Tenosynovitis: treatment and symptoms of crepitant tenosynovitis, wrist joint

General information

Tenosynovitis is a disease whose characteristic feature is an inflammatory process of the tendon and tendon sheath, the so-called tendon sheath.
Tendon sheaths are the tubes around them made of connective tissue. They are filled with lubricating fluid, which reduces friction during movement. The tendons are covered by a thin membrane. When it becomes inflamed or changes in structure due to constant strong tension, nagging pain develops in the projection of the tendon. Speaking about what kind of disease this is, it should be noted that most often such lesions occur in the tendons of the wrist. But a similar pathology can develop in any of the tendons if they pass into the vagina. Tenosynovitis is characterized by a prolonged pain syndrome, which significantly worsens a person’s quality of life and prevents him from playing sports and any active activities. The ICD-10 code is M65 (synovitis and tenosynovitis).

With timely diagnosis and prevention of the influence of provoking factors, it is possible to prevent the disease from becoming chronic. How exactly the disease manifests itself, why it develops, and what treatment should be, you can learn from this article.

Treatment of infectious tenosynovitis

In the early stages (serous) of infectious tenosynovitis the following is carried out:

physiotherapy
immobilization
antibacterial therapy

For purulent tenosynovitis, surgical treatment is indicated, since there may be breakthroughs of pus outward with the formation of fistulas, as well as purulent damage to nearby joints and bones, involvement of muscle tendons in the inflammatory process with the subsequent formation of contracture (lack of ability to flex and extend in the joint).

Prevention of infectious tendovaginitis - timely treatment of microtraumas of the hand and foot, early and radical treatment of panaritium.

Pathogenesis

In the body, a tendon connects bones to each other or bones and muscles. The tendon is covered on top by connective tissue, and inside it is covered by a synovial membrane. It releases lubricant to ensure better gliding and movement of the limbs. With the development of inflammation, this process is disrupted. Sliding worsens, resulting in pain.

Inflammation is provoked by pathogenic microorganisms, in response to which leukocytes . Due to the formation of pus, the inflamed area swells and its sensitivity increases. This leads to compression of the tendon, blocking its mobility, and decreased motor activity.

Tenosynovitis

The inflammatory process most often develops in the tendons of the forearm, wrist joint, hand, foot, and ankle. If treatment is not carried out and the person continues to load the tendon, the disease progresses. As a result, degeneration of the tendon sheaths occurs, which leads to a decrease in motor activity.

Treatment of crepitating tenosynovitis

Elimination of swelling, inflammation, pain, and restoration of range of motion in the wrist joint with tendovaginitis is accelerated by the use of physiotherapy.
Treatment for crepitating tenosynovitis includes:

immobilization of the hand or fingers
physiotherapy (ultrasound with hydrocortisone, magnetic laser)
physical therapy

Elimination of swelling, inflammation, pain, and restoration of range of motion in the ankle joint with tendovaginitis is accelerated by the use of physiotherapy.

If crepitant tenosynovitis is treated late or is insufficiently treated, it may relapse with the development of joint stiffness or contracture of the affected joint.

There are contraindications. Read the instructions or consult a specialist.

Classification

There are several different types of tenosynovitis. Taking into account the origin of the disease, they bottle:

Infectious – develops under the influence of pathogens. As a rule, infectious agents penetrate the tendon sheaths through microcracks and wounds.
Aseptic – develops as a consequence of degenerative changes, prolonged monotonous loads. It can be caused by injury, as a result of which normal blood flow is disrupted and an inflammatory process occurs. Typically, this type of disease affects the thickest and longest tendons.

In turn, infectious tenosynovitis is divided into:

Specific – develops as a result of the influence of specific pathogens ( tuberculosis , syphilis , etc.) The disease often develops in patients with osteomyelitis .
Nonspecific - it is provoked by pyogenic microorganisms . The inflammatory process can be triggered by a pathogen entering through wounds, a splinter.

The aseptic form of the disease is divided into the following types:

reactive;
post-traumatic;
professional.

Depending on the nature of the inflammation:

Purulent
Serous.
Serous-fibrinous.

Depending on clinical signs:

Spicy
Chronic.

Causes

Factors that can provoke the disease are the following:

Heavy physical activity associated with joint overload.
Microtraumas of tendons.
A bruise received when a person falls on a sharply extended or bent limb.
Rheumatic joint damage, in which toxic reactive inflammation occurs.
Infection of tendons and their sheaths with phlegmon , osteomyelitis , infectious arthritis .
Penetration of pathogens into joint structures through the bloodstream. A similar thing happens with gonorrhea , tuberculosis and other infectious diseases.

Independent aseptic tendovaginitis (occupational) develops as a consequence of prolonged microtraumatization and constant tension of the tendon sheaths in people of certain professions. This can happen to loaders, pianists and representatives of other professions who are forced to perform the same type of movements for a long time using a limited group of muscles. This is also common for people who play certain sports (skiers, speed skaters) if they train too hard.

Causes of tenosynovitis

Tenosynovitis can be either an independent disease (primary tenosynovitis ) or secondary - as a complication of any process of a specific or infectious nature.

Infectious tenosynovitis occurs as a result of infection entering the tendon sheath due to wounds and microtraumas, purulent inflammation of surrounding tissues. Infectious tendovaginitis (nonspecific purulent tendovaginitis or specific - tuberculosis, brucellosis) is quite rare.

The most common non-infectious (aseptic) tendovaginitis is crepitating, stenotic.

The cause of non-infectious (aseptic) tenosynovitis is most often excessive stress on the tendons. tenosynovitis develops . This is usually associated with the patient’s professional activities or sports activities, which is why such tenosynovitis is called professional. There is also post-traumatic tenosynovitis , which is also most often observed in athletes, although household trauma may well lead to its appearance.

Tenosynovitis can also be degenerative in nature - if it is associated with circulatory disorders of adjacent tissues (for example, with varicose veins). The cause of degenerative tendovaginitis is a violation of the blood supply to the periarticular tissues, leading to degenerative changes in the synovium of the tendon sheath.

Symptoms of tenosynovitis

The symptoms of this disease depend on its type.

Acute nonspecific tendovaginitis develops sharply. Swelling develops very quickly at the site of the lesion. Most often, this type of disease affects the tendons on the dorsum of the hand and foot. Less commonly, such a pathology develops in the synovial sheaths of the fingers and flexor tendons of the fingers. The swelling gradually spreads from the hand to the forearm, and from the foot to the lower leg. Flexion contracture of the fingers may develop, and movements are limited. chills , regional lymphadenitis and lymphangitis develop . Most often, the purulent form of the disease develops in the area of the sheath of the flexor tendons of the hand.
Acute aseptic (crepitating) tenosynovitis , as a rule, affects the synovial vagina on the dorsum of the hand. In more rare cases, the foot is affected; even less often, the intertubercular synovial sheath of the biceps is affected. Crepitant tendovaginitis of the forearm and other areas begins acutely. A swelling forms in the area of the affected tendon, and when you feel it, you can feel crepitus, that is, a crunching sound. Finger movement is limited or pain occurs when moving. The disease can become chronic over time.
Tenosynovitis of the wrist joint leads to damage to the tendon in the wrist area. In case of an illness of infectious origin, a person is bothered by severe throbbing or twitching pain, swelling, and redness. The temperature rises, joint movements are limited. If treatment is not carried out, the fever may increase and a feeling of body aches may appear. With the aseptic form of the disease, pain, a feeling of crepitus, and slight swelling are noted.
of tenosynovitis of the knee joint appear similarly , affecting the corresponding tendons.
Tenosynovitis of the ankle joint most often manifests itself as swelling and pain during movement. Like lesions in other areas, tenosynovitis of the ankle joint can lead to increased temperature and enlarged lymph nodes. The appearance of a cracking sound when moving is typical if we are talking about the crepitating form. With the purulent form of the disease, the symptoms are more pronounced.
In the chronic form of the disease, the sheaths of the flexor and extensor tendons of the fingers in the area of their retinaculum are affected. Often chronic tendovaginitis affects the common synovial sheath of the digital flexors. This condition is called carpal tunnel syndrome, in which an elongated tumor is identified in the carpal tunnel area, causing pain. The tumor is elastic, often taking on an hourglass shape. Sometimes “rice bodies” are felt in the formation or fluctuation is determined (a sensation of a transmission wave manifested due to the accumulation of fluid). With this condition, tendon movement is limited.
Stenosing (de Quervain's tenosynovitis) is a chronic form of the disease that affects the sheath of the extensor brevis and abductor pollicis longus tendons. With this form of the disease, the walls of the vagina thicken, as a result of which its cavity narrows. The patient complains of pain in the place where the styloid process of the radius is located, and swelling develops in the same place. The pain may radiate to the elbow or the first finger of the hand. If the patient presses the thumb to the palm and bends the other fingers over it, the pain becomes stronger. If at the same time the hand is retracted towards the elbow, then sharp pain is noted. On palpation, swelling with severe pain is noted.
Tuberculous tenosynovitis - leads to the development of dense formations along the tendon sheaths. Such formations are determined by palpation.

Tenosynovitis

Tenosynovitis

is a muscle tendon disease in which the inflammatory process is localized on the inner surface of the fibrous tendon sheath. This disease requires special attention, since many patients ignore unpleasant sensations, provoking the transition of the subacute stage to the chronic stage, which is not only difficult to treat, but can provoke an expansion of the localization of inflammatory processes and a transition to other tissues.

ETIOLOGY AND PATHOGENESIS

Tenosynovitis can occur as an independent disease, or as a provoked inflammatory process of the inner side of the tendon sheath against the background of the underlying disease. In the first case, as a rule, aseptic (crepitating tenosynovitis) is considered. In the second case - infectious (specific and nonspecific).

Aseptic tenosynovitis

in most cases it occurs as a result of microtrauma in connection with professional activities or excessively intense sports. This is due to the performance of the same type of movements using a limited group of muscles, resulting in improper distribution of the load. The risk group includes the following categories of citizens: loaders (tenosynovitis of the forearm), computer workers (tenosynovitis of the hand), skiers, weightlifters, speed skaters (tenosynovitis of the foot) and so on.

Infectious tenosynovitis

may be triggered by the presence of a purulent focus of the underlying disease in the immediate vicinity of the muscle tendon. Non-specific development and course is observed in the presence of osteomyelitis, acute purulent arthritis, and so on.

FLOW

In the case of the development of an independent disease before the onset of the acute period, the incubation period of the course may be minimal (2 - 3 hours). Although in most cases the subacute course is preceded by pronounced crepitus (crunching in the affected area), to which the patient often does not pay attention. After the crunch, a painful swelling occurs at the site of the lesion and weakness in the limb with the inability to continue with the usual work or sports activities, which is what they usually come for the first examination with.

Infectious tenosynovitis is characterized by a sharp rush of blood to the lesion and a subacute course of the inflammatory process. A painful swelling forms against the background of general inflammation, expressed by chills and increased body temperature. If the treatment of tenosynovitis is not implemented in a timely manner, this symptomatology is added to the reduction of the fingers of the limbs and severe convulsive syndrome. In the most complex and advanced cases, compression of blood vessels and necrosis of adjacent tissues is possible, followed by the development of septic infection.

SYMPTOMATICS

For the convenience of the reader, the symptoms of tenosynovitis will be discussed punctually in the order of their typical occurrence.

ASEPTICA (CREPITATING) Tenosynovitis

Nonspecific mild pain in the area of the feet, forearm, hands, and less commonly in the area of the fingers.
Crepitation in the area of the affected area.
Redness and swelling; in some cases, visual subcutaneous bruising is noted.
Weakness of the limbs with loss of ability to work.
Manifestation of periodic pain syndrome of a pulling, sometimes piercing nature.
Contraction of the affected area and limb spasms that occur in the subacute period.

Infectious tenosynovitis.

The presence of an underlying disease, which provokes tenosynovitis.
Redness and swelling of the affected area.
Severe pain that worsens with physical activity.
Chills and significant increase in body temperature.
Limb spasms.
Pinching of blood vessels with the possibility of necrotic areas of tissue.

RECOGNITION (DIAGNOSTICS)

Before starting treatment for tendon tenosynovitis, it is necessary to differentiate the aseptic course from the infectious one. The initial examination involves visual diagnosis (the swelling is usually oblong) and palpation of the affected area (pain increases with palpation). Subsequently, a test for crepitus is carried out. The final stage of recognition is the appointment of tests for the presence of the underlying disease.

TREATMENT

Treatment of tendovaginitis directly depends on the type of disease and its symptoms.

We, in Kaluga, at the Pain Clinic adhere to the following treatment regimen:

The most adequate treatment methods are the following classification: acute aseptic tendovaginitis, acute infectious tendovaginitis, chronic tendovaginitis of both types (often manifests itself as de Quervain’s disease, which can be seen in more detail in the video at the bottom of the article).

Acute aseptic tenosynovitis

The affected tendon is immobilized by securing a plaster splint.
The inflammatory process is stopped by oral use of general-spectrum anti-inflammatory drugs (aspirin, butadione, etc.), physiotherapeutic procedures using novocaine blockades to reduce pain and local applications (dimexide, ozokerite, etc.).
After the acute course of the disease has resolved, supportive physical therapy (ultrasound, microwaves, etc.) is used.
In the future, home physiotherapeutic procedures are used using mud applications with a high iodine content.

Acute infectious tenosynovitis

In the case of a purulent course of the disease, immediate opening and drainage of the muscle tendon sheath is required.
Treatment of the underlying disease.
The use of antibiotics and antiseptics of a general spectrum of action.
Relief of the inflammatory process.
Supportive physiotherapy. If pain persists, novocaine blockades are used.

Chronic tenosynovitis

Antibiotic therapy using general-spectrum drugs with a course of treatment of at least two weeks.
The use of non-steroidal drugs to relieve inflammatory processes. As a rule, hydrocortisone is prescribed, which can be supplemented with novocaine in the presence of pain.
Use of paraffin applications.
Massage the affected area. It is most effective in the treatment of tenosynovitis of the hands.
Physical therapy, which consists of a gradual increase in physical activity and its correct distribution.

In general, tendon tenosynovitis has a very favorable prognosis when treated.

If your arm hurts in the forearm area, then you need to make an appointment with an orthopedist by phone or through the online appointment system on the website.

Tests and diagnostics

During the diagnostic process, the doctor pays attention to the characteristic localization of the pathological manifestation, the patient’s complaints, as well as data obtained during the clinical examination.

If tenosynovitis is suspected, a general blood test is performed. In patients leukocytosis and increased ESR .

A bacterioscopic examination of pus is also carried out (microscopic examination after special staining) or bacteriological examination (isolation of a pure culture on nutrient media). This allows you to determine sensitivity to antibiotics .

An X-ray examination is recommended, which can determine the presence of soft tissue thickening in the affected area.

If necessary, other studies are prescribed.

Treatment of tendovaginitis

The main thing with tendovaginitis is timely consultation with a doctor and proper treatment. The therapeutic anti-inflammatory patch NANOPLAST forte can provide effective assistance in the fight against this unpleasant disease.

Treatment of acute tenosynovitis

Treatment of acute tendovaginitis is divided into general and local.

With infectious tendovaginitis , first of all, it is necessary to stop the development of the infectious process, for which various antibacterial agents are used, as well as drugs that strengthen the body's defenses. For acute non-infectious tenosynovitis, non-steroidal anti-inflammatory drugs are used. In case of a purulent process, an urgent opening and drainage of the tendon sheath is performed to remove purulent exudate. It is necessary to ensure rest and fixation of the limb.

After the acute effects of tendovaginitis , warm compresses, physiotherapeutic procedures (microwave therapy, ultrasound, UHF, ultraviolet rays) and physical therapy are prescribed.

At this stage of treatment of tenosynovitis, the use of a modern innovative drug is effective - the therapeutic pain-relieving anti-inflammatory patch NANOPLAST forte.

A course of use of NANOPLAST forte in the treatment of tenosynovitis allows you to reduce the dosage of anti-inflammatory and painkillers, provide deep heating of the affected area, reduce inflammation and speed up recovery.

Chronic tenosynovitis

In case of exacerbation of chronic tendovaginitis , rest and warming up are recommended first of all. If necessary, anti-inflammatory and painkillers are prescribed.

is effective and convenient in the treatment of chronic tendovaginitis . Gentle heat and the therapeutic effect of a magnetic field relieve inflammation and swelling during tendovaginitis , improve blood circulation in the affected area, and promote the restoration of damaged tissues.

Treatment with folk remedies

Traditional methods are used for this disease as an auxiliary treatment, which can slightly alleviate the patient’s condition. However, such methods cannot under any circumstances replace the main therapy. Before using any folk remedy, you should consult a doctor about this.

Calendula ointment . It can be prepared using Vaseline, for which fresh calendula flowers along with the stems are crushed and mixed with the base. This ointment is used daily to lubricate the sore spot.
Compress made of olive oil and wormwood . The oil is heated and a little dry wormwood powder is added to it. After mixing, the product is applied warm to the affected area and left for an hour.
Salt for warming . It is heated in a frying pan and poured into a cloth bag. This warming agent is kept on the affected area for 15-20 minutes.
Compress of vodka and honey . This remedy is suitable only for the chronic form of the disease. Vodka is mixed with honey in equal proportions and applied to the affected area.
Ointment with propolis . It is prepared from baby cream and alcohol tincture of propolis. You need to mix 1 teaspoon of cream with 10 drops of tincture. This remedy is applied to the affected area daily for two weeks.

Prevention

To prevent the development of the disease, the following rules of prevention must be observed:

Lead an active and healthy lifestyle.
Treat all infectious diseases in a timely manner and prevent diseases from becoming chronic.
To prevent occupational tendovaginitis, it is necessary to adhere to a rest and work regime, be sure to take regular breaks from work and carry out high-quality warm-ups.
It is important to avoid activities that pose a risk of injury. If a wound has been received, the affected area should be thoroughly disinfected to prevent infection.
Do not overload the ankle and be sure to take breaks when practicing long-term loads.
Important rules of personal hygiene should not be ignored.

Diet

Diet for sore joints

Efficacy: therapeutic effect after 2-3 months
Terms: 2-6 months
Cost of products: 1700-1800 rubles. in Week

During the period of illness and recovery after it, the diet should be such as to strengthen the tendons. For this purpose, it is recommended to introduce the following products into the diet:

beef;
jelly and jellied meat;
jellied fish;
dishes containing gelatin;
liver;
dairy products;
apricots, citrus fruits;
nuts;
Bell pepper.

It is recommended to drink green tea with ginger.

In general, the diet should be rich in calcium, iodine, iron, phosphorus, vitamins A, C, D, E. All these substances help strengthen the tendons.

Consequences and complications

The following conditions and diseases may develop as complications of the disease:

Purulent radiation tenobursitis - this disease can be complicated by purulent tendovaginitis of the thumb. It develops when a purulent process spreads to the sheath of the long flexor pollicis tendon. If the disease progresses, the purulent process can spread to the forearm.
Purulent ulnar tenobursitis can become a complication of purulent tendovaginitis of the little finger. Sometimes, as the disease progresses, cross cellulitis , often interfering with the functioning of the hand. This condition is characterized by severe pain, swelling of the palm, little finger, thumb, and significant limitation in finger flexion.
Carpal tunnel syndrome - develops due to compression of the median nerve in the carpal tunnel. It manifests itself as a feeling of numbness, tingling, sharp pain in the area of the 1st, 2nd, 3rd fingers and the inner surface of the 4th finger.

In addition, as complications of the disease, compaction in the joint, its deformation, and the growth of scar tissue may develop. Sometimes the functionality of the limb is completely lost.