Tendovaginitis (ICD-10 code M65) is a disease characterized by inflammation of the tendons and surrounding membranes. Tendovaginitis can develop only in that tendon, which has a soft tunnel, represented by connective tissue. There are many reasons for the development of this disease - these are infections, rheumatic pathologies, along with professional sports and more. So, we begin our article with the symptoms that accompany this pathology.
We will consider the treatment of tenosynovitis later.
Symptomatology
Symptoms of tenosynovitis, regardless of the location of the inflammation, have a similar picture. The presence of an acute form of inflammation is indicated by the following symptoms:
- The presence of pain localized in the place where the inflammation occurs. The pain is acute and does not depend on the time of day. In the event that pus accumulates in the synovial bags, the patient feels a pulsation. The pain can intensify when a person makes an attempt to move with the involvement of inflamed tendons.
- The appearance of swelling with tendon tendonitis. In the area of ​​inflammation, the vessels usually expand, becoming permeable, and fluid from them seeps out. It can linger in the tissues, which leads to the formation of edema, which is significant in size. Sometimes, cracks form on the skin surface due to edema. Edema builds up very quickly, as fluid is constantly produced by the synovial walls. It happens that tenosynovitis, which manifests in the fingers, after a couple of hours leads to edema of the entire limb. Wrist tendovaginitis is often manifested.
- The development of hyperemia of the skin. Redness of the dermis occurs due to excessive filling of small vessels with blood. First, redness spreads over the skin and takes the form of a tendon that has been inflamed. Further, the area of ​​hyperemia is more extensive. In that case, if you touch the area characterized by the most intense color, you can hear a light crunch.
- Local increase in temperature with tendovaginitis of the ankle joint. This symptom can also be explained by an increased rush of blood to the area of ​​inflammation.
- The appearance of disturbances in the work of the limb. In the event that the inflammation is localized in the area of ​​the flexor tendons, then the leg or arm will simply be impossible to bend. In the case of involvement in the pathological processes of the extensors, severe pain during extension will be present. When the tendon is at rest, the pain will be minor.
Any pathological formations lead to a restriction of tendon mobility. Against this background, a limb may completely or partially lose its ability to function.
Types of tenosynovitis
To systematize the information, doctors use several classifications of tenosynovitis, which are based on different criteria. So, depending on the nature of the inflammation, the following types are distinguished:
- The development of serous tenosynovitis. This is the initial form of the disease. Against this background, the patient has a minimal set of symptoms in the form of mild redness against the background of inflammation, along with slight swelling of the tissues.
- The development of serous-fibrous tendovaginitis of the ankle joint. In this case, exudation accumulates in the synovial vagina, and, in addition, a swelling forms, and there is an increase in pain.
- The occurrence of purulent tenosynovitis. Against its background, redness intensifies, and the pains become so unbearable that a person needs emergency therapy.
Acute and chronic tenosynovitis
Depending on how the disease proceeds, acute tenosynovitis and chronic are isolated. And depending on the etiological factors that caused the development of the disease, there are:
- Aseptic type of tenosynovitis, which is divided into professional, reactive and post-traumatic.
- An infectious type of tenosynovitis, which may be nonspecific or specific.
What is creping tenosynovitis?
The cause of the problem also allows us to differentiate the disease. It can be:
- infectious (non-specific, specific);
- aseptic (crepitating, stenosing).
If the name “aseptic” is present in the name of the ailment, this means that the synovial membrane of the tendon was not inflamed due to any infectious disease of the body or infection from the outside, that is, a wound, cut, or puncture.
There is a big difference between aseptic crepitating tenosynovitis and tenosynovitis of infectious origin. The first can be recognized by the characteristic cod that is heard during palpation of the swollen area or during the movement of the limb, when the tendon moves along the injured synovial membrane.
Tendovaginitis and its diagnosis
It is very important that the diagnosis of tenosynovitis is not only high-quality, but also fast. The success of treatment directly depends on this, and, in addition, the likelihood of certain complications.
Usually, doctors do not experience any difficulties in making a diagnosis. For this, an external examination of the patient is enough to suspect tendovaginitis of the wrist joint. Specialists, as a rule, are repelled by the signs of the disease described above. The patient may experience swelling along with contracture and deformation of the tendon capsule. Against the background of septic inflammation, the patient may suffer from general intoxication of the body. The temperature in this case exceeds 38 degrees, and, in addition, there is increased sweating along with chills.
It is more difficult to diagnose chronic tenosynovitis, since the symptoms of the disease are not pronounced enough, and directly in the period of remission it can be absent altogether. Therefore, patients who have undergone acute tenosynovitis once must pay attention to their health. Usually, chronic tenosynovitis is confirmed with repeated inflammation of the synovial bags. As part of the confirmation of the diagnosis, the following methods are used along with laboratory tests:
- Blood sampling for general analysis. With severe inflammation, an increase in ESR with leukocytosis is observed.
- Bacterioscopic analysis of the purulent contents of the synovial tendon bags. To do this, perform a puncture.
- If sepsis is suspected, blood is checked for sterility.
- Performing computed tomography allows you to visualize the thickening of soft tissue, and, in addition, to see the presence of adhesions.
X-ray examination in terms of the detection of tenosynovitis is uninformative. So, then we find out how the treatment of tenosynovitis is carried out.
Therapy
Treatment occurs, as a rule, medically or promptly. Physiotherapeutic procedures have a good effect, which are allowed to be practiced even against the background of the acute stage of tenosynovitis. The physician should evaluate the condition of the patient and establish how intense the inflammation is.
Treatment of acute and chronic forms of aseptic tenosynovitis
Acute, and in addition, chronic aseptic tendovaginitis can be cured exclusively through the use of drugs. In this case, the patient is prescribed anti-inflammatory drugs, used not only locally, but also systemically. Antibiotics are prescribed by the doctor at their discretion. Most experts believe that they can be used even with a preventive purpose in order to prevent suppuration of synovial bags and tendon tissue. What are the recommendations for the treatment of tenosynovitis?
Patients with an acute form of septic tenosynovitis are recommended to minimize the load on the affected limbs. Gypsum is used for this. Cold is applied to the affected area. Analgesics are used to reduce pain tendon pain. In the event that the therapy was carried out adequately, then it is possible to completely get rid of the disease in just a few days.
To prevent relapse, it is recommended to minimize the load on the limb in the future. Especially if it is a tendovaginitis of the forearm. Shock wave treatment is one of the effective methods of treatment of aseptic tenosynovitis. Among physiotherapeutic methods, phonophoresis with hydrocortisone is also used, and in addition, electrophoresis with potassium iodide and with novocaine is also used.
In the event that with the help of analgesics or physiotherapeutic procedures it is not possible to stop the pain, then the patient is recommended to establish a therapeutic blockade with the use of hormonal drugs. As soon as the acute stage of the disease is completely eliminated, the patient will be prescribed a special gymnastic complex.
In order to prevent exacerbations of the disease, a patient with chronic tenosynovitis is prescribed Ozokerit. If treatment does not bring the desired effect, then in this case, the affected tendon sheaths are excised or dissected. What exactly should be done in a particular case, the doctor decides.
Treatment of acute post-traumatic tenosynovitis
For the treatment of acute tenosynovitis, plaster or a plastic longuet is applied to the damaged area. In the first days after the injury, cold should be applied to the sore spot, and then thermal procedures are recommended. A good effect is UHF therapy.
If the disease was diagnosed at an early stage, then until the abscess is formed, conservative treatment is allowed. For these purposes, the limb is immobilized, the patient is administered novocaine blockade, imposing alcohol lotions. From physiotherapeutic techniques, the use of UHF treatment and laser therapy is indicated.
In the event that pus accumulates in the area of ​​the synovial sacs, the operation is indicated. In this case, the synovial vagina is widely opened, and it is relieved of purulent masses, rinsing with antiseptic solutions. Immediately before and after the operation, the patient must undergo antibiotic therapy.
Drug treatment
Medicines used to treat tendovaginitis (ICD-10 code M65) are typically as follows:
- Treatment with drugs from the group of non-steroidal anti-inflammatory drugs in the form of Nimesulide and Diclofenac.
- Glucocorticosteroid therapy, for example, Dexamethasone. With tendovaginitis, brushes are very often prescribed.
- The use of antibiotics. In this case, Ceftriaxone is used predominantly.
Physiotherapy treatment
The physiotherapeutic methods that are used to treat tendon tendonitis of the hand are usually as follows:
- Electrophoresis treatment.
- Therapy through the application of alcohol compresses.
- Conducting laser therapy.
- Performing UHF therapy.
- Ultrasound treatment.
- Mud treatment and massage.
At the stage of remission of the disease, the patient must necessarily engage in therapeutic exercises. Tendon loads should increase smoothly. Now we find out which of the popular recipes are used to treat this disease.
Alternative treatment of tenosynovitis
There are situations in which the question arises as to how to cure pathology without drugs. In the presence of drug intolerance or an allergic reaction to antibacterial drugs, they turn to useful plants. Traditional medicine for tenosynovitis recommends treatment with agents in the form of herbal infusions, decoctions, compresses and ointments. Here are a few recipes:
- Treatment of tenosynovitis with calendula ointment. To prepare the medicine, they take an equal number of calendula flowers and baby cream, after which everything is mixed. Ointment is applied to the affected surface. The sick area is covered with a bandage, leaving it overnight. This prescription has antimicrobial and anti-inflammatory effects.
- Treatment of tenosynovitis with wormwood. Take two tablespoons of dry wormwood, add 200 milliliters of boiling water and insist the medicine for half an hour. Then the tincture is filtered and drunk on a spoon before meals three times during the day. This medicine can have anti-inflammatory, and, in addition, a general strengthening effect.
- Treatment of finger tendovaginitis with compresses from a shepherd’s bag. The infusion is prepared as follows: pour a spoonful of grass with 200 milliliters of boiling water. Next, the tool is insisted in a thermos for two hours. A water bath is also suitable. Then the medicine is filtered and used as part of local treatment in the form of compresses for the night.
- Treatment of tenosynovitis with ointment from pork fat and wormwood. Take 100 grams of lard and 30 grams of wormwood. All ingredients are boiled over low heat, cooled and applied to a sore spot.
- Compresses using medical or bear bile. Bile is heated in a water bath and with its help make a regular compress, which is applied to the sore spot. Hold the medicine for one night. Bile can have a resolving, and at the same time anti-inflammatory effect. Treatment with such compresses gives good results.
Which doctor treats tenosynovitis? In the event that a person suffers from such a disease, then he should turn to narrow-profile specialists, who are a rheumatologist, orthopedist and arthrologist.