Nodular tenosynovitis histology. Symptoms and treatment of nodular tenosynovitis. Tenosynovitis in adults

Nodular tenosynovitis(benign gangant cell synovioma, according to G. Geiler) was first described by Chossignac (1852). Throughout the following years, the essence of this process was the subject of discussion. Considerations were made about its metabolic, granulomatous and blastomatous nature, which was expressed in a large number of synonyms of tendon xanthoma, xanthomatous gigantoma, tendon myeloxanthoma, giant cell sarcoma, tendon giantoma, tendon sheath tumor, fibroendothelioma of the joint, synoviendothelioma, fibrous hystibrosis variant. The different definition of the process does not make it possible to judge its true frequency. According to Schajowicz (1981), nodular tenosynovitis was found in 151 cases among 305 joint pseudotumors.
In 15%, the process occurs in the area synovial membrane of the joints, in 80% - in tendon sheaths, in 5% - in mucous bags.

Possible true relapse usually several years after surgery. Metastases are not observed. Macroscopically, the formation is a dense knot with a diameter of up to 2-5 cm, sometimes lobulated, in the section of a grayish-white, yellowish, sometimes ocher-yellow color; occasionally consists of several nodules merged into a conglomerate. The microscopic picture is extremely polymorphic: the node is built from small spindle-shaped cells with a dark elongated nucleus and a narrow rim of the cytoplasm, which resembled fibrocytes, and from larger oval cells with a light rounded nucleus and a wide rim of the cytoplasm. Among these cells, multinucleated giant cells with homogeneous, often vacuolated cytoplasm are scattered in various numbers. Spindle cells form strands that run in various directions, enclosed in powerful bundles of collagen and argyrophilic fibers. Rounded cells are located in small loose clusters, in which the fibrous substance is not defined. These cells are considered by some authors as "histiocyte-like". A constant structural feature is the presence of numerous slit-like spaces lined with elongated light cells.

In the lining of these spaces giant cells are also involved. In the peripheral parts, less often in the depth of the node, there are fields of xanthoma cells, hemosiderophages. Hemosider granules are also located extracellularly. Sometimes xanthomatosis is expressed so sharply that it is proposed to distinguish the xanthomatous form of the process. The stroma of the node is represented by argyrophilic and collagen fibers, in places with sclerosis and hyalinosis, sometimes reaching a high degree.

To that description, given by us in previous editions, some details from the works of G. Geiler should be added. In his opinion, the node is built on the principle of synovial structures and has a biphasic cellular composition, and the epithelioid phase is not pronounced, but in all cases it can be detected with a detailed study. The node is mostly surrounded by a collagen capsule, from which fibrous bundles enter into its thickness, dividing it into separate fields.

lipid deposition- the result of cell necrosis in trauma, hemorrhage, lymphostasis is often noted, which, perhaps, is the cause of progressive stromal hyalinosis.

Lipids and hemosiderin are located predominantly intracellularly, as a result of the phagocytic activity of cells characteristic of the synovial membrane and in the norm. It should be noted the uneven distribution of slit-like spaces in the node, due to which there are significant areas of tissue in which there are no slits; in addition to slits, one can also find tubular formations, sometimes branched and with papillary outgrowths. The tumor nature of the process has not been confirmed by clear facts.

There are indications in the literature for benign meniscal tumors. The described tumors were microscopically lipomas, one recurred in a 29-year-old patient, located in the thickness of the meniscus, but was clearly demarcated, localized dorsally from the initially removed tumor. There is a report of fibrochoidroma of the knee joint (in a 14-year-old patient). The tumor originated from the outer region of the meniscus or from the zone transitional to the ligaments. Microscopically nests of proliferation of chondrocytes with fibrous transformation. There was no suspicion of malignancy. The tumor was removed, 2 years - without dysfunction and relapse.

Nodular tenosynovitis is also called giant cell synovioma. This is a nodular type neoplasm, which is formed mainly on the fingers, feet, extremely rarely on large joints. Very common.

In 80% of cases, the disease is diagnosed in the tendon sheaths, in 15% - in the synovial membrane of the joint, in 5% - in the mucous bag.

The disease is prone to recurrence, mainly due to the fact that during the operation the neoplasm is not completely removed. True recurrence may be several years after surgery.

The tumor does not metastasize. The formation is a dense knot, which can reach a size of 2-5 cm. Sometimes it can have a lobed structure. Color - gray-white yellowish.

A feature is the cells of very large sizes and a characteristic shape. Also distinguishing feature is a large number of spaces between cells in the form of gaps.

The main causes of the development of the disease are called:

• old age;
• congenital defects of the connective tissue;
• inflammatory processes in the joints;
• constant overload of the tendon at work or in the household.

It is not yet known what becomes the root cause: the flexor tendon or the sheath of the tendon sheath in the area of ​​the annular ligaments. Due to the fact that the diameters of the vagina and the tendon do not converge, an inflammatory-degenerative process occurs, and a knot forms on the tendon. The site becomes narrower and when moving, a person hears a click. Gradually, the synovial membrane begins to become irritated, and the process progresses faster.

Usually this type of disease does not manifest itself for a long time and does not have obvious symptoms. Isolated formations for many years may not make themselves felt, gradually increasing. Once they get big enough, the tumors press on the nerves, causing pain and also restricting the joint from moving.

A characteristic feature is clicks during flexion and extension of the fingers. They arise due to deterioration and malnutrition of tissues, as well as formations that become obstacles to the movement of the joint. In older people, this disease can occur against the background of other pathologies or in itself due to disturbances in the processes of nutrition and weakness of the joints.

Large loads or infections can cause an inflammatory process, which as a result will cause severe pain, inability to move your fingers.

Usually, a pronounced nodule is felt on palpation of the palm near the flexor tendon of the finger.

Diagnostics

To determine the doctor conducts an examination, palpation and collect anamnesis. To the touch, the neoplasms are round and firm. It is important to distinguish them from rheumatic nodules, cysts, subcutaneous granuloma annulare.

How to treat

Since this formation, benign treatment is not required as long as it does not bring inconvenience to a person.

In the presence of inflammation, the use of glucocorticosteroids in the tendon is effective. Also use phonophoresis, electrophoresis.

If the neoplasm causes great inconvenience, an operation is performed, removing it. However, adhesions may form and the movement of the tendon may be impaired. It is also worth considering that the likelihood of recurrence is quite high and over time the tumor may appear again.

Nodular tenosynovitis - symptoms and treatment

A huge number of people daily face various injuries of muscles, ligaments and tendons. The resulting injuries can provoke the development of pathological processes and the occurrence of diseases. In this article, we will take a closer look at the disease that affects the tendons, describe the causes, symptoms and ways to get rid of it.

Definition

Nodular tenosynovitis is an inflammatory process that occurs externally on the synovial sheath of the tendons of the fingers of the upper and lower extremities. As a result of this phenomenon, benign tumor neoplasms appear in the affected area. The disease was first described by a French scientist and surgeon in 1952. Today it is very common. Late treatment can lead to loss of joint function and disability.

For a long period of time, scientists could not find one name for this disease. This is due to the lack of a unified view of its etiology and pathogenesis. There were guesses that the pathology appears as a result of disorders and inflammatory processes. The results of immunohistological studies and DNA analysis showed the presence of a set of cells that have tumor characteristics. Their further study made it possible to determine that the neoplasms are benign.

The tumors that appear are located under the skin near the joint and ligaments. Neoplasms are single and multiple. The main places of localization of the disease are the phalanges of the fingers and toes.
With the help of microscopic studies, the shape, size and structure of the tumors that appeared were studied. These are lobed formations that are covered with a capsule on top and have a white or gray color. The size of the nodes can be varied and range from 1.6 to 6 cm. They grow very slowly and often do not exceed 4 cm.

Classification

In medical practice, the classification of the disease depends on the following characteristics:

• flow patterns;
• reasons for development;
• severity of clinical signs.

According to the form of the course of the disease, they are distinguished the following types:

Depending on the causes contributing to the development of nodular tenosynovitis, the following types are distinguished:

In turn, the aseptic type is caused by various injuries and disorders and is divided into:

• traumatic;
• diabetic;
• allergic;
• immunodeficient;
• endocrine.

The infectious species is characterized by the appearance of purulent discharge and happens:

• bacterial;
• viral;
• fungal;
• specific;
• non-specific.

According to the degree of manifestation of clinical signs, the disease is:

There are a huge number of factors that contribute to the development of inflammatory processes in the connective sheath around the ligamentous apparatus. The main ones are:

• damage and injury to the musculoskeletal system;
• arthritis, arthrosis;
• osteoporosis;
• vasculitis;
• bursitis;
• weakened immunity, which is unable to overcome infections that have fallen into the resulting wound;
• heredity;
• infectious diseases (HIV, tuberculosis, syphilis);
• excessive physical activity.

In cases where a different kind of infection enters an open wound, therapy using drugs will be longer. During the treatment period, any physical activity will be difficult. After getting rid of the disease, the functional state of the joint is normalized.

A common cause of occurrence is old age. It is during this period of time that the delivery of nutrients and nutrients to the tissues worsens. As a result, their condition worsens and there is a loss of functional abilities, as well as an increased risk of disease and injury at the slightest impact on the body.

Every day we perform almost the same movements, in which only certain muscle groups are involved. Frequent exposure to them leads to the appearance of nodular tenosynovitis.

Symptoms

When an illness occurs, symptoms appear gradually. At first, this is a slight discomfort in the area of ​​the affected joint, and after a while the situation worsens and the signs become more and more noticeable. Due to the fact that symptoms may not manifest themselves for a long time, people do not immediately seek help. The main emerging symptom, indicating the obviousness of this disease, is a kind of crunch in the joints during flexion and extension of the fingers of the extremities. In addition to the crunch, a number of other signs occur, such as:

• pain;
• puffiness;
• difficulty in motor activity;
• skin color changes.

Soreness can be of a different nature and be:

Over time, it can spread to the entire limb right up to the shoulder, and its special strengthening occurs when performing any movement.

Neoplasms become noticeable, the skin around them may swell and redden.
If such symptoms occur, you should seek help from the hospital as soon as possible. This greatly depends on the method and duration of treatment.

Diagnostics

After contacting a medical institution, a series of actions will be carried out with the help of which the correct diagnosis will be established and the necessary course of therapy will be prescribed. First, a visual examination is performed with the help of palpation of the affected area, after which the patient must pass a general blood test and undergo the following types of examination:

To diagnose the disease using the method of ultrasound. With it, you can see the number and size of tumors, as well as examine in detail the location of the localization. The degree of formation of new blood vessels at the nodes can be determined using the color Doppler scanning function. Often, according to the results of an ultrasound scan, it is clear that this formation is located very tightly near the tendons and is in contact with it.

This type of diagnosis is used to see the presence of pathological changes in the bones. The main causes of bone destruction in the disease are:

• increased intra-articular pressure;
• erosion of the metaepiphysis;
• active growth of tumors;
• compression atrophy.

A widely used method is magnetic resonance imaging of the upper and lower extremities. It makes it possible to view the tumor from all sides.

In addition to ultrasound, X-ray and MRI, a biopsy is also used. A small piece of tissue is taken from the patient from the site of the lesion, which is studied using a cytological examination. This procedure makes it possible to distinguish neoplasms caused by the disease from other types of tumors.

Neoplasms with which it is necessary to differentiate this disease:

• hemangioma;
• lipoma;
• fibroma;
• scar tissue;
• neuroma;
• mucoid cyst;
• neurofibromatosis;
• osteoblastoma.

The differentiation process can be carried out without any problems using the above diagnostic methods.

To get rid of the disease, the following types of therapy are used:

• medication;
• physiotherapy;
• surgical.

To increase the effectiveness of a particular method of treatment, as well as the fastest possible recovery, complex therapy is used.

Medicines

To relieve the symptoms that occur with nodular tenosynovitis, are used medications local and systemic effects, which help to remove:

• pain sensations;
• swelling;
• puffiness;
• redness;
• inflammatory processes.

The following groups of drugs are prescribed for treatment:

• anti-inflammatory drugs;
• antibiotics;
• drugs that help strengthen the immune system;
• analgesics;
• painkillers;
• drugs that improve metabolism.

The course and duration of medication is set individually for each patient and depends on the location and number of neoplasms. It is forbidden to use any funds on your own without the appointment of the attending physician, as a result of which serious complications may arise.

Physiotherapy

Physiotherapeutic methods of therapy contribute to the restoration of the lost functions of the affected joints.

The most commonly used are:

Surgery

Removing nodes is often done through surgery. For intervention, delicate surgical instruments and special devices for optical magnification are used. Together with the tumor, the compromised areas of the tendon sheath, capsule, and sometimes particles of the tendon itself are removed.

This procedure is performed using conduction anesthesia, in which there is a blockade of the nerve impulse transmitted to the affected area of ​​the body. In addition to such anesthesia, anesthetics are also used, which have a longer duration of action. After removal of large nodes, the patient sometimes undergoes tendon plasty, and in some cases, arthroplasty.

When removing one node on the phalanx of the finger, an oblique or transverse incision is made in relation to the axis of the finger. Removal of several neoplasms occurs using a zigzag or Z-shaped incision. Very often there are difficulties in removing tumors located on the back and volar surface of the finger.
Nodes that have a dense capsule are removed without any problems. Sometimes there is no capsule and it is necessary to separate the formation from nearby tissues.

This action is performed using a special periosteal elevator-raspator of the Freer type, which is very often used in the field of dentistry and otorhinolaryngology. With the help of tweezers, a slight loosening of the knot occurs, and then it is removed by an elevator from the tissues. The removal takes place very carefully so that there are no pieces left and there is no recurrence of this disease. In cases of recurrence of nodes, surgical intervention is again performed.

After the operation, the following complications may occur:

• loss of sensation in the finger;
• deterioration of mobility in the joints;
• the appearance of pain in the area of ​​the scar.

Prevention

It is known that this disease is prone to recurrence. To prevent this from happening, you must strictly adhere to all the recommendations of the attending physician during the period of therapy and rehabilitation. In addition, it is recommended to eat food rich in vitamins and proteins. Such products will help strengthen the immune system.

It is very important to remember that self-medication can lead a person to disability, because the process of atrophy will begin to occur in the muscles of the affected limb, and it will become incapacitated.

Voronezh regional
clinical hospital №1

Budgetary healthcare institution of the Voronezh region

DEPARTMENT OF HEALTH OF THE VORONEZH REGION

BUZ VO "VORONEZH REGIONAL CLINICAL HOSPITAL № 1"

Nodular tenosynovitis

fingers of the hand

orthopedic traumatologists and students of IDPO

Compiled by:

Head of the Department of Microsurgery, BUZ VO VOKB No. 1

MD Khodorkovsky M.A.

Doctor of the Department of Microsurgery of the BUZ VO VOKB No. 1

PhD Skorynin O.S.

Voronezh - 2015

Introduction

Nodular tenosynovitis is a benign locally invasive tumor of the soft tissues, most often affecting the synovial membranes and tendon sheaths of the fingers. Nodular tenosynovitis is the second most common (after tendon ganglion) neoplasm of the soft tissues of the hand. The disease was first described in 1852 by the French surgeon Édouard-Pierre-Marie Chassaignac), calling it "cancer of the tendon sheath".

Rice. 1. Edouard Chassegnac (1804 – 1879)

В дальнейшем это новообразование получило множество названий: ворсинчатый артрит, гигантоклеточная фиброгемангиома, гистиоцитарная ксантоматозная гранулема, доброкачественная гигантоклеточная синовиома, доброкачественная синовиома, ксантогранулема, ксантома, ксантосаркома, миелоидная эндотелиома, миелоксантома, миелома сухожильного влагалища, миелоплаксическая опухоль, плазмоцитарный синовит, склерозирующая гемангиома, фиброгемосидерическая tumor, fibrous xanthoma, tendon fibroma, endothelioma. In modern domestic literature, this nosology is called "nodular tenosynovitis", in foreign - "giant cell tumor of the tendon sheath (GCTTS)" or "pigmented villonodular synovitis (PVNS)".

Etiology and pathogenesis

Such a number of names for one disease indicates the absence of a unified view of its etiopathogenesis. It was assumed that this pathology occurs due to metabolic disorders or an inflammatory process. Subsequently, DNA analysis and immunohistochemical studies showed the presence in the foci of nodular tenosynovitis of cell populations with some tumor characteristics. However, the belonging of nodular tenosynovitis to benign or malignant neoplasms of the connective tissue has long been the subject of discussion. It has now been proven that, despite the high frequency of local recurrences, nodular tenosynovitis is not a malignant neoplasm and does not metastasize. Most experts believe that the cause of nodular tenosynovitis is reactive or regenerative hyperplasia associated with the inflammatory process. However, the inflammatory factor triggering this mechanism has not yet been identified either clinically or experimentally.

Clinic

Nodular tenosynovitis clinically manifests as a slowly growing tumor-like formation located under the skin of the fingers and hand, near the tendons or joints. Tumor nodes can be single and multiple (Fig. 2). Typical localization of tumors in nodular tenosynovitis is the proximal phalanges of the II, III and IV fingers of the hand (Fig. 3). The dorsal surface of the phalanges is affected in 57%, the volar surface in 37%, and both surfaces in 6% of cases. The size of the tumor averages 1.6±0.6 cm, and, as a rule, does not exceed 4 cm. Large tumors can cover the phalanx circularly. No relationship was found between tumor size, location, gender, and age of patients. In 15% - 28% of cases, a growing tumor can cause destruction of the bone tissue of the phalanx without signs of infiltrative growth. Pain in nodular tenosynovitis is not typical. Patients usually come with complaints of finger deformity.

Rice. 2. Nodular tenosynovitis of the distal phalanx II finger.

Diseases of the periarticular tissues of the hand area

Periarticular lesions of soft tissues, including the area of ​​the hand, are a common reason for seeking medical help. The genesis of these diseases most often consists in a degenerative-inflammatory lesion of the tendons and / or tendon sheaths, resulting from relative overload against the background of age-related changes or due to a systemic connective tissue defect, which occurs with hypermobility syndrome. However, a number of soft tissue lesions have a different, not yet completely clear genesis, for example, changes in the palmar aponeurosis in Dupuytren's disease or palmar fasciitis in tumors of various localizations.
The basis of the diagnosis of soft tissue lesions is the analysis of complaints and clinical examination. Symptoms of lesions of the tendon apparatus in older persons age group often occurs against the background of manifestations of nodular osteoarthritis of the hands (Heberden's, Bouchard's nodes), which can lead to the erroneous conclusion that all the symptoms (pain, numbness, “clicks” when moving the fingers) are associated only with osteoarthritis. Such misinterpretation of complaints leads to inadequate treatment.

Nodular tenosynovitis of the flexors of the fingers
The characteristic symptomatology of this disease is reflected in one of its names - "snapping finger". The main symptom of nodular tenosynovitis is a distinct click felt by the patient during flexion-extension of the finger (or several fingers) of the hand. The disease occurs in people over 60 years of age, both in isolation and against the background of other manifestations of degenerative skeletal damage. The development of nodular tenosynovitis at a younger age may be due to special types of professional activities with an overload of the fingers, a congenital systemic connective tissue defect, or inflammatory diseases joints. So far, it is not clear what is primarily affected - the flexor tendon or the sheath of the tendon sheath in the narrowest zone of the annular ligaments located distal to the metacarpophalangeal and proximal interphalangeal joints (Fig. 1). The discrepancy between the diameter of the tendon sheath and the tendon of the flexor of the finger leads to a degenerative-inflammatory productive process and the formation of a nodule on the tendon. Difficult movement of the flexor tendon in the tendon sheath (“squeezing”) at the level of the finger with the release of the nodule after passing through the narrowed area and is felt by the patient as a click. The resulting conflict leads to irritation of the synovial membrane of the tendon sheath and further progression of the process. As a result, a snapping or even persistent flexion or extensor contracture of the finger may occur. Inspection (palpation) of the palmar surface during flexion-extension of the finger makes it possible to detect a distinct movable thickening in the projection of the affected tendon.
The treatment of nodular tenosynovitis consists in the elimination of the inflammatory component, which in most cases allows the restoration of normal sliding of the flexor tendon of the fingers in the tendon sheath. The most effective is the introduction of a small amount (1/4 ml of diprospan) of a long-acting microcrystalline preparation of glucocorticosteroid into the lumen of the tendon sheath of the finger flexor. The injection point is located 1-0.5 cm proximal to the interdigital fold in the projection of the affected flexor tendon. When performing an injection, 1 ml of a suspension of the drug is diluted with 1 ml of 0.5% novocaine or 0.9% sodium chloride solution. 0.4–0.6 ml of the mixture is injected into each affected tendon sheath. Immersing the needle in the direction of the tendon sheath, simultaneously exert pressure on the syringe plunger. The presence of the needle in the lumen of the tendon sheath will be indicated by a decrease in resistance during the administration of the drug, a feeling by the patient of “bursting” in the projection of the tendon sheath and the appearance of a bulge distal to the injection site. As a rule, one injection is enough to achieve the effect. In case of relapses occurring after 6–12 months, the procedure is repeated. In the absence of the effect of 2 injections (with a long, many months of the process), phonophoresis or electrophoresis with hyaluronidase is used. Injections of hyaluronidase into the nodule or tendon sheath often cause a violent inflammatory reaction. Data on the results of surgical treatment are ambiguous: in particular, the revision of the tendon sheath and excision of the thickening on the tendon can lead to the formation of adhesions and unsatisfactory functional results.

Ganglion (hygroma)
Ganglion is a hernial protrusion of the wall of the tendon sheath of the extensor or flexor of the hand at the level of the wrist joint. The communication of the formation with the tendon sheath has a valvular character, i.e., the synovial fluid enters the ganglion when the tendon is tensed, but not vice versa. Partially, the liquid is resorbed by the walls of the ganglion, which leads to its thickening. The disease is common, mainly in women of young and middle age, in whom, on examination, signs of congenital weakness of the connective tissue (hypermobility of the joints) are often found. Patients complain of the appearance in the indicated area of ​​a painful “nodule” 0.5–1 cm in size of an elastic or dense consistency, unpleasant or painful sensations in which are associated with finger or hand movements. Individuals with severe hypermobility have giant ganglia up to 5 cm in size (Fig. 2). The diagnosis is established by detecting a mobile soft tissue formation in the projection of the tendon sheaths.
Treatment consists in ganglion puncture (sometimes it is possible to obtain a few drops of a normal or high viscosity of a clear synovial fluid) and the introduction of 0.2–0.4 ml of a microcrystalline glucocorticosteroid preparation into its cavity. It is preferable to use undiluted triamcinolone acetate, which, due to its local degenerative effect, can cause the walls of the hernial sac to “stick together” and the formation disappear. With insufficient effect or recurrence of the ganglion, it is excised.

De Quervain's disease
The full name of this pathology is stenosing tenosynovitis of the long abductor and short extensor of the first finger of the hand. The disease is manifested by bouts of sharp pain in the base of the first finger. At the same time, patients themselves can hardly describe or reproduce the movement that causes pain. On examination, pain is found in the area of ​​the “anatomical snuffbox” - that wall of it that faces the palm; swelling of this zone is sometimes observed (Fig. 3). The Finkelstein test is pathognomonic: the patient is asked to press the thumb to the palm as much as possible, cover it with other fingers, and take the resulting “fist” to the elbow side. In this case, tension arises in the above tendons and a pain sensation familiar to the patient is reproduced. This disease affects young women who have recently given birth and those of middle and older age with joint hypermobility.
In mild cases, treatment consists of limiting the load on the affected hand, wearing an orthosis, and using ointments and gels with non-steroidal anti-inflammatory drugs. With persistent flow, local infiltration of the affected area with a glucocorticosteroid in combination with an anesthetic is carried out. In the future, in order to prevent relapses, it is recommended, if possible, to limit the load on the hands.

Rice. 1. Nodular tenosynovitis of the flexors of the fingers.

Rice. 3. Puffiness in the area of ​​the affected tendons in de Quervain's disease.

Rice. 4. Carpal tunnel syndrome.

Rice. 5. Tenosynovitis of the tendons of the flexors of the fingers and hand in the lower third of the forearm as a cause of carpal tunnel syndrome.

Rice. 6. Introduction of a glucocorticosteroid into the carpal tunnel.

Rice. 7. Flexion contractures of the IV and V fingers in Dupuytren's disease.

carpal tunnel syndrome
This is the most common disease from the group of tunnel neurovascular syndromes. The main (but not the only) cause of carpal tunnel syndrome is nonspecific tendonitis of the flexors of the fingers, which occurs mainly in women after 50 years of age. Due to the anatomical features of the carpal tunnel (stiffness of the walls), even moderate tenosynovitis of the flexors of the fingers, passing in the carpal tunnel together with the median nerve, causes compression of the nerve trunk, which determines the symptoms (Fig. 4). Patients complain of sensations of numbness, paresthesia in the fingers after periods of rest (in the morning after sleep), in more severe cases, they wake up from these sensations at night.
Upon detailed questioning, it turns out that these sensations are localized mainly in the tips of the first three fingers of the hand - a zone sensitive to innervation by the median nerve. Objective symptoms in the initial stages of the disease are scarce, but upon closer examination, one can often see a bulge along the inner surface of the forearm in the projection of the flexor tendons of the fingers adjacent to the transverse ligament of the wrist (hot-dog sign of American authors). This sign is found in 80% of patients and is a predictor of the success of local injection anti-inflammatory therapy (Fig. 5).
With a long duration of the disease, signs of involvement of the motor fibers of the median nerve are revealed - hypotrophy of the muscles of the eminence of the thumb, which indicates irreversible changes and a poor prognosis of conservative therapy.
Diagnosis of carpal tunnel syndrome is not difficult. Consideration is given to the patient's characteristic description of complaints, their localization, and tests designed to temporarily increase pre-existing compression of the median nerve (and therefore reproduce pain sensations).
1. Tinel test - the doctor performs percussion with a neurological hammer in the canal area or applies thumb pressure (energetic, until the nail turns white) on this area. The patient feels the appearance or intensification of a familiar numbness in the tips of the first three fingers of the hand.
2. Cuff test - with the help of a device for measuring blood pressure, arterial circulation in the upper limb is stopped. The median nerve is the first to react to this as an already ischemic structure; paresthesias appear in the zone of innervation.
The Phalen test recommended for the diagnosis of carpal tunnel syndrome (hyperextension in the wrist joint, which should increase pressure in the carpal tunnel and reproduce symptoms), according to our data, is extremely rare.
The characteristic clinical presentation and one of the positive diagnostic tests are usually sufficient to establish a diagnosis of carpal tunnel syndrome. Treatment consists in the introduction of a microcrystalline preparation of glucocorticosteroid into the carpal tunnel (Fig. 6). The procedure is not difficult, since this canal is quite wide and its side and back walls are formed by the bones of the wrist. The insertion point is the middle of the proximal wrist crease. The only possible complication during the procedure is trauma to the median nerve trunk with a needle. In this case, the patient experiences severe (“shooting”) pain in the fingers of the hand. In this case, the needle is removed and inserted 0.5 cm lateral or medial to the original injection site (the transverse dimensions of the channel allow this). Enter 0.5 ml of betamethasone dipropionate, diluted in 1.0–1.5 ml of a 0.5% solution of novocaine.
The lack of effect from the introduction of glucocorticosteroid indicates a non-inflammatory cause of compression of the median nerve in the carpal tunnel or compression of the median nerve at another level. In this case, an electromyographic study is shown, which will allow to objectively determine the localization of the lesion. Persistent sensory disturbances and the ineffectiveness of conservative therapy for carpal tunnel syndrome are indications for surgical revision of the canal.

Guyon's canal syndrome
This tunnel syndrome consists in compression of the sensitive branch of the ulnar nerve at the level of the wrist joint in the Guyon canal formed by the transverse carpal ligament, pisiform bone and superficial fascia of the forearm. The tendon of the ulnar flexor of the hand passes through the canal, inflammation in which usually causes compression of the nerve trunk. This syndrome is much less common than carpal tunnel syndrome. A combination of both syndromes is also possible. The clinical picture of Guyon's canal syndrome consists in paresthesias and numbness in the zone of innervation of the distal sensitive branch of the ulnar nerve - the tips of the IV and V fingers of the hand. For diagnosis, an analogue of the Tinel test and a cuff test are used. When conducting the Tinel test, pressure is applied along the medial surface of the pisiform bone (the most protruding bone of the wrist on the palmar surface, located opposite the little finger). With the introduction of a glucocorticosteroid into Guyon's canal, the medial surface of the pisiform bone of the wrist also serves as a guide.

Dupuytren's contracture
Dupuytren's contracture is a fibrosis of the palmar aponeurosis believed to be caused by neurotrophic disorders. The genesis of the disease is not completely clear. Dupuytren's contracture affects patients with diabetes mellitus, people who have had disorders cerebral circulation, although often no predisposing factors can be identified. Men are predominantly ill. The main symptom of the disease is the appearance on the palmar surface of painless seals in the form of nodules and strands. In the debut of the disease, they do not cause any dysfunction of the hand. At this stage, the disease can be discovered by chance during examination for some other reason or simply by shaking hands. Fibrosis progresses slowly and becomes clinically significant when the flexor tendons of the IV and V fingers are involved in the process. This results in a permanent flexion contracture. specified fingers, the degree of which depends on the severity of the lesion of the tendons. In severe stages IV and V, the fingers are fixed in the position of full flexion, which significantly impairs the functional ability of the affected hand. This picture occurs after 8-12 years of the disease.
Currently, there is no generally accepted conservative treatment for Dupuytren's contracture. The proposed physiotherapeutic methods (phonophoresis with hyaluronidase) and infiltration of compacted areas of the aponeurosis with triamcinolone acetonide have not been tested in controlled studies, and therefore there is no reason to recommend them as effective. the only effective method treatment of Dupuytren's contracture is a surgical method, which consists in excising an altered palmar aponeurosis. The effectiveness of the operation depends on the stage of the disease. An unconditional indication for surgical intervention is initial signs involvement in the process of the flexor tendons of the IV and V fingers (Fig. 7). The operation at this stage leads to a complete restoration of the function of the hand. At later stages (pronounced contracture of the fingers), more complex operations are required, including tendon plasty and giving a less satisfactory functional result.

Palmar (palmar) fasciitis
The disease is relatively rare and is manifested by painful bilateral compaction of the palmar aponeurosis with the simultaneous formation of fixed flexion contractures of the fingers. In contrast to Dupuytren's contracture, palmar fasciitis has pain and damage to the flexor tendons of all fingers (Fig. 8). Examination reveals moderate hardening and tenderness of the palmar aponeurosis.
In about 50% of cases, palmar fasciitis is a manifestation of paraneoplastic syndrome in tumors of the female genital area and gastrointestinal tract. In this regard, all patients with palmar fasciitis who applied for the first time should be examined according to the oncological program. And only with the exclusion of oncological disease, symptomatic treatment is carried out, which consists in infiltration of the affected aponeurosis zone and tendon sheaths at the level of the hand with microcrystalline glucocorticosteroid preparations. However, the effect of this treatment is observed only in the initial stage of the disease; after several months, persistent fibrotic changes occur and patients often become disabled.

The article was written based on materials from the sites: meduniver.com, nashynogi.ru, nogi.guru, www.hospital-vrn.ru, old.consilium-medicum.com.

Diseases of the musculoskeletal system is a common pathology that causes serious illness, disability, and death. Tenosynovitis - inflammation of the tendons and synovial membranes - affects the able-bodied part of the population, accompanied by severe pain, loss of function of the affected limb. Timely diagnosis and effective treatment prevent disability and restore health to patients.

Causes of the disease

Tendons - bundles of connective tissue fibers by which muscles are attached to bones. Injuries and diseases of the tendons with involvement in the process of special membranes, synovial sheaths, in which they are located, causes tenosynovitis. Causes of pathology:

• injury, injury;
• spread of inflammation from adjacent joints;
• dystrophic changes, malnutrition of tissues in systemic, endocrine diseases.

Diseases of the upper limbs limit a person's ability to work. Tenosynovitis of the long head of the biceps brachii muscle occurs more often during work associated with heavy physical exertion, and is detected in weightlifters. There is pain in the shoulder, which sharply increases with palpation. Tenosynovitis of the long head of the biceps often occurs when working with arms raised high - wallpapering, puttying, painting walls, ceilings.

Elbow disease

The muscles of the forearm are attached to the condyles of the humerus. Tenosynovitis of the extensor tendons of the hand is accompanied by pain when working in the garden, in the garden, sports activities(tennis elbow) The condyle is involved in inflammation, epicondylitis occurs. The patient indicates the point of pain. In the pathology of the tendons of the muscles fixed to the internal condyle (golfer's elbow), pain occurs during rotational movements of the forearm, flexion of the hand, and radiates along the inner surface of the elbow.

Hand disease

snap finger - inflammation of the flexors, in which the tendons are restrained in a narrow channel formed by the synovial sheath and ligaments. The finger must be extended with the free hand. It develops as an occupational disease in tailors, locksmiths, hairdressers, surgeons.

Tenosynovitis of the extensors of the fingers is manifested by swelling on the back of the hand. Differential diagnosis is necessary with arthritis of the wrist joint, in which swelling also appears in this area. In tenosynovitis, the swelling moves distally, following the movement of the tendons.

The joint has a complex structure, performs motor and support functions. Tenosynovitis "crow's feet"- This is a pathology of the tendons of the thigh muscles, which are attached to the inner surface of the knee. Older, obese women get sick more often. Walking, climbing stairs increase discomfort.

Tenosynovitis of the hamstring tendon is manifested by pain on the back of the knee, aggravated by rotational movements. The semimembranosus muscle starts from the ischial tuberosity, passes into a flat tendon, which is attached to the tibia. Its inflammation causes pain in the knee, limiting flexion.

Tenosynovitis in advanced cases, if left untreated, involves the condyles and articular bags in the inflammatory process. With active inflammation, a large amount of exudate, a breakthrough of fluid into the lower leg is possible. The patient feels a sharp pain when climbing stairs. The joint increases in volume, the edema spreads to the lower leg. Flexion of the foot provokes acute pain, aggravated by walking. The disease is often mistaken for deep vein phlebothrombosis, improper treatment exacerbates the pathology.

The joint is subjected to large static and dynamic loads. Tenosynovitis of the Achilles tendon often develops in long-distance runners, ballet dancers and in patients with foot deformity, flat feet due to improper load distribution. Active and passive foot movements are limited. Tissue compaction in the tendon area is often palpable. The skin over the site of the lesion is hyperemic, edematous.

The peroneal muscles have a bipennate structure, which is why they are called peroneal. They start from the fibula, pass along the lower leg, go around the outside of the foot, and are attached to the metatarsal bones. Their function is to flex and support the arch of the foot. Tenosynovitis causes pain when walking, trying to actively move the ankle. Behind the outer ankle, an oblong roller is palpable - an inflamed tendon. A cock's gait is characteristic - the patient raises his leg high, throws the foot forward and quickly lowers it.

In the foot, tenosynovitis often affects the flexors of the fingers. Characterized by pain, aggravated by pressure on the sore spot, lameness when walking. Inflammatory lesions of the tendons of the ankle joint and foot are dangerous because repeated injuries lead to the appearance of bone growths - osteophytes, the foot is deformed, and lameness develops. A decrease in motor activity, even for a short time, leads to muscle atrophy, a chronic process.

cause of tenosynovitis often is inflammation of the adjacent joint, arthritis. Differential diagnosis is critical for effective treatment. The table lists the main signs that distinguish tenosynovitis from arthritis.

The clinical signs of both diseases are different, which allows for effective diagnosis without resorting to complex examination methods.

Patients in this group develop due to:

• metabolic disorders;
• with systemic and endocrine diseases;
• dystrophic changes in organs and tissues;
• genetic pathology.

nodular tenosynovitis It affects more often middle-aged and older women. Neoplasms 2–5 cm in size appear on the hands, wrist, interphalangeal joints, grow from the synovial sheaths of the tendons. Since 1852 (the first description of this pathology), discussions have continued about their origin. Various assumptions are made, the main theories are tumor, infectious, genetic. There is no single opinion. It is difficult to treat, after surgical removal of formations, relapses occur.

Tenosynovitis de Quervain first described as an occupational disease of laundresses. The tendons of the long extensor and short flexor of the first finger of the hand pass in the same synovial sheath. Their thickening as a result of repeated microtraumas leads to restriction of movements of the thumb. It develops in kindergarten teachers with frequent picking up of children, in women in the postpartum period due to the burden of caring for a child. Patients complain of pain at the base of the first finger, the inability to perform their usual work.

A peculiar form of inflammation of the tendons and synovial sheaths of the forearm is crepitant tenosynovitis. It develops with frequent repetition of the same type of hand movements. Swelling and redness appear on the back of the forearm. A special symptom is crepitus (if you put your hand on the affected area and ask the patient to move his fingers, a kind of crunch is felt by palpation).

Depends on the severity, localization of the lesion, the presence of complications and concomitant diseases. Tenosynovitis treatment is complex, the following methods are used:

Immobilization, the purpose of which is to immobilize the limb, is a mandatory method of treating injuries, injuries and diseases of the musculoskeletal system. Traditionally, plaster casts have been used to treat tenosynovitis. Disadvantages of the method:

• bulkiness, inconvenience when wearing with clothes;
• destroyed by water;
• do not pass X-rays;
• complicate treatment procedures.

Modern technologies make it possible to create fixators, orthoses and bandages made of light polymer for immobilization. Devices have a number of advantages in comparison with gypsum, reduce the duration of treatment, and contribute to the complete restoration of limb functions. Pharmacies offer a large selection of orthoses for all joints. The latch must be properly selected.

Drug therapy is carried out according to medical indications. With purulent complications, antibiotics are used. The acute course of the process is accompanied by anti-inflammatory therapy. Symptomatic treatment is prescribed in case of severe pain syndrome, fever. If tenosynovitis of the tendon of the long head of the biceps has developed, then treatment involves limiting weight lifting.

Physiotherapy procedures apply after subsiding of acute phenomena and in the rehabilitation period:

1. Electrophoresis is a method in which drugs in electric field move into damaged tissues.
2. Ultrasound promotes exposure to high frequency acoustic waves, improves blood circulation, accelerates healing.
3. Thermal treatment - applications of ozokerite (mountain wax), paraffin have a pronounced therapeutic effect in the rehabilitation period.
4. Of the new methods, laser therapy is used - exposure to a sore spot with a focused optical beam.

The main method of restoring joint mobility lost after prolonged immobilization. It is important to observe the following rules:

Surgical treatment is indicated for purulent complications of tenosynovitis. The surgeon opens the synovial vagina, removes pus, and rinses the wound with an antiseptic. The operation is also necessary in the presence of adhesions of the tendon with the surrounding tissues.

Tenosynovitis affects the periarticular tissues of all large joints, is accompanied by a pronounced pain syndrome, limitation of human motor activity, and significantly reduces the quality of life. Timely diagnosis and effective treatment help to reduce the period of disability of patients, prevent disability.

Tenosynovitis develops as a result of inflammation of the synovium of the tendons. For various reasons, pathological changes and processes occur in it. As a result, there is a gradual decrease in the mobility of the tendon and joint. Advanced forms of the disease on the legs lead to muscle atrophy, bone destruction, disability and disability.

What is tenosynovitis

Synovitis and tenosynovitis are associated with damage and inflammation of the synovium. It limits the joint capsule and surrounds large tendons and ligaments. Its task is to protect against mechanical damage and produce synovial fluid, which facilitates the sliding of bones, cartilage, and muscles relative to each other. When the shell of the joint capsule is damaged, synovitis develops. The spread of the inflammatory process to the tendon membranes is called tenosynovitis.

On a note!

What is tenosynovitis is a lesion of the synovial sheaths of the tendons. Ligaments of the most active joints - knee, wrist, ankle - are predominantly affected by the disease.

Main types and forms

Tenosynovitis of the tendon most often occurs as a result of direct mechanical impact and physical damage to the sheath. Subsequently, an inflammatory process develops in this place, which gradually worsens. As a result, the formation of synovial fluid decreases, friction between the tendons increases, and further injury occurs.

Depending on the form of the course, etiology, severity, the following types of the disease are distinguished.

ICD-10 encoding

According to the International Classifier of Diseases, the ICD 10 code is indicated in section M65. The exact coding depends on the cause, localization, form of the course of the disease. Unspecified tenosynovitis refers to a disease without a clear etiology. Her code is M65.9.

Characteristic symptoms

One of the first signs of tenosynovitis is discomfort during flexion, extension of the affected joint. The slightest movement is accompanied by a crunch, indicating pathological changes in the tendon and surrounding tissues. Common symptoms in the development of tendon tenosynovitis:

• pain of a different nature (acute, aching, constant, periodic);
• swelling of the limb, the formation of a soft bump or seal;
• reddening of the skin, discoloration, local temperature increase;
• limited mobility of the joint and the diseased limb.

The nature of the clinical picture depends on the specific location of the disease. Tenosynovitis of the knee joint is accompanied by a significant increase in its size. The defeat of the ankle is characterized by constant pain when walking, running, the feeling of immobility gradually increases. With nodular tenosynovitis, seals (nodules up to 6 cm) form around the tendon.

Causes on the feet

The acute form of the disease most often occurs as a result of mechanical action. In the absence of treatment or under the influence of other factors, chronic tenosynovitis develops. The most common causes of damage to the tendons of the joints in the legs:

• injuries (bruises, falls, fractures, dislocations);
• penetration of infection through open wounds;
• autoimmune reaction of the body in rheumatoid diseases;
• after a viral, bacterial disease;
• age-related changes in tissues (cartilaginous, bone);
• regular physical activity (sports, hard work);
• complication of synovitis of the articular bag, arthrosis, arthritis.

On a note!

The cause of damage to the tendon of the long flexor of the big toe is a direct physical impact or prolonged monotonous loads. The disease begins with a painful swelling in the affected area, a tingling sensation, and numbness of the foot. Timely therapy allows you to avoid complications and restore mobility to the foot.

Diagnostic methods

When the popliteal muscle is damaged, the patella greatly increases in size. Pain extends to the lower leg and foot. To identify the disease and distinguish it from other joint ailments, a thorough diagnosis using different methods will be required.

On a note!

If necessary, an examination is prescribed by narrow specialists - an endocrinologist, an infectious disease specialist, an allergist. An integrated approach improves the accuracy and objectivity of the diagnosis, allowing you to choose the optimal therapeutic regimen.

Medical therapy

Treatment of tendon tenosynovitis in a particular case depends on the form, degree of neglect, and the cause of the disease. Conservative therapy includes immobilization of the affected limb (splint, plaster) and medication. Drug treatment is aimed at stopping pain, reducing inflammation, swelling, tissue regeneration. Used drugs:

• from the group of non-steroidal anti-inflammatory drugs - based on Ibuprofen, Diclofenac, Indomethacin, Ketoprofen, Analgin;
• hormonal preparations for intra-articular injections - corticosteroids for rapid pain relief from the group of Betamethasone, Methylprednisolone, Hydrocortisone;
• antibiotics - are selected according to the results of bacteriological culture (usually use Amoxiclav, Ceftriaxone, Cefazolin);
• chondroprotectors, hyaluronic acid - to restore cartilage, connective tissue, accelerate recovery processes (Rumanol, Alflutop);
• vitamin complexes (group B) - to improve tissue trophism, cell renewal.

Physiotherapy methods

Treatment is carried out using methods of physiotherapy. Their use allows you to stop inflammatory processes, accelerate tissue regeneration. In combination with drug therapy are used:

• electrophoresis, phonophoresis;
• magnetotherapy, UHF, ultrasound;
• thermotherapy, laser therapy;
• radon baths, applications.

Physical Therapies

The therapy program must include physiotherapy exercises or wellness massage. Procedures prevent stagnation of blood in the legs, promote blood and lymph flow, improve the mobility of the diseased joint. The scheme of such therapy for tenosynovitis of the Achilles tendon is established by the attending physician and includes the following methods of exposure.

Traditional medicine methods

Non-traditional methods of treating ankle tenosynovitis are based on methods traditional medicine. They are used in consultation with the attending physician in order to avoid side effects and complications. At home, therapy is allowed with the following means:

• alcohol compress (combine 1 part of medical alcohol with 3 parts of water) in the acute phase reduces inflammation, eliminates hyperthermia, swelling;
• an infusion of bay leaves (20 g of crushed dry leaves, pour 1 tablespoon of olive oil and leave for 1 week) is rubbed into the affected area to reduce inflammation;
• apply a fresh cabbage leaf to the sore spot to reduce swelling, pain;
• dissolve 3 tbsp. l sea or table salt in 1 tbsp. warm water, moisten a gauze bandage and apply to the diseased joint for 10-15 minutes to eliminate swelling, inflammation;
• massage the affected area three times a day with pieces of ice for 15 minutes for 2-3 weeks;
• with tenosynovitis of the ankle joint, coniferous baths are useful - make a decoction of 1 part of pine (spruce, fir) needles and 3 parts of water, add the strained solution to the foot bath.

Surgical methods

Tenosynovitis of the tendon in a neglected or chronic form requires cardinal medical intervention. Conservative therapy in such cases is ineffective and does not prevent the progression of the disease. To avoid complications, experts recommend surgical methods of treatment:

• excision of the cavity of the affected joint with the removal of nodules, seals, tumors;
• puncture of the cavity to remove excess synovial fluid with purulent contents;
• tendon plasty is a painstaking work to restore form and functionality.

Operations are carried out in stationary conditions, require a long rehabilitation period. Most often, the prognosis of surgical intervention is favorable and allows you to get rid of the disease for a long time. In order to prevent and prevent relapses, physiotherapy, massage, and physiotherapy exercises are prescribed.

Many are familiar with such a thing as stretching muscles or ligaments. But next to these anatomical elements are tendons, which can also be stretched, torn, damaged. Often accompanied by simultaneous damage to the tendons. But every disease has its own name.

What is tenosynovitis?

There are two concepts: tendovaginitis and tenosynovitis. Sometimes they are not distinguished, since we are talking about inflammation of the synovial membrane of the tendons, which consists of connective tissues. Why are there two names for the same disease? Because we are talking about inflammation of the various layers of the synovial membrane. Tenosynovitis is an inflammation of the synovial membrane of the tendon from the inside. What is tenosynovitis? This is an inflammation of the paratendon, that is, the synovial sheath of the tendon on the outside.

Tenosynovitis has the following types:

1. It comes in the form:
   • sharp;
   • Chronic.
2. For reasons of development:
   • Aseptic - neurological disorders, injuries, allergies, endocrine disorders. Divided into types:

• Traumatic;
• Diabetic;
• Allergic;
• immunodeficient;
• Endocrine, etc.

• Infectious - proceeds in a purulent form. There are types:

• Bacterial;
• Viral;
• Fungal;
• Specific;
• Non-specific.

1. Common types of tendon inflammation:

• Stenosing - damage to a specific joint:
  • Thumb extensor.
  • Long head of biceps (biceps);
  • Ankle;
  • Knee;
  • Elbow;
  • brushes;
  • Hip;
  • Wrist (tenosynovitis de Quervain).
• Tuberculous - refers to a group of specific tenosynovitis that develop against the background of tuberculosis.
• Inflammatory chronic - develops as a result of rheumatic diseases.

1. By expression:

• Minimum;
• Moderate;
• Expressed.

What are the causes of tenosynovitis of the tendon synovium?

What are the main causes and factors for the development of tenosynovitis of the synovial sheath of the tendon?

• Tendon wounds and injuries. If it proceeds without penetration of the infection into the injury, then the wound heals faster and the disease passes easily. If an infection gets inside, then it delays the healing process, requiring medical treatment. For a while, a person loses the ability to fully move, as before, a diseased limb. But if you recover, then the functionality will return.
• Rheumatic diseases.
• Low immunity, which could not overcome the infection that penetrated the synovial membrane.
• Joint degeneration. A disease like bursitis often affects the tendons.
• genetic predisposition.
• Other infectious diseases, for example, tuberculosis, HIV, syphilis, herpes, etc. Here, the infection spreads through the body through the blood.
• Old age, which is marked by the fact that the nutrition of the joints becomes worse with age.
• Tendon stress and fatigue. Usually, in professional activities, a person must perform the same actions, that is, load a specific muscle group, while the rest are little involved. The lack of variety in movements gives a large load, which develops tenosynovitis. This applies not only to actively leading people, but also to those who have a sedentary job.

Symptoms and signs

General symptoms and signs of tenosynovitis develop gradually. It all starts with mild discomfort in a particular joint. Adults usually do not pay attention to this, because they assume that it is temporary. And indeed: acute tenosynovitis will soon turn into chronic, which is just a matter of time. Therefore, at the first such signs, contact a rheumatologist for help:

• The pain is sharp, dull, aching, prolonged, or otherwise.
• Swelling that can be seen and felt.
• Some immobility of the joint, there is no possibility to move freely.
• Redness in the area of ​​the affected tendon.
• The pain is aggravated by movement.

Consider the symptoms at the site of inflammation:

1. Ankle joint:
   • accumulation of fluid;
   • Pain all over or only in one part of the foot;
   • Pain increases with prolonged walking or standing, as in arthritis;
   • Forced change in gait.
2. Knee-joint:

• Swelling of the knee, increases in size;
• Blunt pain;
• Inability to move the affected knee;
• Sharp pain on exacerbation.
  1. Long head of biceps:
• Pain in the biceps, which can go to the shoulder girdle.
  1. Tenosynovitis de Quervain:
• Pain at the edge of the thumb or radial wrist;
• The pain may extend to the elbow or to the shoulder;
• The pain is aching in nature, acquiring an acute form with movements.

Tenosynovitis in a child

Is it possible for a child to develop tenosynovitis? Perhaps, but often due to a penetrating wound into which the infection has entered. Other reasons that were discussed in this article are more inherent in adults.

Tenosynovitis in adults

Tenosynovitis is common in adults. Infectious species appear at any age, as traumatic or allergic. However, they distinguish special kind tenosynovitis, which develop in men and women in old age due to loss of elasticity, tension and strength.

Diagnostics

Tenosynovitis is diagnosed by a physical examination, blood tests, and x-rays that rule out osteomyelitis, bursitis, or arthritis.

Treatment

Treatment of tenosynovitis is carried out in three directions: medication, physiotherapy and surgery. Let's consider them in more detail.

What is the treatment for tenosynovitis? Initially, with medication:

• anti-inflammatory drugs;
• Antibiotics for the infectious nature of the disease: clindamycin, cefotetam, penicillin;
• Immune drugs to enhance immunity;
• Medications that normalize metabolism;
• Analgesics;
• non-steroidal anti-inflammatory drugs;
• Painkillers;
• Colchicine and NSAIDs in the development of the disease as a result of gout.

How else is tenosynovitis treated?

Thanks to physiotherapy procedures:

• Magnetotherapy;
• laser therapy;
• Ultrasound;
• electrophoresis;
• Cold and thermal applications;
• Ultraviolet;
• Therapeutic massage of the affected joint.

Surgical treatment involves tapping a joint that otherwise does not heal. The doctor removes the fluid accumulated in the joint, as well as the exudate of the inflammatory process. Introduces hormonal drugs to relieve inflammation.

Everything is accompanied by immobilization of the affected part of the body, so as not to provoke pain. The limb is fixed with plaster, bandages or splints. Crutches are also used so as not to put additional stress on the tendons.

At the stage of recovery, immobilizing dressings are removed in order to prescribe a course of physiotherapy exercises, which the patient can do at home. The treatment itself is carried out only in a stationary mode. You can recover at home. Here it is allowed to use folk remedies, which help warm and cool the affected area. Any alternative methods should be agreed with the doctor.

Diet

Should I follow a special diet? There are no hard and fast recommendations here. You can only increase the intake of foods that are rich in vitamins and proteins, which will strengthen the immune system and help tendons grow.

life forecast

Tenosynovitis gives a favorable prognosis of life in case of timely treatment. Patients recover within a month. How many live without treatment? The disease does not affect life expectancy, but can make a person disabled if not treated. Soon, the muscles of the affected area atrophy, making the limb incapacitated (non-functional).

Many are familiar with such a concept as sprains, muscles. Next to these elements are tendons, which are also subject to stretching. Often, damage to the ligaments or muscles is accompanied by stretching of the tendons, an inflammatory process is gradually formed that prevents the victim from living normally.

Each ailment has its own name, inflammation of the tendons is called tenosynovitis. Pathology occurs in acute or chronic form, the patient feels a strong pain syndrome. How to identify the disease, what are the favorite areas of localization of the pathology, effective methods of treating the disease? Knowing these aspects, you can easily determine the onset of tenosynovitis, prevent a lot of complications.

general information

Some consider tendovaginitis and tenosynovitis to be identical ailments. They are not distinguished because we are talking about the inflammatory process in the tendons. Why are there two names for the same disease? In view of the fact that we are talking about a pathological process in different layers of the synovial membrane. Tenosynovitis is an inflammation of the synovial membrane inside the tendon, tenosynovitis - an inflammatory process occurs in the paratendon (outside the synovial membrane).

Only an experienced specialist can determine the course of tenosynovitis by doing some research. Self-selection of treatment methods is prohibited. Improper medication can aggravate the situation, lead to the development of complications.

Causes

Tenosynovitis develops due to many reasons, experts identify several main negative factors:

• injuries and tendon injuries. If the damage proceeds without infection, then the wound heals quickly, leaving no trace behind. The presence of infection leads to a delay in the healing process, pathogenic microorganisms contribute to the development of inflammation, it is impossible to cope with the disease without medical help. In some cases, a person temporarily loses the motor activity of the affected limb, after recovery, the function returns;
• weakened immunity. Insufficiently strong body defenses are not able to protect it from infection, which leads to an increase in the inflammatory process in the tendons;
• degenerative changes in the joints. Often tenosynovitis occurs against the background of rheumatoid arthritis, bursitis. The components of the musculoskeletal tissue are closely related. The course of the pathological process in one area can provoke a lesion in other areas;
• course of other infectious diseases. Tuberculosis, syphilis, HIV infection, herpes. Pathogenic microorganisms spread through the body through the blood, affecting more and more new "territories";
• advanced age. Tenosynovitis affects people of all ages, but most often the disease is diagnosed in older patients. Over time, the nutrition of bone and muscle tissue is disturbed, blood flow decreases, which makes them weak, any negative factor can lead to an inflammatory process;
• genetic predisposition. Experts insist that the disease can be inherited. If you have relatives with such an ailment, carefully monitor your health, follow preventive rules;
• overwork, overload of the tendon. In most cases, a person performs the same movements every day. The rest of the muscle groups are not involved in any way. It is those tendons that are constantly in tension that are most susceptible to the development of tenosynovitis. This aspect concerns not only people leading an active lifestyle, professionally involved in sports, but also patients who have a sedentary job.

Before starting therapy, it is important to identify a provocative negative factor, get rid of it. After all, it is impossible to overcome tenosynovitis that arose against the background of an infection without getting rid of pathogenic microorganisms. The doctor will tell you the right path to recovery, to get a quick result, strictly follow the doctor's instructions.

Classification

Doctors divide all inflammatory processes of the tendons into several types:

• stenosing. The disease is often localized in the area of ​​large joints (elbow, knee, hip, ankle). Often the tendons that are responsible for abducting the fingers to the side are affected. As a result, the movement of the affected area is severely limited. If the pathology becomes chronic, then scars form on the tendons and joints. In the absence of medical assistance, the movements of the joint are completely blocked, tenosynovitis of this type is often noted in the female;
• tuberculous tenosynovitis. It is formed against the background of the defeat of the patient's body with a tuberculosis bacillus. The form of pathology often affects the synovial sheaths of the carpal tendons. The hand is noticeably swollen, the mobility of the fingers is reduced. Oddly enough, pain in this form of pathology is not pronounced, often the disease is asymptomatic, which makes timely diagnosis and treatment difficult. In most cases, such tenosynovitis is diagnosed in patients older than 18 years;
• inflammatory chronic form of pathology. The course is similar to the tuberculous form of tenosynovitis. Rheumatoid arthritis is often the result of this disease. An accurate diagnosis can only be made by carefully examining the patient's blood test (for the presence of bacterial microflora).

Signs and symptoms

Often the disease proceeds unnoticed by the patient, slowly. Many people do not pay attention to discomfort in the limbs, they visit the doctor only in advanced cases. Experts recommend visiting a doctor at the onset of unpleasant symptoms, the sooner you start treating tenosynovitis, the more chances you have to fully restore motor abilities and avoid negative consequences. If treatment is not started in time, then the damaged joint can be blocked, making a person permanently disabled.

Tenosynovitis has a characteristic clinical picture:

• inability to move a sore spot;
• pain during work with a damaged muscle or tendon;
• redness of the inflamed tendon;
• palpation can reveal swelling of the tendons.

Specific symptoms depend on the location of the disease:

• inflammation of the knee joint. The first sign of the disease is a sharp increase in knee size. If you notice such a sign, visit the doctor immediately. The sign is observed with inflammation of the synovial membrane, the articular bag is filled with fluid, which provokes an increase in the size of the knee. Often the pain is dull in nature, if the pathology is in the acute phase, then the discomfort cannot be tolerated, an urgent intake of analgesics is required;
• pathology of the ankle joint. The tendons themselves do not change their usual shape and color, but a lot of fluid accumulates inside the tissues that surround them. Often, the ankle joint is affected against the background of the course of rheumatoid arthritis or a serious injury to this area. The patient complains of pain in the back or forefoot, advanced cases are characterized by discomfort throughout the plane. If the pain sensations are burning, have a strong color, we are talking about a neurogenic character, the discomfort increases when the sore leg is straightened;
• de Quervain's disease. Occurs against the background of an overload of the wrist or thumb on the hand. The inflammatory process is triggered due to regular physical exertion or a single, but great strength. There are also injuries in this area. The disease does not give itself away for a long time, only the pathology that develops against the background of a serious injury is characterized by severe pain, sharply unpleasant sensations;
• damage to the long head of the biceps. Some call the pathology triceps tenosynovitis. People who constantly put their hand behind their head or sideways (for example, tennis players) suffer from this type of disease. Inflammation is localized in the upper anterior part of the biceps, sometimes spreading to the elbow joint. The patient feels sharp pain when raising the arm up, during other movements. At rest, tenosynovitis may not manifest itself in any way.

To identify the disease, X-ray, CT and MRI are performed. If necessary, a bacteriological analysis is prescribed to identify the causative agent of the disease. Based on the results obtained, the necessary course of therapy is prescribed.

Approximate treatment regimen

The doctor will help you choose the right treatment. It will not be possible to cope with the inflammatory process on its own. To eliminate tenosynovitis of various departments, the following treatment regimen will help:

• drug therapy. Includes the use of non-steroidal anti-inflammatory drugs. They stop inflammation, pain syndrome, quickly improve the patient's well-being. Apply analgesics and multivitamin preparations. Specific medications are prescribed by a doctor;
• physiotherapy(using a laser, electrophoresis, magnetotherapy and other methods) is aimed at restoring motor function, start of blood circulation, relief of pain syndrome. All manipulations are performed by an experienced specialist;
• joint puncture. Used in chronic tenosynovitis. The doctor removes excess fluid from the synovial cavity by disinfecting it with special preparations. The operation allows you to cope with inflammation, stop its further spread.

To prevent the development of the disease, doctors recommend with the help of useful tips:

• take care of your body: give up heavy loads, exercise regularly at a moderate pace;
• Having noticed the first symptoms of the disease, consult a doctor. Advanced cases lead to joint pinching, complete loss of its motor activity.

Tenosynovitis is treatable, get therapy in time, give up self-medication. Take care of your health, follow the preventive recommendations.

Read more about de Querwin's tenosynovitis in the following video: