Tenosynovitis of the long head of the biceps tendon: causes, symptoms, diagnosis, treatment and recommendations

Biceps tendonitis is an inflammatory process localized in the tendon part of the muscle. Usually the process develops near the junction with the bone.

As a rule, tenosynovitis of the long head of the biceps develops at the beginning, then the process spreads beyond the tendon sheath. Many patients simultaneously develop tendinitis of the supraspinatus tendon.

The pathological process is accompanied by pain and dysfunction of the upper limb. With timely treatment, it is possible to relieve inflammation and restore hand function in the shortest possible time. In the absence of qualified medical care, a purulent process in the joint capsule may develop, and fibrous changes are also characteristic.

This leads to complete or partial dysfunction of the joint. Patients who promptly turned to traumatologist orthopedist A.S. Petrosyan, did not experience these complications because they received high-quality medical care, but in modern practice there are many examples of irreversible changes in the joint due to tendinitis.

Causes

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The active development of the disease is facilitated by infection of adjacent tissues or the penetration of pathogenic microflora into the tendon structure. In 80% of cases this occurs due to a puncture or other violation of the integrity of the tendons. Main routes of damage:

1. Existing infections, especially STIs (in 90% of cases of identified infectious tenosynovitis, the patient suffered from gonorrhea).
2. Physical trauma, after which the acquired acute infection is divided into monomicrobial and polymicrobial. Each of them progresses depending on the nature and extent of the damage.
3. Physiological aging process (common cause of patellar tenosynovitis).
4. Staphylococcus aureus migrating from the epidermis, with which the patient was previously infected.
5. Animal bite and subsequent suppuration of the bite wound.
6. Intravenous use of hard drugs (tenosynovitis of the long head of the biceps tendon is likely to occur).
7. Open damage to the skin, the surface of which was exposed to fresh or salt water with the presence of mycobacteria.

Any of the above methods leads to tenosynovitis. This includes situations where the patient has not completed the full course of treatment for rheumatoid or reactive arthritis.

Rehabilitation

Rehabilitation is required only after surgery for tenosynovitis of the shoulder joint. In most cases, the patient does not need rehabilitation measures.

Prevention and prognosis

Persistent monotonous movements and/or poor posture are often the cause of tenosynovitis. They are also central starting points for disease prevention. People who do a lot of computer work should make sure the keyboard is as flat as possible.

This relieves pressure from the wrist. It is also recommended to place a pillow in front of the keyboard. It is recommended to purchase an ergonomic mouse.

People who work on computers, musicians, massage therapists and others should pay attention to the variety of movements and take breaks more often.

Advice! It is not recommended to self-medicate with folk remedies, exercises or other alternative therapeutic measures.

If you have muscle or joint diseases (right or left shoulder, ankle, patella and others), you should consult a doctor. Sometimes surgery is required. If there is severe pain in the ligaments or joints (right or left), fever, swelling, you need to urgently call an ambulance, as this may indicate an infection.

Clinical example

Hello, my right shoulder hurts when I make sudden movements; when I stretch, the pain reaches my elbow. The pain is either pulsating or stretching. We had an ultrasound of the right shoulder joint. I am attaching the results. We have already seen a neurologist and prescribed a blockade and manual therapy. All this didn't help

Symptoms

An examination is enough for a doctor to make a preliminary diagnosis. And using diagnostic methods, the doctor confirms it, determining the nuances of the pathology.

Tenosynovitis of the tendon of the long head of the biceps brachii muscle is a stenotic disease that manifests itself as a specific pulling pain. In 9 out of 10 cases, the patient complains that an unpleasant sensation covers the shoulder and spreads along the front surface of the arm (along the biceps muscle). Palpation of the affected area gives a painful sensation: its localization is the groove between the tubercles of the humerus and in the direction below, where the tendon is even better accessible to palpation. Due to the pain, the patient has difficulty abducting his arm.

Tenosynovitis of the popliteus tendon is manifested by the following distinctive features:

Symptoms may be supplemented depending on the period of limitation of the lesion.

Stages and forms of the disease

There are acute and chronic forms of the disease. In acute cases, symptoms occur suddenly and the intensity of pain increases sharply. Limitation of range of motion in the joint progresses.

Chronic tendinitis develops gradually and the pain is usually mild. Over time, the joint loses mobility. Fibrous changes in the tendons and joint capsule develop. With calcific tendinitis, calcium salts are deposited in the affected area. Patients complain of constant aching pain, crunching when moving, and degenerative changes in the shoulder joint progress.

The acute form develops in three stages:

1. periodic pain when performing certain movements;
2. severe pain after physical activity;
3. severe pain of a constant nature or paroxysmal, which does not go away within several hours.

According to the localization of the pathological process, the following forms are distinguished:

• tendinitis - isolated inflammation of the tendon:
• tenosynovitis, tendovaginitis - involvement of the tendon sheath in the process;
• tendobursitis - spread of the pathological process to the mucous bursa;

Diagnostics

Diagnosis of tendon tenosynovitis is difficult only because of the premature prescription of antibacterial therapy, which 60% of doctors carry out even before the final diagnosis is made. Laboratory research regarding the pathology in question is of secondary importance.

Methods for identifying tendon pathology are as follows:

1. Laboratory research. In the blood, an increase in the content of leukocytes and an increase in ESR are established as indicators of an active inflammatory process.
2. X-ray examination. The main goal of the method is to confirm the presence of tenosynovitis and exclude the concomitant development of osteomyelitis, bursitis, and arthritis.
3. Ultrasound research. The method is informative and has advantages over MRI: low price, technical simplicity. Ultrasound does not involve the use of magnetic field energy. The procedure is safer for health and does not affect devices implanted inside the body (heart rate drivers). Ultrasound helps to study in detail the structures of tendons and ligaments, making it possible to differentiate tenosynovitis, including through the use of color Doppler mapping (CDC).
4. MRI. The method provides an image of the entire joint, including the capsule with the glenohumeral ligaments, the articular cartilage on the head of the humerus. The muscles and tendons surrounding the joint and the synovial bursae are also visualized.

MRI and ultrasound of the shoulder or knee joint are not interchangeable diagnostic methods. The implementation of each of them involves specific goals and objectives.

What is Achilles tendinitis?

The Achilles tendon is considered one of the densest formations in our body. With the participation of this ligament, the heel is raised and pushed off the surface with the fingers.

When using unsuitable shoes, while moving on an inclined surface, or jogging, significant loads are placed on the heel tendon, which causes frequent injury.

In addition, a load of identical force can reduce the strength of this ligament and provoke the appearance of dystrophic disorders. All kinds of changes in conductivity can also lead to tissue dehydration, slowdown of metabolic processes and salt deposition.

As a result of the above processes, the tendon's resistance to micro-tears that occur during sudden changes in body position and stretching is significantly reduced.

People in the middle age group (over 35 years old) are susceptible to similar degenerative processes. However, in people who daily engage in strenuous physical work and athletes, such manifestations can occur much more often, which is due to regular overload and premature aging of tissue in the tendon area.

According to experts, it is precisely those who engage in active sports training and do not pay enough attention and time to the recovery period that develop Achilles tendinitis. A similar situation can manifest itself when carrying out excessive loads without going through the preparatory stage.

As a result, the muscle stretches weakly, inflammatory processes appear, and damage appears in the ligament area. This is accompanied by acute pain during physical activity.

If a person does not visit a specialist in a timely manner and does not begin treatment procedures, this may provoke a tendon rupture in the future.

In some situations, damage may be mechanical. But the most common is tendinitis of the Achilles tendon, which is accompanied by the appearance of inflammatory foci.

If Achilles tendonitis is of a similar nature, then treatment is carried out with the use of anti-inflammatory drugs. In case of mechanical damage, long-term therapy and special exercises are required until the ligament tissue is fully restored.

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Treatment

Delay in going to the hospital does not promise a positive prognosis - the disease progresses to an even more aggravated stage. Then the patient loses the opportunity to even self-care, and there is no need to talk about the implementation of work activity. One of the options for wasting time is the desire to normalize health using unofficial methods. Traditional medicine does not contain a single recipe that can restore the tendon-ligament apparatus. And patients taking decoctions and applying compresses to the body waste time, increasing the risk of developing disability.

Conservative

If the diagnostic results confirm that the existing disorder is tenosynovitis of the long head of the biceps tendon, treatment with conservative methods involves the following:

To implement hormonal treatment, drugs from the glucocorticoid group are used - Dexamethasone and Prednisolone.

Injection of hormonal drugs, especially in chronic processes, does not provide a complete cure, increases the rate of collagen degradation, and negatively affects the production of new collagen (reduces its synthesis by 3 times).

The doctor expands general prescriptions with the active use of immunomodulatory agents and vitamin therapy.

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During conservative therapy, it is important not to load the affected joint; for this purpose, immobilization is performed with an orthosis. Local application of ointments is recommended: Nise, Dolobene, Ketonal.

Physiotherapy

Physiotherapeutic methods help normalize blood circulation, relieve or minimize pain, and improve metabolic processes in the affected area. Procedures that are advisable to prescribe if tenosynovitis of the biceps brachii tendon, popliteal fossa or other part is confirmed include magnetic therapy; laser therapy; applying thermal applications. The use of electrophoresis with novocaine will improve limb abduction and reduce pain.

Recently, radon baths have been actively used.

After the documented recognition of the safety of radon in the treatment of joint pathologies, interest in this gas is growing. The element’s demand is explained by its unique therapeutic capabilities.

Radon is an inert gas that is colorless and odorless. It is 7.5 times heavier than air, has 3 isotopes, the most important of which is 222 Yal with a half-life of 3.82 days.

Before performing radon baths, the doctor makes sure that the patient has no contraindications to the medical technology:

Among them:

1. Fever of unknown origin.
2. Oncological processes (confirmed) – the presence of malignant neoplasms, benign tumors that have a tendency to grow.
3. All blood diseases.
4. Heart rhythm disturbances (atrial fibrillation, extrasystole).
5. Psycho-emotional disorders (epilepsy, neuroses, schizophrenia).
6. Previous large-focal or multiple small-focal cerebral infarction.
7. Professional activities associated with prolonged exposure to radioactive or electromagnetic radiation.
8. The period of pregnancy and breastfeeding.
9. Violation of the functional activity of the thyroid gland, high predisposition to its hyperfunction.
10. Condition on the eve of surgery.
11. Severe gynecological conditions - fibrocystic mastopathy, uterine fibroids, fibroids, adenomyosis, endometriosis.
12. In men - prostate adenoma.
13. Cholelithiasis.
14. The presence of stones in any segment of the urinary system.
15. Confirmed retinal detachment.
16. The presence of defects on the skin, areas of weeping dermatitis, pathologies of fungal origin.
17. Confirmed osteoporosis.

To determine the radon concentration for the procedure, the doctor is guided by the dominant pain manifestations. Dry air baths and traditional water baths are performed. The effect of the procedure is improved blood supply to the tissues adjacent to the joint; high probability of long-term pain relief (in 90% of cases).

Anton Epifanov about physiotherapy:

Surgery

Surgical intervention is performed in extreme cases when it is not possible to restore the limb using conservative methods. Surgical treatment is aggravated by the patient's age over 45 years, the presence of insulin-dependent diabetes mellitus, and if the etiology of tenosynovitis is the progression of a polymicrobial infection.

Tendon plastic surgery is a multi-stage, delicate operation. It involves subsequent long-term recovery and has a high price.

The introduction of antibiotics a day before surgery and active intraoperative antibiotic therapy help eliminate the risk of complications in the postoperative period.

Features of anesthesia during surgery for tendon tenosynovitis:

• in the choice of anesthesia, the short duration of the intervention, the absence of the need for deep relaxation, and the presence of adequate hemostatic measures are important;
• modern medications provide adequate pain relief without threatening the patient’s life;
• A common complication after surgery is short-term post-anesthesia depression. It provides the possibility of early transfer of the patient from the ICU (intensive care ward) with patient activation;
• The depth of immersion in anesthesia is ensured by narcotic analgesics. In clinics with high financial support, they practice the most successful combination for anesthesia during short operations - Diprivan + narcotic analgesics (in 68% of cases). But the high cost of Diprivan limits its use in clinical practice. Hospitals with less funding use Ketamine for anesthesia. Its difference from Diprivan is specific: as patients recover from anesthesia, they need sedative therapy (carried out in standard dosages). It is important for the specialist to monitor the main vital signs - they must be stable throughout the entire surgical intervention.
• In 23.3% of cases, barbiturates were used for anesthesia, mainly sodium thiopental in standard dosages. If the depth of anesthesia was sufficient, “controllability” of anesthesia causes certain difficulties. Long-term post-anesthesia depression is possible, requiring constant monitoring of the patient.

The prognosis for recovery is favorable (subject to early seeking of medical help). However, the patient should prepare: full recovery will take 3-4 months.

Preventive actions

To prevent the development of calcific tendinitis of the Achilles tendon, the following principles should be adhered to:

• If you are advised to exercise for Achilles tendonitis, the load should be increased gradually;
• Warming up the tendons and muscles is a must before performing any physical exercise;
• For daily use and sports activities, you should choose the right shoes;
• If pain occurs, you must stop training.

Achilles tendonitis, as evidenced by reviews, is easily treatable, but only if it is carried out at the initial stage of the disease. In advanced forms, severe consequences such as chronic Achilles tendinitis or tendon rupture can occur. To achieve a positive result, it is necessary to use a set of procedures aimed at ensuring immobility of the affected area, as well as achieving the necessary analgesic and anti-inflammatory effect.