Tenosynovitis - Causes, Symptoms and Treatment .MF .
Tenosynovitis - inflammation of the lining of the fibrous tendon sheath muscles, ie the synovium.The synovium contributes to alleviate the slip corresponding tendon kostnofibroznyh channels in the implementation of muscular work.
Figure 1. Schematic representation of tenosynovitis - inflammation of the synovial membrane of the fibrous tendon sheath muscles.
are acute and chronic tendovaginitah.
Acute tenosynovitis manifested edema of the synovial membrane and accumulation of fluid in the cavity of the synovial membrane.
Chronic tenosynovitis accompanied by a thickening of the synovial membrane and the accumulation in the synovial cavity effusion with a high content of fibrin.Over time, as a result of the organization of fibrinous exudate formed the so-called "rice bodies", and there is a narrowing of the lumen of the tendon sheath.
Depending on the nature of the inflammatory process distinguish serous, seroplastic and purulent tendovaginitah.
causes of tenosynovitis
Depending on the causes
1) independent aseptic tendovaginitah, the occurrence of which is the result of long-term micro-traumas and overvoltage synovial sheaths of tendons and their surrounding tissues in individuals of certain professions (carpenters, plumbers, porters, typists, pianists, chulochnitsy, molders brick production, iron and steel industry working hard), performing a long time the same type of movement, which involved a limited group of muscles;In addition, such tendovaginitah can occur in athletes (skiers, skaters and others) with overtraining.
2) infectious tendovaginitah:
a) specific tendovaginitah in some infectious diseases (such as gonorrhea, brucellosis, tuberculosis, etc.), in which the spread of pathogens often occurs by hematogenous (through the blood);
b) nonspecific tendovaginitah in purulent processes (suppurative arthritis, felon, osteomyelitis), of which there is a direct spread of inflammation in the synovial sheath, as well as in wounds;
3) reactive tendovaginitah, whose appearance is accompanied by rheumatic diseases (rheumatism, ankylosing spondylitis, rheumatoid arthritis, systemic scleroderma, Reiter's syndrome, etc.).
Symptoms of tenosynovitis
For acute nonspecific tenosynovitis characterized by acute onset and rapid development of painful swelling at the site of the affected synovium tendon sheaths.Most often, acute tenosynovitis occurs in the tendon sheaths on the dorsum of the feet and hands, more rarely - in the synovial sheaths of the fingers into the vagina and the flexor tendons of the fingers.Swelling and soreness is usually spread from the foot to the lower leg and hand on his forearm.Appears restriction of movements, may develop flexion contracture of the fingers.If the inflammation becomes purulent character, body temperature rises rapidly, there are chills, developing regional lymphadenitis (swollen lymph nodes due to inflammation) and lymphangitis (inflammation of the lymphatic vessels).Purulent abscess often develops in the sheath of the flexor tendons of the hand.
For acute aseptic (krepitiruyuschie) tenosynovitis characteristic lesion of synovial sheaths on the dorsum of the hand, not so much - the feet, more rarely - intertubercular synovial sheath of the biceps (biceps).Onset Island: formed by swelling in the affected tendon at which palpation felt crepitus (crunching).There is a limit finger movement or pain during movement.A transition to a chronic form of the disease.
For chronic tendovaginitis characteristic lesion sheaths of tendons flexors and extensors of fingers in their retainer.Symptoms of chronic tenosynovitis total synovial sheath of the flexor fingers often occur - the so-called carpal tunnel syndrome, in which the tumor is determined by the formation of painful elongated in the carpal tunnel, which has elastic texture and often take shape hourglass shifts slightly when driving.Sometimes it is possible to test the "rice bodies" or to determine the fluctuation (the sensation of the transfer wave caused by accumulation of fluid).Characteristically limit tendons movements.
highlights the peculiar form of chronic tenosynovitis - the so-called constrictive tenosynovitis or De Quervain syndrome , which is characterized by lesions of the extensor tendon sheath short and long abductor muscle of the thumb.The walls of the vagina in this form of tenosynovitis thicken and synovial cavity of the vagina, thus narrowing.De Quervain syndrome is manifested by pain at the location of the styloid process of the radius, which often radiating to the I finger or hand in the elbow, and swollen.Increased pain occurs when the patient presses the I finger to the palmar surface of the fingers and bends over him;if at the same time the patient removes the brush in the ulnar side, the pain dramatically.In the course of vaginal palpation is determined very painful swelling.
tuberculous tenosynovitis characterized by the formation of dense formations ( "rice bodies") during the extension tendon sheath, which can be palpated (probe).
Festering radiation tenobursit - is usually a complication of purulent tenosynovitis of the thumb.It develops when purulent inflammation spreads to the vagina all the flexor tendon of the long thumb.Characterized by severe pain on the palmar surface of the thumb and then along the outer edge of the hand to the forearm.If the disease progresses, the possible spread of purulent process in the forearm.
Festering elbow tenobursit - is usually a complication of purulent tenosynovitis little finger brush.Because of the anatomical structure of the inflammatory process often goes with synovial sheath of the little finger on the total synovial sheath of the flexor wrist, at least - in the synovial sheath tendon flexor hallucis longus.In this case, it is developing the so-called Cross-abscess, which is characterized by severe course and often complicated functioning of the brush.Characterized by severe pain and swelling of the palmar surface of the hand, the thumb and the little finger, as well as a significant limitation or extension of the fingers of his inability to complete.
carpal tunnel syndrome: its occurrence and clinical manifestations are due to compression in the carpal canal of the median nerve.Characterized by sharp pain and a feeling of numbness, tingling, pins and needles in the area (paresthesia) I, II, III of the fingers, as well as the inner surface of finger IV.There is a decrease in muscle strength brush, sensitive tips of the fingers decreases.Increased pain occurs at night, leading to sleep disturbances.Perhaps some offensive relief when lowering the arms down and waving it.Quite often there is a discoloration of the skin painful toes (cyanosis tips, pallor).Perhaps a local increase in sweating, reduction in pain sensitivity.When the feeling of the wrist are determined by swelling and soreness.Forced flexion of the hand and lifting his hands up can cause worsening pain and paresthesias in the median nerve innervation.Often, carpal tunnel syndrome is combined with the syndrome Guyon channel, which is itself very rare.When Guyon canal syndrome due to the fact that the ulnar nerve is compressed in the pisiform bone, there is pain and a feeling of numbness, tingling, pins and needles in IV, V fingers, determined by swelling in the pisiform bone and tenderness to palpation with the palmar side.
examination and laboratory diagnosis of tenosynovitis
diagnose tenosynovitis characteristic allows the localization of the pathological process and the data obtained in the clinical trial (threadlike form painful compression in the typical places, movement disorder, the definition of "rice bodies" at a palpation).
Laboratory tests in acute purulent tenosynovitis in the general analysis of blood (UAC) is determined by leukocytosis (increased white blood cell count of more than 9 x 109 / l) with increasing content of band forms of neutrophils (over 5%), increased ESR (erythrocyte sedimentation rate).Pus investigated smear microscopy (microscopic examination after special staining material) and bacteriological (isolation of a pure culture on nutrient media) methods, which makes it possible to establish the nature of the pathogen and determine its sensitivity to antibiotics.In cases where for acute purulent tenosynovitis complicated by sepsis (in the propagation of the infectious agent of purulent focus in the bloodstream), performed blood tests for sterility, which also allows you to establish the nature of the pathogen and determine its sensitivity to antibiotics.
When X-ray characterized by the absence of pathological changes in the joints and bones, can be determined only by soft tissue thickening in the relevant field.
Chronic tenosynovitis should be differentiated from Dupuytren's contracture (a painless, progressive flexion contracture IV and V fingers), acute infectious tenosynovitis - acute arthritis and osteomyelitis.
Treatment of tenosynovitis
Treatment of acute tenosynovitis is divided into general and local.
general treatment of acute infectious nonspecific tenosynovitis provide infection control, which apply pritovobakterialnye means and measures are being taken to strengthen the body's protective equipment.When tuberculous tenosynovitis used anti-TB drugs (streptomycin, ftivazid, PAS and others).General treatment aseptic tenosynovitis involves the use of nonsteroidal anti-inflammatory drugs (aspirin, indomethacin, phenylbutazone).
Local treatment both in infectious and aseptic tenosynovitis in the initial stage is to ensure the rest of the affected limb (in acute tenosynovitis spend a plaster splint immobilization), the use of warming compresses.Once manages to reach the acute effects subsided, apply physiotherapy (ultrasound, UHF, microwave therapy, ultraviolet rays, electrophoresis of novocaine and hydrocortisone), physiotherapy exercises. When purulent tenosynovitis immediately opened and drained tendon vagina and pus zatёki. If tuberculous tenosynovitis made topical administration of streptomycin solution and excision of the affected synovial sheaths.
in the treatment of chronic tenosynovitis apply the above methods of physiotherapy, as well as appoint or ozokerite paraffin baths, massage and an electrophoresis lidazy;classes physiotherapy.If a chronic infectious process progresses, shows puncture synovial vagina and antibiotics directed action.In chronic aseptic tendovaginitah used non-steroidal anti-inflammatory drugs, it is effective topical administration of glucocorticoids (hydrocortisone, metipred, deksazon).In the case of poorly treatable chronic krepitiruyuschie tendovaginitis sometimes resort to radiotherapy.In some cases, the ineffectiveness of conservative treatment of stenotic tenosynovitis spend surgical treatment (incision narrowed channels).
tenosynovitis accompanying rheumatic diseases are treated in the same way as the underlying disease: prescribe anti-inflammatory drugs and basic electrophoresis nonsteroidal anti-inflammatory drugs, hydrocortisone phonophoresis.
prognosis of tenosynovitis
In the case of a timely and adequate treatment initiated tenosynovitis is characterized by a favorable prognosis.However, sometimes purulent tenosynovitis may remain persistent dysfunction of the affected hand or foot.
Surgeon Kletkin ME