Tendinit – a disease of inflammatory character in a sinew. Can be both sharp, and chronic. At a chronic tendinit degenerate processes in the affected sinew develop over time. As a rule, the part of a sinew adjoining a bone suffers, less often the inflammation extends on all sinew. The single or regular raised loading leading to a mikrotravmatization of tendinous fibers is the main reason for a tendinit. The disease often occurs at athletes and people of physical work (especially if this work assumes the monotonous movements). Tendinit is followed by pain during movements, insignificant hypostasis, hyperaemia and local temperature increase. Treatment can be both conservative, and quick. At a chronic tendinit prevention of aggravations is of great importance.
Tendinit – a sinew disease. Is followed by an inflammation, and in the subsequent – and a degeneration of a part of tendinous fibers and adjacent fabrics. Tendinit can be sharp or subsharp, but has chronic character more often. As a rule, at a tendinita the sinews close to elbow, shoulder, knee and coxofemoral joints suffer. Sinews in an ankle and luchezapyastny joint can be also surprised.
Tendinit can develop at the person of any gender and age, but it is usually observed at athletes and at people of monotonous physical work. Too high loads of a sinew leading to its mikrotravmatization are the reason of a tendinit. With age because of weakening of sheaves the probability of development of a tendinit increases. In this case in the place of an inflammation calcium salts are often laid, that is, develops kaltsifitsiruyushchiya tendinit.
Reasons and mechanism of development of a tendinit
The sinew is dense and strong inelastic , formed by bunches of collagenic fibers which can connect a muscle to a bone or one bone to another. Mission of sinews – transfer of the movement, providing its exact trajectory, and also maintenance of stability of a joint.
At repeated intensive or too frequent movements processes of exhaustion in a sinew prevail over restoration processes. There is a so-called fatigue trauma. In the beginning tissue of a sinew swells, collagenic fibers begin to be split. If loading remains, in the subsequent islands of fatty regeneration, necrosis of fabrics and adjournment of salts of calcium are in these parts formed. And the formed firm kaltsifikata injure surrounding fabrics even more.
High level of physical activity and microtrauma win first place among the reasons of development of a tendinit. Some athletes get into risk group: tennis players, golfers, throwers and skiers, and also the people doing monotonous manual work: gardeners, carpenters, painters, etc.
However in some cases tendinit can arise also for other reasons, for example, owing to some rheumatic diseases and diseases of a thyroid gland.
Tendinit also can turn out to be consequence of a number of infections (for example, gonorrhoeas), to develop as a result of effect of medicines or owing to anomalies of a structure of a bone skeleton (for example, with a different length of the lower extremities).
Symptoms of a tendinit
Usually tendinit develops gradually. At first the patient with tendinity is disturbed by the short-term pains arising only at peak of physical activity on the respective area. In the rest of the time unpleasant feelings are absent, the patient tendinity keeps the level of physical activity, usual for it.
Then the pain syndrome at a tendinita becomes more expressed and appears even at rather small loadings. In the subsequent pains at a tendinita gain intensive pristupoobrazny character and begin to prevent usual daily activity.
At survey reddening and local temperature increase is defined. Sometimes there is hypostasis, usually unsharp. Pains at the active movements come to light, the passive movements at the same time are painless. The palpation on the course of a sinew is painful. A characteristic sign of a tendinit is the pokhrustyvaniye or crackling at the movements which can be as loud, freely heard at distance, and defined only by means of a phonendoscope.
Lateral epikondilit, it lateral tendinit or the tennis player's elbow – an inflammation of sinews which fasten to muscles to razgibatel of a wrist: to a short and long razgibatel of a wrist, and also plecheluchevy muscle. Less often at a lateral tendinit sinews of other muscles are surprised: elbow razgibatel of a brush, long beam razgibatel and general razgibatel of fingers.
Lateral tendinit – one of the diseases of an elbow joint, most widespread in traumatology, which are found at athletes. About 45% of professionals and about 20% of the fans on average playing once a week suffer from this form of a tendinit. The probability of development of a tendinit increases after 40 years.
The patient with tendinity shows complaints to the pain on the external surface of an elbow joint which is quite often giving by an external part of a forearm and shoulder. Gradually increasing weakness of a brush is noted. Over time the patient tendinity begins to experience difficulties even at the simple household movements: handshake, twisting of linen, cup raising, etc.
At a palpation accurately localized painful site on the external surface of an elbow and over a lateral part a nadmyshchelka comes to light. Pain amplifies in attempt to unbend the bent middle finger with overcoming resistance.
The X-ray analysis at tendinita is not informative as changes affect not bones, and myagkotkanny structures. For specification of localization and character of a tendinit the magnetic and resonant tomography is carried out.
Treatment of a tendinit depends on disease severity. At unsharp pains it is necessary to exclude load of an elbow. After total disappearance of pains renewal of loading, in the beginning – in most sparing mode is recommended. In the absence of unpleasant symptoms in the subsequent loading is very smoothly and gradually increased.
At a tendinita with the expressed pain syndrome the short-term immobilization with use easy plastic or plaster steaks, local nonsteroid anti-inflammatory medicines (ointments and gels), reflexotherapy, physical therapy ( with a hydrocortisone, an electrophoresis with novocaine solution, etc.), and in the subsequent – remedial gymnastics is shown.
At the tendinit which is followed by a persistent pain syndrome, and lack of effect of conservative therapy blockade with glyukokortikosteroidny medicines are recommended.
The indication to expeditious treatment of a tendinit is inefficiency of conservative therapy within one year at a reliable exception of other possible reasons of development of a pain syndrome.
There are 4 techniques of surgical treatment of a lateral tendinit: poslablyayushchy operation of Goymann (partial cutting off of sinews of razgibatel in the field of an attachment), excision of the changed sinew tissues with its subsequent fixing to external a nadmyshchelka, intra articulate removal of a ring sheaf and sinovialny bag, and also lengthening of a sinew.
In the postoperative period the short-term immobilization is recommended. Then the remedial gymnastics for restoration of volume of movements in an elbow joint and strengthenings of muscles is appointed.
Medial epikondilit, it tendinit pronator and muscles of sgibatel of a forearm or the elbow of the golfer develops at an inflammation of sinews of a long palmar muscle, elbow and beam wrists of sgibatel, and also a round pronator. Medial tendinit comes to light 7-10 times less often than lateral.
This disease develops at those who are busy with easy, but monotonous physical work in the course of which it is necessary to carry out the repeating rotary motions by a hand. Except fans of golf from a medial tendinit mounters, typists and seamstresses often suffer. Among athletes tedninit also often occurs at those who borrow with baseball, gymnastics, ordinary and table tennis.
Symptoms remind lateral tendinit, however the painful site is on inside of an elbow joint. When bending a brush and pressing on the field of damage there is pain over an internal part a nadmyshchelka. For confirmation of a tendinit and assessment of nature of process the magnetic and resonant tomography is carried out.
Conservative treatment – as at a lateral tendinit. At inefficiency of conservative therapy carry out surgery – excision of the changed sites of sinews of a round pronator and beam sgibatel of a wrist with their subsequent sewing together. After operation the short-term immobilization is appointed, and then – occupations physiotherapy exercises.
Tendinit patella ligaments
Tendinit ligaments of a patella or the jumper's knee – an inflammation in own ligament of a patella. Usually develops gradually and has initially chronic character. It is caused by short-term, but extremely intensive loads of a chetyrekhglavy muscle.
At initial stages of a tendinit of a knee joint there is a morbidity after physical activities. Over time pain begins to develop not only later, but also during physical activity, and then – even at rest. At survey of the patient suffering tendinity morbidity at active extension of a shin comes to light and when pressing on the field of damage. In hard cases there can be local hypostasis. For confirmation of a tendinit MRT is appointed.
Conservative therapy at a tendinita includes an exception of loadings, a short-term immobilization, local protivospalitelny medicines, cold and physiotreatment (ultrasound). Blockade at this kind of a tendinit are contraindicated as introduction of glucocorticosteroids can become the reason of weakening of own ligament of patella with its subsequent gap.
The indication to surgical treatment of a tendinit of a ligament of patella is inefficiency of conservative therapy within 1,5-3 months or the mucous degeneration of a sinew revealed on MRT. During operation excise the damaged site and make reconstruction of the rest of a sinew.
The choice of a way of surgical intervention (opened – through a usual section or arthroscopic – through a small puncture) depends on prevalence and the nature of pathological changes. At infringement of a sheaf because of a bone outgrowth on a patella arthroscopic operation is possible. At extensive pathological changes in tissue of a sinew the big section is necessary.
After operation to the patient with tendinity impose plastic or plaster to steak. In the subsequent appoint recovery remedial gymnastics.