extremely painful swelling.

Tuberculous tendovaginitis characterized by the formation of dense formations ("rice bodies") along the extensions of the sheaths of the tendons, which can be palpated (palpated).

Complications of tendovaginitis

Purulent radiation tenobursitis- is, as a rule, a complication of purulent tendovaginitis of the thumb. It develops if purulent inflammation spreads to the entire sheath of the tendon of the long flexor of the thumb. Severe pain is characteristic along the palmar surface of the thumb and further along the outer edge of the hand to the forearm. If the disease progresses, the purulent process may spread to the forearm.

Purulent ulnar tenobursitis- is, as a rule, a complication of purulent tendovaginitis of the little finger of the hand. Due to the peculiarities of the anatomical structure, the inflammatory process quite often passes from the synovial sheath of the little finger to the common synovial sheath of the flexors of the hand, less often to the synovial sheath of the tendon of the long flexor of the thumb. In this case, the so-called cross phlegmon develops, which is characterized by a severe course and is often complicated by impaired 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 limitation of extension of the fingers or its complete impossibility.

Carpal Tunnel Syndrome: its occurrence and clinical manifestations are due to compression in the carpal canal of the median nerve. Characterized by sharp pains and a feeling of numbness, tingling, crawling in the area (paresthesia) of the I, II, III fingers of the hand, as well as the inner surface of the IV finger. There is a decrease in the muscle strength of the hand, the sensitivity of the tips of these fingers decreases. Increased pain occurs at night, which leads to sleep disturbance. There may be some relief when lowering the hand down and waving it. Quite often there is a discoloration of the skin of painful fingers (cyanosis of the tips, pallor). Perhaps a local increase in sweating, a decrease in pain sensitivity. When feeling the wrist, swelling and soreness are determined. Forced flexion of the hand and raising the arm up can cause aggravation of pain and paresthesias in the region of innervation of the median nerve. Often, carpal tunnel syndrome is combined with Guyon's canal syndrome, which is very rare on its own. With Guyon's canal syndrome, as a result of the fact that the ulnar nerve is compressed in the pisiform bone, there are pains and a feeling of numbness, tingling, crawling in the IV, V fingers, swelling in the pisiform bone and pain when palpated from the palmar side.

Examination and laboratory diagnosis of tendovaginitis

Diagnosis of tendovaginitis allows the characteristic localization of the pathological process and the data obtained during the clinical study (cord-shaped painful seals in typical places, movement disorders, the definition of "rice bodies" when probing).

In a laboratory examination with acute purulent tendovaginitis in the general blood test (CBC), leukocytosis is determined (an increase in white blood cells over 9 x 109 / l) with an increase in the content of stab forms of neutrophils (over 5%), an increase in ESR (erythrocyte sedimentation rate). Pus is examined by bacterioscopic (examination under a microscope after special staining of the material) and bacteriological (isolation of a pure culture on nutrient media) 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 (when the infectious agent spreads from the purulent focus into the bloodstream), a blood test for sterility is performed, which also makes it possible to establish the nature of the pathogen and determine its sensitivity to antibacterial drugs.

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

Differential Diagnosis

Chronic tendovaginitis should be differentiated from Dupuytren's contracture (painless progressive flexion contracture of fingers IV and V), 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 tendovaginitis provides for the fight against infection, for which bacterial agents are used, and measures are taken to strengthen the body's defenses. At tuberculous tendovaginitis anti-tuberculosis drugs (streptomycin, ftivazid, PASK and others) are used. General treatment aseptic tendovaginitis involves the use of non-steroidal anti-inflammatory drugs (aspirin, indomethacin, butadione).

Local treatment both in infectious and aseptic tendovaginitis in the initial stage it comes down to ensuring the rest of the affected limb (in the acute period of tendovaginitis, immobilization is carried out with a plaster splint), the use of warming compresses. After it is possible to achieve subsidence of acute phenomena, physiotherapeutic procedures are used (ultrasound, UHF, microwave therapy, ultraviolet rays, electrophoresis of hydrocortisone and novocaine), physiotherapy exercises. With purulent tendovaginitis, the tendon sheath and purulent streaks are urgently opened and drained. When tuberculous tendovaginitis local administration of a solution of streptomycin is performed, as well as excision of the affected synovial sheaths.

AT treatment of chronic tendovaginitis apply the above methods of physiotherapy, as well as prescribe applications of paraffin or ozocerite, massage and lidase electrophoresis; physical therapy classes are being held. If the chronic infectious process progresses, punctures of the synovial vagina and the introduction of targeted antibiotics are indicated. In chronic aseptic tendovaginitis, non-steroidal anti-inflammatory drugs are used, local administration of glucocorticosteroids (hydrocortisone, metipred, dexazone) is effective. In the case of chronic crepitating tendovaginitis that is difficult to treat, radiotherapy is sometimes used. In some cases, with the ineffectiveness of conservative therapy for stenosing tendovaginitis, surgical treatment is performed (dissection of the narrowed canals).

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

Prognosis for tendovaginitis

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

Surgeon Kletkin M.E.

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

Description of the disease

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

A characteristic pain syndrome accompanies movements or is felt during palpation of the diseased area. The chronic course is dangerous due to the replacement of healthy scar tissue, leading to immobility of the upper or lower limb.

A tendon is a dense formation of connective tissue that provides the terminal connection of the striated muscles and bones of the skeleton. The formation has a dense structure, due to which the tendon is strong and practically does not stretch.

At the border with muscle fibers, the tendon forms a thickening in the form of a flexible tunnel, called the tendon sheath. The inner surface of the vaginal bursa is covered with a synovial membrane, which produces a small amount of fluid, which ensures the gentle movement of the tendon during the motor process.

During repeated microdamages or the influence of an infectious stimulus, an inflammatory response appears to the process of cell damage. On the surface of the inflamed membrane, metabolic reactions are disturbed, which is the cause of tissue necrosis. When you try to make a movement in the area of ​​​​the junction of the connecting cord and muscle fibers, pain and difficulty in further movement occur.

A third of the cases of diagnosing tendovaginitis was recorded by the defeat of the muscles involved in the flexion of the upper or lower extremities. Most often, the tendons of the muscles of the shoulder, hand, elbow, fingers, popliteal region, Achilles tendon become inflamed.

Causes of tendovaginitis

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

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

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

Forms of pathology

In medical practice, tendovaginitis is classified depending on the etiology, duration of the disease and clinical signs. Inflammation can be acute or chronic. The acute form is characterized by the sudden onset of intense pain, the rapid development of a vivid clinical picture. Chronic course is a sluggish inflammatory process without severe symptoms with alternating stages of remissions and relapses.

Due to the origin of tendovaginitis, there are:

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

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

Purulent forms of tendovaginitis signal the addition of an infection that significantly worsens a person's condition. The chronic process of inflammation contributes to the appearance of a serous-fibrous structure of the effusion with the synthesis of protein filaments, which can subsequently form a fibrous plaque on the synovial sheath of the tendon.

Disease Clinic

The symptoms of tendovaginitis are different and depend on the etiology of the pathology. Common symptoms include pain in muscle movement involving the diseased tendon, swelling is observed when effusion accumulates in the tendon sheath, stiffness in the movements of the diseased limb, if you press on the inflamed area, a sharp pain appears. In the absence of effusion, crepitus is present in the tendon, which can be heard with a stethophonendoscope.

Acute nonspecific form

Sudden pain in the inflamed tendon appears along with severe swelling of the tendon sheath, which is easily determined by probing with the hand. Gradually, the edema spreads to nearby tissues, turning off the entire limb from the process of movement.

Orthopedist: "If your knees and hip joint ache, immediately eliminate from the diet ...

Do not destroy diseased joints with ointments and injections! Arthritis and arthrosis are treated ...

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

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

Acute aseptic form

The main difference between the aseptic form of tendovaginitis is the absence of exudate and the appearance of a crepitus sound in a sore spot. This course often develops on the hands and in the area of ​​the shoulder joint. The sudden onset with acute pain is accompanied by swelling in the inflamed tendon, on palpation of which a crisp sound is clearly audible. Fingers lose their mobility, movements are accompanied by severe pain. The aseptic form may be followed by a chronic process.

Chronic form

Inflammation of tendovaginitis takes a chronic course with repeated mechanical damage to the tendon in the same place, or as a complicated condition after an acute form of non-infectious etiology. The patient has constant soreness, which increases with movement. In the area of ​​the affected tendon, an oblong formation is formed, which has an elastic structure.

This symptom is more often observed in carpal tunnel syndrome with tendovaginitis of the tendons of the muscles of the hand. The long course of the chronic stage in the tumor-like formation can be felt for dense formations, the so-called "rice bodies". When pressing on the tendon with two fingertips from opposite sides, a push is felt, indicating the accumulation of fluid in the tendon canal.

Diagnosis of the disease

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

Diagnostic signs of inflammation of the tendon sheath:

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

Treatment of tendovaginitis

Therapeutic measures begin with ensuring complete rest of the limb. This can be achieved by strict adherence to bed rest or immobilization with rigid fixation orthopedic products.

Acute forms of tendovaginitis require cooling of the inflamed surface, this can be done using frozen foods, a heating pad with cold water, or a Snowball hypothermic package, which can be purchased at a pharmacy. Chronic course is treated with warming procedures in the form of therapeutic compresses or ointments.

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

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

Surgical treatment of tendovaginitis may be required for persistent pain and limited movement, more often in the shoulder joint. During the operation, the scar tissue is excised, followed by suturing of the tendon. During the rehabilitation period, sessions of physiotherapy exercises are shown to restore the work of the tendon.

Conservative treatment of tendovaginitis is supplemented by a course of massage, UHF, and ultrasound treatment. Particular importance is given to swimming and performing a special set of exercises in the water, which is compiled by a medical specialist, taking into account the stage of the disease and the functional state of the patient.

Therapeutic exercise is carried out taking into account the therapeutic load on the diseased limb. The set of exercises is constantly changing to increase the load on the tendon. Proper dosing of the intensity of movements determines the rate of recovery of affected tissues. Excessive efforts can nullify all previous treatment.

Prevention of tendovaginitis

You can prevent the development of tendovaginitis if you follow the well-known rules of a healthy lifestyle:

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

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

If the joints of the arms and legs begin to hurt, immediately remove from the diet ...

Orthopedist: "If your knees and lower back start to hurt, make it a habit ...

- this is an inflammation that affects the inner sheath of the sheaths of the flexor and extensor tendons of the fingers and hand. It occurs due to injuries, constant muscle strain, degenerative changes, rheumatic diseases and infectious lesions. It can be acute or chronic, infectious or aseptic. It presents with pain, swelling and limitation of movement. With stenosing tendovaginitis, the “trigger finger” syndrome is observed - a sensation of an obstacle and a click when flexing or extending. The diagnosis is made on the basis of the clinical picture, treatment is usually conservative.

ICD-10

M67 Other synovial and tendon disorders

General information

Tenosynovitis of the hand is an acute or chronic inflammatory process in the sheath area of ​​the tendons of the muscles of the hand and fingers. It often develops as a result of constant overload of the hand during repetitive movements. It usually occurs in the middle part of the tendon sheaths, inflammation prevails in the acute phase, and degenerative changes gradually develop in the chronic course. The process can spread to neighboring tissues: tendon canals and tendon tissue. Treatment of this pathology is carried out by surgeons and orthopedic traumatologists.

Causes

Depending on the cause of development in traumatology and orthopedics, there are:

• Professional aseptic tendovaginitis of the hand. The most common form of the disease. Occurs due to overload of certain tendons. Initially, it is acute, often becomes chronic. It affects people who, by virtue of their profession or household duties, perform repetitive brush movements. At risk are musicians, typists, PC operators, carpenters, locksmiths, carpenters, turners, blacksmiths, ironers, grinders, hand milkers, polishers.
• Reactive aseptic tendovaginitis of the hand. It is the body's response to adverse effects. Initially, it also proceeds acutely, under adverse conditions it is prone to transition into a chronic form. Occurs with violations of local blood supply, rheumatic diseases, etc.
• Nonspecific infectious tendovaginitis of the hand. It develops with contact, hematogenous or lymphogenous infection. Runs sharp. It can occur with lacerations, stab and incised wounds, abrasions and pustular skin lesions in the tendon area, as well as in the presence of foci of infection in remote organs.
• Specific infectious tendovaginitis of the hand. It is observed with specific infections: tuberculosis, gonorrhea, syphilis and brucellosis. It is rare and can be both acute and chronic. Clinical manifestations depend on the type of pathogen.

Classification

There are aseptic and infectious forms of the disease. Aseptic tendovaginitis of the hand develops as a result of irritation or damage to the inner membrane of the tendon sheath, the inflammation is serous in nature and proceeds without the participation of microorganisms. Infectious tendovaginitis occurs when microbes penetrate the tendon sheath, inflammation is often purulent, the nature of the inflammatory process depends on the type of pathogen. Infectious tendovaginitis may be specific or nonspecific. Nonspecific is usually caused by pneumococci, staphylococci or streptococci, specific - by pathogens tuberculosis, gonorrhea, syphilis, etc.

Symptoms of tendovaginitis of the hand

Aseptic tendovaginitis develops acutely, a history usually reveals an overload of the hand (for example, prolonged work at the computer). The patient complains of pulling pain, aggravated by movement. The affected area is edematous, movements are limited. Sometimes there is a slight local hyperemia and hyperthermia. In the subacute period, patients may complain of an unpleasant feeling of a reduced hand. With the transition to the chronic form, the pain becomes less intense and occurs only with movements and palpation of the tendon area. There is no swelling, with movements a soft crunch can be heard.

A special form of chronic aseptic tendovaginitis of the hand is stenosing tendovaginitis, usually affecting women aged 40-50 years. With this form of the disease, there is swelling, local thickening of tissues, discomfort or pain after exercise. Over time, there is difficulty in bending or unbending the finger - an obstacle is felt in a certain area, when it is overcome, a click is heard (syndrome of "trigger finger"). In severe cases, overcoming the obstacle becomes impossible, contractures are formed.

Acute nonspecific infectious tendovaginitis is characterized by intense pain against the background of severe edema, local hyperemia and hyperthermia. There are signs of general intoxication: weakness, weakness, fever, chills, headache. With suppuration, the pains become twitching, arching, and can disrupt night sleep. The movements of the brush are sharply limited. Specific infectious tendovaginitis usually proceeds in almost the same way as non-specific ones, but occur against the background of the underlying disease.

Diagnostics

The diagnosis is made on the basis of clinical symptoms. To differentiate infectious tendovaginitis with arthritis and osteomyelitis, radiography of the hand and radiography of the wrist joint are prescribed. In doubtful cases, bone CT or MRI is used. Patients with a suspected specific process are referred for consultation with a phthisiatrician, venereologist, or

With exacerbations of chronic aseptic tendovaginitis, the limb is immobilized, painkillers, anti-inflammatory drugs, massage, exercise therapy, ozokerite applications and electrophoresis with lidase are prescribed. With stenosing tendovaginitis, blockades with corticosteroid drugs are performed; in severe cases, surgical intervention may be required - dissection or excision of the tendon sheath.

In acute nonspecific infectious tendovaginitis, painkillers, antibacterial drugs (usually broad-spectrum antibiotics) and means to increase immunity are prescribed. With suppuration, the tendon sheath is opened, followed by drainage. In patients with specific processes, the underlying pathology is treated: for tuberculosis, anti-tuberculosis drugs are prescribed, for gonorrhea - drugs from the group of penicillins, fluoroquinolones, tetracyclines, as well as cephalosporins, aminoglycosides, macrolides and azalides.

Tenosynovitis is a very severe disease of the tendon sheaths (sheath surrounding the tendon), which occurs with severe pain and a pronounced inflammatory process.

Ineffective treatment, a running inflammation process can provoke tendon necrosis, the spread of purulent inflammation throughout the body. Various injuries (bruises, injections, cuts) can lead to tendovaginitis, which led to trauma to the walls of the tendon sheaths located close to the surface. However, often the disease develops as a result of excessive stress on the tendon, and not as a result of infection. Such loads are often related to the professional activity of a person (milkmaids, pianists, machinists, etc.).

The disease can affect the hand, Achilles tendon, forearm, wrist, feet, and ankle.

ICD-10 code

M65.2 Calcific tendinitis

M75.2 Biceps tendonitis

M75.3 Calcific tendonitis of shoulder

M76.0 Gluteal tendonitis

M76.1 Lumbar tendonitis

M76.5 Patellar tendonitis

M76.6 Calcaneal [Achilles] tendonitis

M76.7 Tendonitis of fibula

Causes of tendovaginitis

Tendovaginitis can be both a separate disease that occurs independently and develop as a result of any complications after the general inflammatory process of the body.

In infectious diseases such as tuberculosis or syphilis, with a variety of minor injuries, the infection can penetrate the tendon sheath, which leads to the development of various forms of tendovaginitis (purulent, nonspecific, tuberculous, brucellosis). In addition, infectious tendovaginitis can develop as a result of another inflammatory process in the body, for example, with rheumatism or rheumatoid arthritis.

Widespread nonspecific tendovaginitis, which usually occurs after prolonged and heavy loads on the tendon. Quite often, nonspecific tendovaginitis occurs as a result of professional activities or hobbies that are associated with frequently repetitive movements. Tendovaginitis in this form refers to occupational diseases. There is also post-traumatic tendovaginitis, which most often affects professional athletes, but sometimes develops as a result of domestic trauma.

Degenerative tendovaginitis is directly dependent on blood circulation in adjacent tissues. When blood flow is disturbed, for example, with varicose veins, a degenerative form of tendovaginitis develops, i.e. there is a change in the synovial membrane of the vagina.

Symptoms of tendovaginitis

In the acute form of tendovaginitis, severe 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 may 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 there are painful sensations in the area 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.

Usually, the causative agents of the purulent process in the tendon are E. coli bacteria, streptococci, staphylococci, and very 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.

With a secondary disease, usually purulent inflammation begins in the adjacent tissues, and only after that it spreads 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 is non-infectious in nature, 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 tissue begins an inflammatory process.

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 the maximum load is placed, 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 that affects musicians, stenographers, typists, etc. 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 an ache, increased fatigue of the hand, 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 is oval in 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 signs by which the development of tendovaginitis can be determined:

• 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 spreads to the back of the hand, when you try to straighten the finger, a sharp pain is felt. 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 ​​​​the 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

Tendovaginitis of the shoulder joint is manifested by 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

Tenosynovitis of the 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 any particular discomfort to the patient, 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. In childhood, the disease can be noticed 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 stress 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.

In addition to external factors, tendovaginitis can develop due to a congenital anomaly of the foot (clubfoot, flat feet).

Tenosynovitis of the knee

As in other cases, tendovaginitis of the 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. The pain may increase with physical exertion, 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

De Quervain's tendovaginitis occurs with severe inflammation of the ligaments of the wrist, which is characterized by inflammation, pain, and limited movement. Many years ago, the disease was called "washerwomen's disease" because it mainly affected women who had to wash large amounts of laundry by hand every day, 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 provoked by frequent inflammations, injuries, muscle strain (especially caused by hard work involving one muscle group). However, for the most part, it is not possible to establish the exact causes of the disease.

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.

Diagnosis of tendovaginitis

Based on the study (palpation, compaction, soreness, stiffness of movements) and the characteristic localization of inflammation, the specialist will be able to diagnose tendovaginitis. Radiography will distinguish tendovaginitis from arthritis and osteomyelitis, in which changes in the bones and joints are observed in the picture.

Ligamentography (X-ray with a contrast agent of ligaments and tendons) is prescribed to exclude stenosing ligamentitis. In addition, the specialist must exclude diseases of a general nature that can provoke tendovaginitis (brucellosis, tuberculosis).

Treatment of tendovaginitis

The main principle of successful treatment of tendovaginitis is timely qualified assistance and effective treatment. First of all, it is necessary to create rest for the diseased limb; in some cases, the doctor may consider it necessary to apply a plaster cast or a tight bandage.

Experts suggest several stages of treatment of tendovaginitis, first of all, the patient is released from work, novocaine is injected into him (to relieve severe pain) and, if necessary, plaster is applied.

After 2-3 days, if the patient continues to suffer from pain, you can repeat the blockade with novocaine. A few days later, warm compresses, warming, UHF therapy are attributed. As a rule, 4-6 paraffin applications are needed for effective treatment. Over time, a passive load is increased on the diseased limb, after which the plaster is removed and movement is increased. If after the course of treatment all unpleasant symptoms disappear, the patient is discharged, and a recommendation is given to observe light work for some time.

Which doctor treats tendovaginitis?

If there is a suspicion of tendovaginitis (soreness, swelling, redness over the sore spot began to bother), then it is necessary to seek advice from a rheumatologist, who, after the first examination, will prescribe the necessary tests and additional examination.

Treatment with folk remedies

Tenosynovitis can be treated in combination with traditional medicine methods, which will increase the effectiveness of treatment. Folk remedies should always be used as adjuvant therapy. Before starting treatment, it is better to consult a specialist in order to exclude other diseases with similar symptoms.

Treatment with traditional medicine is mainly local, using lotions, ointments, compresses. Well helps to cure inflammation of the tendons ointment from calendula flowers. Which you can cook yourself. This will require calendula flowers, which can be purchased at the pharmacy. A tablespoon of dried flowers must be carefully ground to make a powder (you can use a coffee grinder), which is mixed with a tablespoon of the base. As a basis, you can take vaseline or any baby cream. Let the mixture brew for several hours, after which it can be used as an ointment or compress. It is best to apply the ointment before going to bed.

Good anti-inflammatory properties have a tincture of chamomile, St. John's wort or calendula. For cooking, you need 1 tbsp. a spoonful of dried chamomile flowers or St. John's wort, if you use calendula, you will need 1 teaspoon. The grass is poured with a glass of boiling water and insisted for half an hour. Then the tincture is filtered and consumed inside half a glass for two weeks.

Treatment at home

Treating tendovaginitis at home will help increase the effectiveness of traditional treatment, help remove inflammation and speed up the healing process.

A fairly effective remedy for the treatment of tendovaginitis is Rosenthal's paste, which can be purchased at a pharmacy. The composition of the paste includes 10 g of wine alcohol, 80 g of chloroform, 15 g of paraffin, 0.3 g of iodine. Before use, the ointment must be slightly warmed up (to a pleasant body heat), then the product is applied to the affected area, after hardening, cotton wool is applied on top and everything is fixed with a bandage. It is better to apply the paste before going to bed. Before using any folk remedy, it is better to consult a specialist to avoid possible complications.

Treatment with ointments

Tendovaginitis in any form is treated with medications, which are used depending on the causes of the development of the disease and the complexity of the inflammatory process. Most often, anti-inflammatory drugs, compresses, ointments are used, in some cases antibiotics are required. In almost any type of tendovaginitis of the affected limb, it is necessary to ensure complete rest.

As a rule, with tendovaginitis, anti-inflammatory, analgesic ointments are prescribed. Also, effective assistance to traditional methods of treatment can be provided with the help of an ointment prepared independently. To do this, you need to mix well 100 g of pork fat and 30 g of wormwood herb, then put it on a simmer for a few minutes. After the ointment has completely cooled, it can be used. The ointment is applied in a thin layer to the affected area, the top can be covered with a napkin and fixed with a bandage.

Treatment of crepitant tendovaginitis

If crepitating tendovaginitis is suspected, it is necessary to completely stop any load on the injured limb in order to avoid involuntary movements, a tight bandage (gypsum) is applied for 6-7 days. After that, warm compresses, anti-inflammatory drugs are prescribed.

It is necessary to return to work after the swelling and crunching in the affected tendon has completely subsided.

Treatment of crepitant tendovaginitis of the hand

Tendovaginitis of the hand with modern medicine is treated successfully in the vast majority of cases. The main principle of effective treatment is timely recognition of the diagnosis and appropriate therapy. With crepitating tendovaginitis of the hand, physiotherapeutic procedures are shown that are highly effective in the early stages of the disease, in addition, the patient is assigned maximum rest and fixation of the affected limb.

Before prescribing treatment, it is necessary to determine the cause of the development of the disease (trauma, regular exercise, infection). If bacteria enters the tendon, the doctor prescribes a course of antibiotic therapy. If the process of inflammation has gone far enough, suppuration has begun, surgical intervention is necessary. The danger of purulent tendovaginitis lies in the fact that pus can break through into adjacent tissues (bones, joints, circulatory system), which threatens sepsis (blood poisoning).

Treatment of tendovaginitis of the wrist

Effective treatment of tendovaginitis depends on the cause of the disease. If the inflammatory process in the tendon began as a result of a general illness (rheumatism, tuberculosis, etc.), the treatment is first of all directed to the underlying disease.

With severe pain in the wrist, a plaster splint is applied, which fixes the hand in one position, providing maximum rest to the sore tendons. After that, drug treatment and physical procedures are prescribed, as a rule, there is no need for the patient to be hospitalized. If the process of inflammation in the tendons has gone too far, pus has appeared, the fusion of the tendons, then the patient is sent for surgical treatment.

Treatment of tendovaginitis of the tendon

Acute tendon tendonitis is treated with local and general procedures. If the disease is nonspecific, then the treatment is aimed at fighting the infection in the body (antibacterial agents, immunostimulants).

With tendovaginitis, which arose against the background of tuberculosis, specific anti-tuberculosis therapy is used.

With tendovaginitis of a non-infectious nature, anti-inflammatory drugs (butadione) are used.

Local treatment for any form of tendovaginitis is to apply a plaster splint and warm compresses. After the inflammation of the tendons begins to subside, a number of physiotherapeutic procedures (UHF, ultraviolet, ultrasound, etc.) are prescribed, as well as therapeutic exercises.

If the inflammation process has acquired a purulent form, the affected tendon sheath must be opened and cleaned of pus accumulations as soon as possible.

The chronic form of tendovaginitis, in addition to all of the above methods of treatment, includes paraffin or mud compresses, massage, electrophoresis. If in chronic tendovaginitis there is an increase in the infectious process, then a puncture is taken from the synovial vagina for a detailed study in the laboratory. Also, a targeted antibiotic is injected into the tendon sheath, the patient is prescribed anti-inflammatory therapy. To reduce pain in the tendon, novocaine blockade is introduced. If the chronic process continues to progress, then a session of X-ray therapy is prescribed.

Treatment of tendovaginitis of the wrist joint

With a disease such as tendovaginitis of the wrist joint, the patient's hand needs first of all complete rest, it is best to apply a tight bandage or plaster to immobilize the diseased tendons as much as possible. Blockades with novocaine, kenalog, etc. have a good effect, which quickly relieves severe pain. Anti-inflammatory drugs (Voltaren, Nimesil, etc.), physiotherapy procedures are also used.

Treatment of tendovaginitis of the forearm

As with other types of tendovaginitis disease, it is necessary to create all conditions for maximum rest of the patient's hand. A blockade in the tendon with painkillers can also be prescribed, if the pain does not go away, it is recommended to repeat the procedure after a few days. After 3-5 days from the start of treatment, warming compresses can be used, if necessary, the doctor can supplement them with special physiotherapy (paraffin applications, UHF). After a week, when the fixing bandage or plaster is removed, the doctor may allow short-term soft movements with the fingers, over time, the load on the arm must be increased. With proper treatment, recovery occurs in 10-15 days, but for about two more weeks the patient is advised to protect his hand from heavy loads and engage in light work.

Treatment of tendovaginitis of the foot

In the early stages of the disease, antibiotic therapy in combination with physiotherapy is quite enough. Purulent tendovaginitis is treated promptly by opening the abscess and cleansing (such treatment is necessary to prevent fistulas and rupture of pus into adjacent tissues).

Immediately after the diagnosis, the foot should be tightly fixed (with plaster, elastic bandage, tight bandage, etc.). To reduce inflammation in the tendons, anti-inflammatory therapy (reopirin) is prescribed. Compresses with dimexide, electropheresis with novocaine also have a good therapeutic effect. Blockade with hydrocartisone helps to stop pain well, after the pain subsides, you can do a compress with ozocerite. After 7-10 days from the start of treatment, the doctor may prescribe therapeutic exercises, during which, over time, the load on the foot will increase.

Treatment of tendovaginitis of the ankle joint

Tenosynovitis of the ankle joint, like other types of the disease, is expressed by severe pain at the site of the lesion of the tendons. The treatment of the inflammatory process in the tendon consists in providing rest, anti-inflammatory, antibacterial therapy, over time, special gymnastics is added to the treatment, aimed at restoring the performance of the tendons, muscles and joints.

Treatment of tendovaginitis does not always occur in a hospital setting. In the early stages of the disease, treatment can be carried out at home. You should not self-medicate, because tendovaginitis can acquire a purulent form, which can provoke a general infection of the body. Traditional methods of treatment are good to use as auxiliary means of traditional medicine to speed up the healing process.

Treatment of tendovaginitis of the Achilles tendon

With inflammation of the Achilles tendon, the foot must be provided with maximum rest. In some cases, a soft liner placed under the heel helps to reduce pain. With severe pain, a specialist can prescribe non-steroidal anti-inflammatory drugs, physiotherapy. If the pain does not subside, then a plaster splint is applied to the foot for 10-15 days. Very rarely there is a need for surgical treatment of tendons.

Experts recommend that athletes who have regular physical activity on their feet (runners, skaters, etc.) do special stretching exercises for the tendons, and after training, apply an ice pack to the Achilles tendon for a while.

Prevention of tendovaginitis

Infectious tendovaginitis can be prevented if you observe personal hygiene, disinfect various damage to the skin in time. For severe or open wounds, it is best to apply an antiseptic dressing to avoid bacteria.

For the prevention of professional tendovaginitis, it is necessary to take regular breaks in work; at the end of the working day, it is good to massage the legs, forearms, and hands. Warm baths for hands (feet) are also well relaxing.

Tenosynovitis prognosis

In most cases, if tendovaginitis was detected at an early stage and timely and effective treatment was prescribed, the prognosis is favorable. Approximately two weeks after the onset of the disease, recovery occurs, and after another two weeks, the person becomes fully able-bodied. However, if a person's activity is associated with regular stress, injuries, then the likelihood that the disease will return and proceed in a chronic form is quite high.

If tendovaginitis proceeded in a purulent form, and the tendon was opened surgically, then there is a high risk that the functions of the foot or hand will be impaired.

Tendovaginitis is a rather severe inflammatory disease that affects the tendon sheath. The progression of the disease can lead to severe complications (suppuration, fusion or necrosis of the tendons, sepsis, etc.).

ICD code 10

The ICD stands for International Classification of Diseases and is a special document that is used to assess the general health of the population, in medicine, and epidemiology. This handbook is indispensable for monitoring and controlling diseases and their prevalence, as well as a number of other health-related problems. The document is subject to revision every ten years.

In modern medicine, the tenth revision classifier (ICD 10) is in force.

Tendovaginitis in ICD 10 is under code M 65.2 (calcific tendonitis).

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

A photo. Tenosynovitis of the hand

Why does tendovaginitis occur?

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

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

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

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

Signs of the disease

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

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

The chronic form of the disease has a sluggish nature, which does not greatly affect the mobility of the fingers. The tendon sheaths of the extensor and flexor fingers are mainly affected, leading to stiffness and poor range of motion. Swelling and slight soreness are noted, discomfort is not localized in one place, but is given to the shoulder or forearm.

The main variants of the course of the disease:

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

Medical treatment of the disease

Timely appeal for specialized help will allow you to cope with the disease in a conservative way. The sooner treatment is started, the more likely it is to prevent the progression of the pathological process and the development of irreversible changes in tissues.

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

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

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

The basis of the treatment of tendovaginitis is the use of the following groups of drugs:

1. Non-steroidal anti-inflammatory drugs. Used externally in the area of ​​the affected tendon. In parallel, NSAIDs are prescribed in the form of tablets or injections. The complex effect will allow to achieve the maximum analgesic, anti-inflammatory, anti-edematous and antipyretic result. In this group of drugs - Nimesulide, Diclofenac, Ibuprofen, Paracetamol, Meloxicam, Movalis, etc.
2. Glucocorticosteroids. They are indicated in the absence of a positive result from NSAIDs, since they are characterized by immunosuppressive, desensitizing, analgesic and powerful anti-inflammatory effects. Hormonal preparations should be used carefully, observing the prescribed dosage, in order to prevent the development of complications. The cancellation of funds is carried out gradually, over several days. For the treatment of tendovaginitis, Dexamethasone is mainly used.
3. Antibacterial drugs. Assign with specific and nonspecific tendovaginitis. In the treatment of the disease, broad-spectrum antibiotics are used. The duration of treatment is determined individually, depending on the presence of positive dynamics. In no case should you stop the course when you feel better, fat threatens to relapse. In the absence of therapeutic results, the attending physician may decide on the need to change the antibiotic.

Puncture and operation

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

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

Surgical treatment of tendovaginitis is indicated in the event of a purulent process or persistent adhesive deformity of the tendons. The operation is performed under local or general anesthesia, depending on the extent of the upcoming surgical intervention. The doctor removes pus and excised necrotic tissues, sanitizes the cavity and revises the presence of fistulas and purulent pockets to prevent relapses. If the muscles are damaged, a plastic defect is performed.

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

Physiotherapy treatment

Physiotherapy can enhance the effect of medications and speed up the recovery of patients.

In the acute period of tendovaginitis, the following procedures are allowed:

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

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

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

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