Tendovaginitis: symptoms and treatment
Tendovaginitis is an inflammatory disease that affects the tendon tissues, as well as the membranes that cover it (in medicine they are called the tendon sheath). This disease from tendinitis differs in that the inflammatory process occurs exclusively in those anatomical places where the tendon is covered by a specific membrane — the ankle joint, the forearm, the foot, the hand, the wrist joint.
Tendovaginitis is a rather common pathology. More often it is diagnosed in representatives of certain professions, who during the working day are forced to perform the same type of movement with their hands or feet. It is worth noting that such an inflammatory process can have severe consequences. Acute tenosynovitis is easily treatable, while a chronic form of pathology can lead to impaired functioning of the fingers, wrist, wrist joint.
Tendons of muscular structures are tightly attached to bone structures. Above, they are covered with a shell that produces exudate, which reduces friction during the performance of certain active movements. This shell consists of two sheets — internal and external. Inflammatory process with tendovaginitis affects only the inner shell, located in close proximity to the tendon. As the inflammation progresses, the production of specific substances — prostaglandins, which irritate the nerve endings (provoking the pain syndrome), provoke edema of the tissues and their hyperemia.
Clinicians identify several main causes that can lead to the progression of tendonitis of the wrist, ankle and others:
- injuries of tendons and their membranes of varying severity
- Nonspecific infections. The development of an ailment is usually provoked by bacteria that are already in the body. Hematogenously, they penetrate the tendon sheath, settle there and begin to actively multiply, thereby causing inflammation;
- Specific infections. The cause of the progression of the disease is already a purulent or inflammatory process in the bone structures. From this focus, infectious agents easily penetrate the tendon sheath;
- prolonged microtraction of tendons
- Available systemic diseases.
Clinicians use a classification that is based on the etiology, the nature of the inflammation, and the duration of the pathological process.
According to the etiology:
- Aseptic. This type includes crepitus tenosynovitis of the forearm, as well as reactive tendovaginitis (with systemic pathologies).
By the nature of inflammation:
- purulent tenosynovitis. The most dangerous. Purulent tendovaginitis develops in the case of an infectious process. As a result of its progression, pus accumulates in the affected tendon and its membrane;
- Serous. For this type of pathology is characterized by inflammation of the inner layer of the membrane with the release of serous fluid;
- serous-fibrous. Simultaneously with the appearance of serous exudate, a specific fibrin gland is formed on the surface of the shell sheets. It becomes the cause of increased friction of the tendon.
From the duration of the current:
- acute — up to 30 days;
- subacute — from month to six;
- Chronic — more than 6 months.
- initial. In this case, only the hyperemia of the synovial vagina is observed. It is possible to form small infiltrates in its outer sheet. These signs are observed on the tendons of the hand, foot and fingers;
- Chronic stenosing.
Given the clinical course, clinicians distinguish acute and chronic pathology.
This clinical form usually begins to progress after a systematic overload of a specific area of the body (foot, hand). At the lesion site, a slight edema is formed, which patients do not immediately pay attention to. The color of the skin does not change. Pain syndrome occurs when the hand or foot performs active movements. Its localization depends on which particular tendon was affected. More often, the thumb and wrist joint is attacked.
When the purulent process progresses, the symptoms of inflammation are very pronounced. The affected finger strongly blushes, the skin is taut and glitters, local hyperthermia is noted. Pain is noted not only with active movements, but also in complete peace.
- enlarged lymph nodes;
- loss of appetite.
If, when these symptoms occur, do not treat the tendovaginitis, then the patient’s condition will rapidly deteriorate. Signs of inflammation from the finger go to the wrist and on the forearm. Septic shock may develop.
Chronic tendovaginitis progresses only with aseptic lesion. At the site of the lesion, the patient marks moderate soreness. When you feel this area, you can note the appearance of crepitus. Chronic tenosynovitis occurs without pronounced symptomatology.
Symptoms of tendovaginitis also depend on which tendon was affected by the inflammatory process. Clinics may differ slightly.
Defeat of the foot
Symptoms of tendovaginitis of the foot are rather specific, therefore pathology can be diagnosed without difficulty:
- pain syndrome with load on the foot. The pain is acute and can be of a pulsating nature (in the presence of purulent exudate);
- swelling of the foot and ankle
- flushing of the skin over the tendon sheath;
- insignificant limitation of joint mobility
- Limited functionality of the tendons
- Local temperature increase;
- when probing the site of the lesion, it may be noted the appearance of pathological nodes and infiltrates
- intoxication syndrome (more pronounced with purulent tenosynovitis of the foot)
Lesion of the wrist joint
The main symptoms of tendonitis of the wrist joint:
- swelling in the wrist area
- spasm of the muscular structure of the hand
- pain in the joint, which tend to increase;
- finger movements are somewhat limited;
- when performing active hand movements, a crunch in the wrist may appear;
- Tenosynovitis of the wrist joint can be accompanied by numbness and tingling in the area of the wrist and fingers.
The clinical picture of tendodaginitis of the hand usually appears after the brush has experienced a strong physical load. Main symptoms:
- edema in the affected area. Most often swell tissues located on the back of the hand;
- persistent hyperemia appears in the site of tendon localization
- Stiffness in the wrist joint is noted
- cramps. When the hand is stretched, the patient often feels as if the brush is brushing.
The tactics of treating tendovaginitis directly depends on the type of pathology, and also on the clinical picture.
Treatment of aseptic species:
- impose a gypsum longe on the affected tendon
- Anti-inflammatory drugs
- physiotherapy with novocain blockades
- mud applications.
Treatment of an infectious type of pathology:
- If a purulent exudate has accumulated in the synovial vagina, it is indicated to perform its immediate opening and drainage of the tendon
- the imposition of a gypsum limestone;
- therapy for the background disease that provoked tendovaginitis
- Anti-inflammatory drugs
Treatment of chronic form:
- broad-spectrum antibiotics
- Non-steroidal anti-inflammatory drugs
- paraffin applications;
- exercise therapy