Tendon tendonitis: causes, symptoms, treatment

Tendon sheaths are an anatomical formation of connective tissue sheaths surrounding the tendons.

The disease of the tendon sheaths is called tenosynovitis. The most common sites for the development of pathology are the hand, foot, and ankle joint. Tenosynovitis, developing in the forearm, is called radial or ulnar tenobursitis, a disease of the Achilles tendon is called achillobursitis. Typical sites for the development of tenosynovitis are the tendon sheaths of the wrist and ankle joints.

Which joints are most often affected?

A tendon connects bones or bones and muscles. It is covered on top with connective tissue, and on the inside with a synovial membrane that secretes lubricant for better gliding and movement of the limbs. The inflammatory process leads to disruption of this process. Sliding slows down and pain occurs.

Most often, inflammation affects the tendons of the forearm, hand, wrist, ankle and foot. Tenosynovitis can be acute or chronic. If, when the first signs of the disease appear, a person does not carry out effective treatment, does not fight inflammation and pain, and after the clinical manifestations subside, he continues to load the tendon, then the disease begins to recur frequently. Dystrophy of the tendon sheaths occurs, and motor activity drops sharply.

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Characteristic features of the pathology

Tenosynovitis of the fingers, together with tendinitis, fasciitis, and bursitis, is included in a large group of pathologies - enthesopathies. This is the name for inflammation of the periarticular tissues, which occurs as periarthritis. First, one structure is damaged, and then nearby ligaments, tendons, and fascial sheets are involved in the destructive process. Gradually they lose strength, resilience, and elasticity, which leads to a significant decrease in their functional activity.

Along with tenosynovitis of the fingers, enthesopathy of the knee joint is most often diagnosed. These structures are susceptible to trauma and microtrauma - the main causes of disease development. The risk group includes athletes and people in their line of work who perform frequent monotonous movements.

What triggers the development of tenosynovitis?

Experts include the following provoking factors:

microtrauma of tendons;
heavy physical work associated with joint overload;
bruises from an accidental fall on a sharply bent or straightened limb;
spread of infection to the tendons and their sheaths with osteomyelitis, infectious arthritis, phlegmon;
toxic reactive inflammation of tendons with rheumatic joint damage;
entry of pathogens into joint structures through the bloodstream during tuberculosis, gonorrhea or other infectious diseases.

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Kinds

Tenosynovitis of the fingers can be infectious and aseptic. The latter occurs as a result of damage to the inner lining of the tendon sheath and is not associated with the introduction of bacteria or viruses. Infectious diseases are classified depending on the species of microorganisms. The cause of the development of nonspecific tendovaginitis is the introduction of Staphylococcus aureus and epidermal Staphylococcus, Streptococcus, and Escherichia coli. Specific pathology is provoked by pathogens of gonorrhea, brucellosis, tuberculosis, and syphilis. In orthopedics, it is also customary to subdivide tenosynovitis as follows:

professional aseptic. Its development is preceded by overload and microtrauma of the tendon sheath with monotonous frequent movements. The resulting inflammatory process can lead to destructive and degenerative changes in connective tissue structures;
reactive aseptic. Occurs as a result of the immune system's response to the introduction of foreign proteins. Most often diagnosed in patients with local circulatory disorders, rheumatic pathologies

Tendinitis of the fingers can manifest itself acutely, with pronounced clinical manifestations. A chronic disease is characterized by alternating remissions with relapses that occur after hypothermia or excessive physical exertion.

How does tenosynovitis manifest?

Acute tendovaginitis develops as a result of sprains, bruises, and overload of the joints. The affected area swells greatly, pain appears along the tendon and in the rest of the limb, and a slight crunching sound is possible when moving. Painful sensations persist for 1–2 weeks and require high-quality pain relief.

With chronic tendovaginitis, pain occurs periodically and intensifies after physical activity. Over time, the sensitivity of the fingers decreases, and the limb loses muscle strength. This is especially noticeable with damage to the tendons of the wrist joint, in which the sick person loses the ability to make fine and precise movements with his hands.

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Causes

In addition to injuries (dislocations, subluxations, ligament ruptures), inflammatory and degenerative pathologies can provoke the development of tenosynovitis of the fingers. These are gout, rheumatoid, reactive, psoriatic arthritis, deforming osteoarthritis. Also, the following conditions become prerequisites for damage to tendon sheaths:

metabolic disorder;
dysfunction of the endocrine glands;
excessive physical activity;
sedentary lifestyle;
disorders of hematopoiesis and circulation.

One of the common causes of the development of tenosynovitis of the fingers is the penetration of pathogenic microorganisms into the periarticular structures. As a result of the active growth and reproduction of bacteria, toxic products of their vital activity are released into the surrounding space. In such cases, tenosynovitis is clinically manifested not only by pain in the joints, but also by symptoms of general intoxication.

Motrin® for tenosynovitis

Motrin® is a modern non-steroidal anti-inflammatory drug that helps relieve pain and inflammation, including tenosynovitis. Motrin® is clinically proven to provide pain relief for up to 12 hours1. At the same time, the active substance of the drug (naproxen) helps to cope with inflammation, reducing the activity of cyclooxygenase and blocking the synthesis of prostaglandins, which is important in the treatment of diseases such as tenosynovitis.

Before use, read the instructions.

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Symptoms

The variety of types of tenosynovitis determines the number of symptoms manifested, as well as their severity. With aseptic pathology, a pulling, pressing pain occurs, intensifying with flexion and (or) extension of the fingers. Swelling is observed in the affected area, and the range of motion is significantly reduced. The skin turns slightly red and becomes hot to the touch. If a person does not seek medical help, the disease becomes chronic. One of its characteristic symptoms is a crunching sound when bending the joints. Upon palpation, mild discomfort occurs.

The clinical picture is somewhat different in patients with stenosing tenosynovitis. In the area of the fingers, the skin swells and seems to smooth out. The tissue thickens locally and a click is heard when flexed. In severe cases, the cause of stiffness is not the prevention of pain and the formation of inflammatory edema, but the formation of contractures.

Causes of de Quervain's tenosynovitis

The disease occurs between the ages of 30 and 50 years, in women 8 times more often than in men. De Quervain's tenosynovitis can be caused by a change in the shape of the 1st canal of the dorsal carpal ligament (for example, after nearby fractures of the radius) or other causes leading to swelling or thickening of the tendons or other parts of the canal. Repeated injuries, overexertion or inflammatory disease are some of the reasons that, with a certain tendency (predisposition), can cause this disease, but in most cases the causes cannot be found out. People who perform jobs that require frequently repetitive side-to-side movements of the wrist while simultaneously stabilizing it (hammering, running with ski poles) may be predisposed to de Quervain's tenosynovitis.

Clinical manifestations of various forms of the disease

The symptoms of acute and exacerbations of chronic tendovaginitis include the following clinical manifestations:

Pain in this disease is felt clearly in the projection of the location of the affected tendon. the pain is acute and constant and intensifies when trying to move. In the case of purulent inflammation, there is a feeling of pulsation.

Nonseptic tenosynovitis is characterized by the presence of crepitus (crunching) about the joint area. Swelling, the development of which is due to the dilation of blood vessels and an increase in the permeability of their walls. A distinctive feature of edema with tendovaginitis is its rapid development and spread.

Hyperemia (redness) and hyperthermia (local increase in temperature) are also caused by a sharp dilation of blood vessels, provoked by the inflammatory process. Impaired functioning of the affected limb. After the acute period of the disease has passed, contractures often develop in the area of the diseased tendon. They provoke a decrease in the length and curvature of the synovial sheath, which leads to limited mobility of the tendon.

Treatment

To eliminate pain, non-steroidal anti-inflammatory drugs are included in therapeutic regimens. These can be injection solutions (Ketorolac, Meloxicam), tablets (Nimesulide, Ibuprofen, Diclofenac), ointments for local application (Voltaren, Nise, Nurofen). After relief of inflammation, therapy continues with external medications with a warming and distracting effect: Capsicam, Finalgon, Apizatron, Nayatox. Glucocorticosteroids are used extremely rarely - usually when performing electrophoresis in combination with anesthetics. Patients are recommended to take a long-term course of chondroprotectors:

Artra;
Teraflex;
Structum.

The drugs not only stimulate the restoration of damaged joint structures, but as they accumulate in the body they exhibit a pronounced analgesic and anti-inflammatory effect. Patients are also advised to wear elastic bandages that secure the hand without restricting movement. In case of acute inflammation, a plaster cast will be applied.

Shock wave therapy treatment

Shock wave therapy (SWT) remains the leading physiotherapy treatment for digital tenosynovitis. Due to the difference between the acoustic resistance of the soft and dense structures of the hand, the waves emitted by the device penetrate into the deepest damaged tissues. Already after the first session, the severity of pain decreases, swelling and redness of the skin is eliminated. UVT is used to accelerate the restoration of mobility of the wrist joint, flexors and extensors of the hand. It is worth noting a certain regenerating ability of physiotherapeutic manipulation.

Tenosynovitis of the fingers responds well to treatment if you consult a doctor in a timely manner. Therefore, you should make an appointment with an orthopedist or traumatologist when the first, mild discomfort appears.

Methods for diagnosing and treating the disease

Early diagnosis of the disease is extremely important for timely initiation of treatment for tenosynovitis. Determining an acute aseptic and infectious nonspecific process is not difficult, since the clinical picture in these forms of the disease is significantly pronounced and specific.

Due to the fact that the symptoms of specific tendovaginitis are vague and have a subacute course, its diagnosis requires:

a comprehensive analysis of the patient’s medical history and anamnesis of the development of the disease;
collecting purulent masses from the lesion to determine the pathogen;
in some cases (if the development of sepsis is suspected), a venous blood test for sterility is necessary.

Sequence of the operation:

Skin incision (Fig. 4)
Preparation of the superficial sensory branch of the radial nerve
Preparation of the 1st canal of the dorsal carpal ligament
Dissection of the 1st canal of the dorsal carpal ligament and removal of the edges on both sides (Fig. 5))
If necessary, incision in the canal of the septum between the APL and EPB tendons
If necessary, removal of synovial tissue altered by inflammation
Pulling both tendons, eliminating their possible adhesion to each other
Tendons slide freely in the canal
Ultimate control of the integrity of superficial nerve branches
Closing the incision with a suture
Sterile pressure dressing

Diagnostics

Vaginitis is diagnosed by an orthopedic traumatologist or rheumatologist. For diagnosis, the doctor uses examination and palpation. To be sure of the diagnosis, the patient is sent for an x-ray, which will help distinguish brachial tenosynovitis from arthritis and some diseases with similar symptoms (in which a change in bone structure is observed on the x-ray).

To exclude stenotic processes, an x-ray using a contrast agent is prescribed. To exclude other general diseases, such as tuberculosis, a fluorogram will be required. General blood and urine tests will help assess the patient's condition.

Brachial tenosynovitis is a rather painful disease in its symptoms that reduces the patient’s quality of life. The main sign of pathology is shoulder pain and impaired function. To distinguish the disease from other similar conditions and prescribe the correct treatment, consultation with an experienced doctor is required.