Posterior tibialis tendon problems

1.What is tendonitis and its causes?

Tendonitis is inflammation or irritation of tendons, the connective tissue fibers that attach bones to muscles.

Causes of tendinitis

Tendonitis most often occurs due to minor but repeated stress to the tendon or from a sudden serious injury. There are many activities that can cause tendonitis.

– gardening, working with a rake, carpentry, drawing, playing tennis, golf, skiing, throwing some objects.

Incorrect postures during all these activities and poor stretching before sports increase the likelihood of tendinitis.

Other risk factors for tendinitis include:

• Problems with the Achilles tendon, including complete or partial ruptures of the Achilles tendon;
• Bone and joint problems (eg, leg length differences, joint arthritis);
• The influence of other diseases - rheumatoid arthritis, gout, psoriatic arthritis, thyroid diseases. This group also includes an unusual reaction of the body to medications;
• Excessive stress after a long period of rest. Tendons can become inflamed if, for example, you exercise intensely on weekends and avoid exercise on other days;
• Sometimes the cause of tendonitis is infection. For example, due to a dog bite on the hand or finger.

Tendonitis can occur in any person, but more often this disease occurs in people over 40. The fact is that with age, the tendons connecting bones and muscles become less elastic and are easier to damage.

A must read! Help with treatment and hospitalization!

Diseases of muscles, synovial membranes and tendons

Diseases of periarticular soft tissues - diseases of tendons (tendinitis, tendovaginitis), ligaments (ligamentitis), places of attachment of these structures to bones (enthesopathies), synovial bursae (bursitis), aponeuroses and fascia (aponeurositis and fasciitis) of an inflammatory or degenerative nature, caused by direct trauma , injury and their consequences. They are one of the most common causes of pain in the joints and difficulty moving in them.

Such pathologies include:

Humeroscapular periarthritis . Characteristic signs of this disease are pain and limitation of movement (stiffness) in the shoulder joint. The causes may be various damage to the periarticular structures (as a result of injury or prolonged physical activity); damage to the tendons of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles of the shoulder joint, which make up the “rotator cuff” of the joint.

Supraspinatus tendonitis is the most common form of glenohumeral periarthritis. This pathology develops in all age groups. With a tear (or rupture) of the supraspinatus muscle tendon, which occurs more often in older people after lifting a heavy object or an unsuccessful fall with support on the arm, in addition to pain and limitation of movements, the inability to hold the abducted arm is characteristic (symptom of a falling arm).

Tendinitis of the biceps brachii muscle is characterized by persistent pain in the anterolateral region of the shoulder joint, significant pain on palpation and simultaneous flexion of the elbow joint.

Inflammation of the epicondyles of the humerus (epicondylitis, tennis elbow syndrome). The most characteristic symptom is pain in the elbow joint when flexing and extending the hand, or when lifting an object with an outstretched arm.

De Quervain's disease is characterized by damage to the extensor pollicis longus and brevis tendons as they pass through the osteofibrous canal at the level of the styloid process of the radius. It manifests itself as pain when moving the thumb, slight swelling in the area of ​​the “anatomical snuffbox”.

Periarthritis, trochanteritis of the hip joint is one of the common causes of pain in the area of ​​this joint. The pain syndrome in some cases has characteristic features - there is no pain at rest (it occurs only when lying on the sore side or in a sitting position, cross-legged), it occurs during the first steps, but then when walking it gradually decreases and goes away completely.

Periarthritis of the knee joint is most often represented by damage to the tendons that make up the so-called pes anserine (attachment of the semitendinosus, tender, sartorius, and semimembranosus muscles in the area of ​​the medial condyle of the tibia). Pain in this area is typical, both during active and passive movements in the joint, and tenderness on palpation. There is also pain in the area of ​​the upper and lower poles of the patella upon palpation

Achilles bursitis is an inflammation of the Achilles tendon sheath and its attachment to the heel bone. It manifests itself as pain when running and fast walking, as well as pain during palpation.

Plantar fasciitis (heel spur) . It is characterized by severe pain on the lower surface of the heel bone at the site of attachment of the plantar aponeurosis. A common cause of this disease is longitudinal transverse flatfoot and uncomfortable shoes.

Diagnosis is based on clinical examination data. If necessary, based on X-ray and magnetic resonance imaging data.

Treatment: In the initial stages, the use of Radial Shock Wave Therapy (RSWT) is effective (up to 90%). If RUWT is ineffective, local administration of steroids is indicated. In rare cases of ineffectiveness of conservative therapy, surgical correction is possible.

4. Treatment of the disease

First aid for tendinitis

is to stop the traumatic impact and give rest to the damaged part of the body. You can apply cold to the area of ​​the damaged tendon. Local anti-inflammatory and analgesic ointments or anti-inflammatory drugs will help cope with pain.

If the condition does not improve within a week after tendinitis begins, see your doctor. Perhaps more serious methods are needed to treat tendonitis. It can be:

• Corticosteroid injections. This injection will quickly help reduce inflammation and pain;
• Physiotherapy. Physical therapy is very helpful for tendonitis. Especially with shoulder tendonitis. This group also includes splinting the damaged area of ​​the body.
• Surgical treatment of tendonitis. Tendinitis is rarely treated surgically, only when other methods of treating tendonitis do not produce any results.

If you are treating tendonitis at home, you should contact your doctor immediately if any of the following symptoms appear:

• Heat;
• Swelling, redness and warmth in the tendonitis area;
• General deterioration in health;
• Inability to move the affected part of the body.

All of the above symptoms may be signs of another health problem that requires careful diagnosis and treatment.

Tendon damage

Causes

They occur with wounds and open fractures, are often the result of an industrial injury and are observed in plumbing and carpentry workers.
Due to the widespread use of household woodworking machines in recent years, the number of such injuries in everyday life has increased (for example, during wood processing in the country). Less commonly, tendon damage is caused by knife wounds received during food processing or during criminal incidents. A distinctive feature of tendon damage caused by a knife or other cutting instrument is the smooth surface of the cut. In case of machine injuries, lacerations and bruises occur, often with a soft tissue defect. Open fractures are possible. The surface of the tendon rupture is uneven, with a fringed edge; sometimes there is disintegration of the tendon tissue over a significant extent.

Kinds

In clinical practice in traumatology, both flexor and extensor tendon injuries are observed, but flexor injuries are more common because they are located on the “working” palmar surface of the hand. All tendon injuries can be complete (total) or incomplete (partial). The most severe dysfunction of the hand due to persistent loss of the ability to grasp objects occurs with complete ruptures of the flexor tendons.

The main clinical symptom of complete tendon damage is loss of extensor or flexion function of the finger. There is an open wound on the skin of the finger or hand, in which the cut or torn ends of the tendon may be visible in the first hours after the injury. Subsequently, these ends “diverge”, and the only sign remains a dysfunction. In case of incomplete rupture, the function is preserved; a tear or cut in the tendon is usually discovered during inspection of the wound.

Treatment

Treatment of injuries to the tendons of the fingers and hand is carried out in a hospital setting. The doctor performs PSO of the wound and applies a primary tendon suture. There are many different methods for applying a tendon suture; the choice of technique is made individually, taking into account the nature and duration of the injury. Usually a thin nylon, nylon or metal thread is used. During the operation, the tendon bed is carefully restored to prevent the formation of rough scars and to provide favorable conditions for the tendon to glide. Then the limb is briefly immobilized with a plaster cast, antibiotics, painkillers, exercise therapy and physiotherapy are prescribed.

The primary tendon suture is applied only during the first 6-10 hours after the injury. For heavily contaminated and lacerated wounds, the primary suture is not applied upon admission, regardless of how old the injury is. For such injuries and injuries that are more than 6-10 hours old, a conventional PST is performed, the wound is waited for complete healing, and then a planned intervention is performed to apply a secondary suture or the tendon is excised and replaced with a tendon graft. The most important role in restoring the functions of the hand with primary and secondary tendon sutures is played by therapeutic exercises, which are carried out throughout the entire period of treatment until complete restoration of movements.

The only case requiring conservative treatment is the separation of the extensor tendon in the area of ​​its attachment to the nail phalanx. The cause of the separation is a closed injury - forced flexion of the finger while the extensor is tense. Damage is manifested by bending of the nail phalanx, active extension is impossible. Treatment is immobilization in the position of hyperextension of the nail phalanx for 6 weeks. In the absence of fusion and old injuries, patients are referred for planned surgical treatment.

Types of damage

Tendon injuries are tendon stretching or rupture. A sprain occurs as a result of excessive effort, for example, when playing sports or doing physical work. Pathological sprains are distinguished. They arise as a result of arthrosis, arthritis, when the tendon loses strength. A stretch of more than half the thickness of the tendon is called a tear.

From the point of view of orthopedics, it is ruptures that are dangerous. They are:

• complete - the tendon is completely torn from the bone;
• partial – incomplete tear.

Also distinguished:

• open gap. Occurs as a result of an open injury - fracture, cut, etc. In addition to the tendon, nerves and blood vessels are damaged;
• closed. When damaged, the skin remains intact.

Depending on the location, there are:

• tendon rupture in the leg;
• tendon rupture in the arm;
• shoulder tendon rupture

and other injuries.

Causes of foot tendonitis

Damage to the tendons of the foot with plantar tendonitis develops due to the influence of the following factors:

• Excessive physical activity;
• Mechanical impact of damaging factors (bruise, bone fracture, dislocation, damage to the ligamentous apparatus);
• Metabolic disorders in the human body;
• Infectious processes in tendons;
• Excess body weight.

Plantar tendonitis occurs when there are bone abnormalities that occur during fetal development or due to injury. Some medications can affect the condition of the tendons.

Symptoms and diagnosis of foot tendinitis

Tendinitis develops suddenly and begins with acute pain in the foot. The foot swells and the skin becomes red. The temperature above the joints rises. The patient cannot stand on his leg due to severe pain.

Over time, the disease enters the chronic stage. The nature of the pain changes. Patients complain of aching pain in a certain area of ​​the foot, which suddenly becomes sharp. When actively moving, a crunching or clicking sound is heard in the joints of the foot. On x-rays you can see changes in bone tissue, deformation of the foot, which led to the development of plantar tendinitis.

Using ultrasound, doctors at the Yusupov Hospital determine changes in the tendons. The location of the pathological process and the severity of tendon changes are clarified during magnetic resonance imaging. If an infectious nature of the disease is suspected, clinical and biochemical blood tests are performed. The use of modern diagnostic technologies helps rheumatologists at the Yusupov Hospital quickly establish an accurate diagnosis, find out the nature of tendonitis, and prescribe adequate treatment.

Hand therapy

The hand therapist will usually replace the plaster splint with a lightweight plastic orthosis and begin an exercise program a few days after surgery. The therapeutic program following tendon repair is extremely important and is at least as important as the surgery itself, so it is vital that you follow your therapist's instructions closely. The goal is to keep the tendon moving in the tunnel to prevent it from “sticking” to the walls of the tunnel, but to avoid damaging the repaired tendon.

The splint is usually worn for five to six weeks, after which you are allowed to gradually return to normal use of the arm. However, the tendon does not reach its full strength until three months after surgery, and its mobility may slowly improve up to six months after surgery.

Complications

• Damage to the repaired tendon. Usually this happens almost immediately, because... in the initial period, the tendon is in the most unstable state. The patient may feel a “pop” as the repaired tendon ruptures, or simply notice that the finger does not bend the way it used to bend.
• The tendon adheres to the surrounding tissue and does not slip in the canal. The fingers can only be moved with the help of the other hand (passive movement), but it does not move independently (active movement). An additional course of manual therapy may help. In some cases, surgery to release the tendon from scar tissue (tenolysis) may improve mobility, but full range of motion may not be restored.

Diagnostics

Injuries to the tendons of the extremities are first diagnosed by taking a medical history. Main symptoms:

• a characteristic click and sharp pain at the site of rupture at the time of injury;
• swelling in the damaged area;
• motor dysfunction. A person cannot bend or straighten a finger if the tendon of the finger is torn, cannot stand “on tiptoe” if the Achilles tendon is damaged, etc.;
• deformation or numbness of the limbs and fingers.

To confirm the diagnosis, doctors prescribe:

• x-ray (not always informative);
• Ultrasound;
• MRI.

Treatment for muscle pain

The CELT Pain Clinic uses modern methods for treating muscle pain, which allows you to effectively cope with the existing problem. First of all, it is aimed at eliminating its original source. Systemic therapy allows you to minimize (or even completely eliminate) pain. It involves the use of painkillers, non-steroidal anti-inflammatory drugs and opiates. Systemic therapy is combined with other treatment methods:

• exercise therapy;
• massage;
• electromyostimulation;
• physiological and manual therapy.

CELT specialists recommend the prevention of muscle pain, which consists of maintaining a healthy and active lifestyle, ergonomics of the workplace and eliminating bad habits.

Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

Driving directions

What to do if ligaments are damaged?

Do you suspect you have an injury? To avoid complications, consultation with a doctor is required. Before visiting him, in the first hours, the patient needs to be given first aid:

• ensuring complete rest of the injured joint:
• applying a tight bandage or elastic bandage;
• applying cold.

Due to the intense pain syndrome, the question immediately arises: what to take when a ligament is torn to avoid suffering? For unbearable pain, it is recommended to take painkillers in tablets or injections. Correct and timely adherence to simple rules will help avoid worsening the condition and make you feel better.