What is tenosynovitis
Tenosynovitis of the ankle joint is a disease characterized by an acute inflammatory process. In this case, the synovial membrane of the human muscle tendon is affected.
This pathology requires urgent treatment, since otherwise it can lead to the development of serious consequences. Of particular danger is the septic type of tenosynovitis, which is accompanied by a high rate of spread of the inflammatory process to the entire affected limb.
Complications of tendovaginitis can be different. This will largely depend on the root cause of the disease, the degree of neglect of the lesions and the timeliness of the treatment started.
With proper therapy, a person will experience only a temporary loss of motor functions of the joint, whereas with advanced pathology, the patient may develop lifelong contractures and even sepsis.
Worth knowing! A distinctive feature of tenosynovitis is that most often it develops in representatives of those professions whose activities are closely related to the daily repeated repetition of monotonous movements.
Causes
Tenosynovitis of the ankle joint can occur as an independent disease or develop as a complication after an injury.
The disease is often provoked by reactive arthritis, rheumatic lesions, and increased physical activity on the legs. Improper metabolism, poor circulation, tuberculosis and household injuries can also contribute to tenosynovitis.
The inflammatory process with tendovaginitis can develop within 2-3 weeks after the tendon is damaged.
Physiotherapeutic procedures
Glucocorticosteroids, NSAIDs, and anesthetics are used during the electrophoresis procedure. Under the influence of electric current pulses, molecules of medicinal substances penetrate directly into the inflamed tendon. This allows you to create a high concentration of active ingredients in damaged tissues. At the final stage of treatment for tenosynovitis and during the rehabilitation period, electrophoresis with chondroprotectors is performed. These drugs accelerate cell division, stimulating the restoration of the tendon sheath and increasing the functional activity of the ankle.
Electrophoresis for reconstruction of the ankle joint.
Other physiotherapeutic procedures are also used in the treatment of the disease:
- UHF therapy;
- laser therapy;
- magnetotherapy.
It is practiced to apply ozokerite and (or) paraffin applications to the ankle area. The mechanism of treatment procedures is to increase the temperature in the foci of pathology, leading to an acceleration of metabolism and tissue regeneration.
Applications of ozokerite to a sore joint.
It is not advisable to use folk remedies in the treatment of tenosynovitis. They do not contain ingredients that have the ability to relieve inflammation or destroy pathogenic microorganisms. The only way to prevent the development of complications and avoid the occurrence of contractures is to contact an orthopedist when the first symptoms of a dangerous pathology appear.
Characteristic symptoms
Characteristic symptoms of ankle tenosynovitis are:
- Soreness. The nature of the pain will be sharp and throbbing. When you try to move the joint, the pain can intensify even more, causing the person suffering.
- Edema. It occurs due to the dilation of blood vessels and the entry of blood into them from the inflamed area. Swelling in this condition will be very pronounced. Sometimes patients also experience skin separation in areas of small cracks. The swelling spreads very quickly.
- Redness of the skin. This symptom is observed due to the dilation of blood vessels in the area of inflammation. Redness appears clearly in the shape of the tendon, after which it gradually spreads to nearby tissues. Also, upon palpation, the area of redness may produce a slight crunching sound.
- General deterioration of condition. With developing tendovaginitis, the patient may experience high body temperature, weakness, sweating, and decreased appetite. In more advanced cases (with infection and purulent inflammation), there may be vomiting, pallor, and fever.
- Impaired motor functions of the joint. Thus, if the flexor tendon is affected, the joint will not be able to bend. If the extensor muscles are inflamed, the joint will be difficult to straighten.
Inflammation of the foot muscles - tenosynovitis: signs, diagnosis, treatment
An abscess of the inner epidermis of the connective fibers of the foot, which are located on the side of the sole and the back of the foot, is called tenosynovitis of the foot. In medical practice there are two types: primary and secondary. The main one occurs in both amateur and first-class athletes, while the minor one is observed due to the occurrence of sepsis (from suppuration or an infectious disease) or from existing diseases of a rheumatic nature.
Etiology
The main reason for the occurrence of the inflammatory process in its primary form is minor trauma to the connective tissues of the feet, which can occur from excessive stress or as a result of the anatomical features of the body. The first category of tenosynovitis includes people with curvature of the legs, congenital or acquired, dancers, ballet actors, loaders, as well as those involved in skating and skiing.
Aggravated inflammation can occur as a result of contact with an infected area or through blood (purulent arthritis of the foot
, purulent-necrotic process). Tenosynovitis of the foot can develop to chronic if a person has any of the infectious diseases - gonorrhea, influenza, brucellosis or syphilis.
If a person suffers from diseases of a rheumatic nature (ankylosing spondylitis, rheumatoid arthritis
, Fissenger-Leroy syndrome), the duration of tenosynovitis of the foot is determined by the immediate intoxication of the body.
Typology
Based on the causes of tendovaginitis, modern medicine has identified several subtypes:
- non-infectious (professional);
- infectious (standard and non-standard);
- chronic;
- acute and inflammatory;
- pleural and pleural-croupous.
In addition to this classification, the disease is also divided according to the forms of development of inflammatory processes within connective tissues:
- Early or inconspicuous form. It implies primary inflammation of tissues in which there are already small accumulations of blood;
- Exudative form. A large amount of liquid is already collected in the connecting case. A slight swelling at the site of injury is visually detected;
- Long-term aseptic form. The area around the damaged tendons begins to become overgrown with dense connective tissue. Tendons become less mobile.
Signs of tenosynovitis
- Painful sensations with any movement of the foot. Unbearable pain at the site of inflammation of the tendon. If the disease is prolonged and purulent masses are already accumulating in places, the pain will be throbbing.
- Redness of the skin. Dilated vessels at the site of inflammation give this visual picture.
- Local increase in temperature. The site of inflammation is hot due to the large influx of blood in a short period of time.
- The foot is swelling. The vessels stretch, accordingly, become thinner and leak - the fluid comes out into the subcutaneous area. The swelling grows very quickly. Skin injury may occur due to sudden stretching.
- A person cannot fully move his foot.
- With purulent inflammation, intoxication of the whole body occurs, the patient experiences nausea, lethargy, and headache.
- When you press on the damaged area, a soft crunching sound is heard.
There is a possibility of the acute form of inflammation turning into chronic. This means that the person will be tormented by painful sensations and will not be able to walk normally. A superficial examination shows tensile neoplasms; in some cases, small compactions, the so-called “rice bodies,” are palpable. They are often found in tuberculous tendovaginitis.
How to diagnose
If you suspect a disease, you should consult an orthopedic doctor. He can give a referral to a surgeon or rheumatologist.
To make a diagnosis, the doctor needs to perform some manipulations:
- palpate the site of suspected inflammation;
- take a blood draw. If inflammation is present and suppuration has already begun, the analysis will show an increase in ESR and an increase in the number of neutrophils;
- prescribe x-rays and MRIs to determine the presence or absence of pathologies of joints and bones;
- take a sample of inflammatory tissue, as well as a sample of periarticular fluid.
Prescribed treatment for tenosynovitis
If the disease has just manifested itself, the patient is advised to rest. In the acute period, the patient is contraindicated to walk; the limb is fixed with an elastic bandage or splint and is in a suspended state. Immunostimulating and antibacterial drugs are also prescribed.
When the causes of acute inflammation are eliminated, procedures with UV rays, electrophoresis with hydrocortisone, physical therapy, and ultrasound are prescribed.
If acute purulent inflammation is detected, an urgent operation is performed, the tendon is opened, and it is drained. In this case, antibiotics are prescribed to suppress the infectious agent.
If the inflammation began against the background of tuberculosis or syphilis, then the primary task is to get rid of the main infection with the help of anti-tuberculosis drugs (streptomycin, PAS).
In the case of a chronic course of the disease, the same methods are used as indicated above - exercise therapy, massage, electrophoresis with lidase, paraffin.
The patient is also prescribed non-steroidal anti-inflammatory drugs and injections into the affected area. In extreme cases, X-rays are used as therapy. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Types of disease
Tenosynovitis can be acute or chronic. Each form of this disease is characterized by its own symptoms and characteristics.
Acute tenosynovitis usually develops after a joint injury or infection. The disease is accompanied by pronounced symptoms, acute pain and a rapidly developing inflammatory process.
The chronic form of this disease occurs after acute tendovaginitis, which has not been completely cured. Repeated joint trauma can also contribute to this type of pathology.
Chronic tendovaginitis is characterized by a wave-like course with periods of exacerbations and improvements in the patient’s condition.
In this condition, for several months or even years, the patient may suffer from prolonged aching pain, redness and swelling of the affected joint. A translucent fluid will constantly accumulate around his tendon.
Depending on the fluids that fill the tendon, tenosynovitis can be serous, hemorrhagic, fibrous and purulent.
The most severe form of the disease is considered to be purulent tenosynovitis. It occurs after infection. The pathology is accompanied by rapid damage to healthy tissues.
Diagnostics
To establish a diagnosis of ankle tenosynovitis, you should initially conduct a visual examination of the area of inflammation. During palpation, the doctor will clearly see swelling, stiffness in the joint, and acute pain in the patient.
In order to distinguish this disease from arthritis, a person should undergo an x-ray. To accurately track the nature of tendon inflammation, MRI is used.
A correctly established diagnosis allows you to successfully select treatment. Otherwise, a person will only waste precious time. At the same time, it is worth differentiating tenosynovitis from other common joint lesions that may have similar symptoms.
In laboratory tests of such patients, the level of leukocytes and ESR are always elevated, which indicates an acute spreading inflammatory process.
Tendonitis in pregnant women and its features
This disease is a frequent “guest” of women who are expecting a child. If there are suspicions, then it is preferable not to do an x-ray or computed tomography during the examination. Any medications that a pregnant woman will take must be prescribed by the attending physician and also agreed with the gynecologist. In this case, self-medication will be dangerous not only for the patient, but also for her unborn child.
When the first symptoms of tendinitis appear, doctors advise limiting yourself to physical therapy, rest, and applying cold compresses to the affected area. If you need to relieve inflammation and reduce pain, ointments based on painkillers are prescribed.
If the problem enters an acute phase, the doctor may resort to immobilization of the joint. Antibiotics may be prescribed, but only if a bacterial infection is found and other treatments have been ineffective. In the most extreme cases, surgery is performed on the joint.
Treatment
Treatment of tendovaginitis can be carried out both on an outpatient basis and in a hospital setting. Therapy is selected for each patient individually, depending on the causes, symptoms and degree of neglect of the pathology.
Traditional treatment includes the following medications:
- anti-inflammatory drugs (Nimesulide);
- antibiotics (Ceftriaxone);
- analgesics (Noshpa).
Additional medications can only be prescribed by the attending physician.
If fluid accumulates in the joint cavity, the patient requires a puncture. If tenosynovitis is accompanied by an infection and accumulation of pus, the person needs to undergo surgery.
Important! Treatment of ankle tenosynovitis should be carried out under the close supervision of the attending physician. Practicing uncontrolled therapy with the help of healers or untested folk remedies is extremely dangerous. All your actions must be coordinated with your doctor to prevent complications.
Shock wave therapy treatment
If tenosynovitis is not severely advanced, shock wave therapy can be used to treat it. This technique works through the impact of targeted acoustic waves at a specific frequency.
The benefits of using shock wave therapy are:
- effective non-surgical treatment;
- rapid pain relief;
- treatment without the use of medications;
- speed of the procedure (no more than 20 minutes);
- high efficiency;
- no pain during the procedure;
- low risk of side effects.
Tenosynovitis is a serious disease that requires carefully selected treatment. At the first suspicion of such a lesion, you should immediately contact a doctor before the disease causes dangerous complications.
Drug therapeutic methods
Prescribing drugs from the group of non-steroidal anti-inflammatory drugs (drugs based on diclofenac and nimesulide) - these substances slow down the rate of synthesis of inflammatory mediators; they can be used in tablet or injection form or topically in the form of ointments and gels.
Hormonal-based anti-inflammatory drugs (dexamethasone) have a more pronounced anti-inflammatory effect and are taken orally according to a specific schedule for 7-14 days.
Antibiotic therapy - in severe cases of aseptic and nonspecific infectious tendovaginitis, broad-spectrum drugs are used, and in case of a specific form of the disease, individual selection of the drug is necessary.