Tendovaginit – an inflammation of a sinew and the cover surrounding it. Unlike a tendinit, develops in areas of sinews which have a vagina – something like the soft tunnel consisting of connecting fabric. Nonspecific and specific infections, rheumatic diseases and the repeating same movements during sports activities or performance of professional duties can become the reason of development. Tendovaginit can proceed sharply or chronically. It is shown by the pains amplifying at the movements. Hypostasis and increase in local temperature is possible. At infectious tendovaginita symptoms of the general intoxication are observed, noninfectious proceed without violation of the general condition of the patient. Treatment depends on a form and option of a current of a tendovaginit and can be both conservative, and quick.
Tendovaginit – the inflammation developing in tissues of a sinew and tendinous vagina. The sinews covered with a soyedinitelnotkanny cover in a forearm, a luchezapyastny joint and a brush, and also an ankle joint, foot and an Achilles tendon suffer. Tendovaginit can have infectious or noninfectious (aseptic) character, to be sharp or chronic. Infectious tendovaginita are usually treated quickly, other forms – is conservative.
The sinew is dense inelastic , connecting among themselves a bone and a muscle or two bones. During movements of a muscle are reduced, and the sinew moves rather surrounding fabrics. In a part of a sinew, average and adjacent to a muscle, are covered with a case from connecting fabric which proceeds on tendinous fabric directly from the surface of muscles.
From within such cases are covered by the sinovialny cover making a small amount of oily liquid. Thanks to it at the movements the sinew easily slides in a peculiar channel, without encountering resistance. At an inflammation or a degeneration of a sinew or a tendinous vagina sliding is at a loss, there are symptoms of a tendovaginit.
Reasons of a tendovaginit
Aseptic tendovaginit can appear owing to a constant overload and the mikrotravmatization of a sinew and its vagina connected with it. Such tendovaginita arise at people of certain professions: pianists, typists, loaders etc., and also at some athletes, for example, skaters or skiers.
In some cases tendovaginit develops owing to a trauma of the copular device (stretching or a bruise).
Besides, aseptic tendovaginit sometimes is observed at rheumatic diseases. In this case the toxic jet inflammation becomes the reason of a tendovaginit.
Classification of tendovaginit
Taking into account an etiologichesky factor allocate:
- Aseptic tendovaginita which, in turn, can be professional, jet and post-traumatic.
- Infectious tendovaginita which are subdivided on specific and nonspecific.
Taking into account the nature of inflammatory process distinguish:
- Serous tendovaginita.
- Serous tendovaginita.
- Purulent tendovaginita.
Taking into account a current distinguish sharp and chronic tendovaginita.
Sharp aseptic tendovaginit
This form of a tendovaginit usually develops after an overload (for example, hard work at the computer, during preparation for examinations at music school, during preparation for competitions etc.). Usually sinews and tendinous vaginas on a back surface of brushes are surprised, is more rare – stop. Meets also tendovaginit in a shoulder biceps sinew.
Tendovaginit develops sharply. In the struck area hypostasis develops. The movements become sharply painful and are followed by a peculiar soft silent crunch in the affected sinew. At adequate treatment symptoms of a sharp tendovaginit completely disappear within several days or weeks. However because of the proceeding excessive loads of the sinew which is already "weakened" by a disease such tendovaginit quite often passes into a chronic form.
To the patient with tendovaginity recommend to limit load of an extremity, it is possible – with use of orthoses. Put cold to an affected area. At an intensive pain syndrome appoint the anesthetizing medicines. Also the physical therapy and shock and wave therapy is used. At a tendovaginita with persistent pains, not removed analgetics, carry out medical blockade with glyukokortikosteroidny medicines. After elimination of a pain syndrome the remedial gymnastics for strengthening of muscles is appointed.
Sharp post-traumatic tendovaginit
Post-traumatic tendovaginit arises at stretchings and bruises of area of a luchezapyastny joint. In the anamnesis – a characteristic trauma: falling on the hand which is sharply bent or unbent in a luchezapyastny joint, less often a bruise of area of a wrist. Pain and hypostasis in the field of defeat is observed.
Appoint an immobilization with use of a hard bandage, plaster or plastic steaks. In the first days after a trauma to the struck area put cold, then carry out thermal procedures and appoint UVCh-therapy. Seldom or never (at considerable hemorrhage in a tendinous vagina) carry out a puncture for removal of the accumulated blood.
Symptoms of a post-traumatic tendovaginit completely disappear within several weeks.
Chronic aseptic tendovaginit
Can be initially chronic or develop after a sharp aseptic or post-traumatic tendovaginit. The chronic mikrotravmatization with the subsequent dystrophy of tendinous covers is the reason. The current is recidivous.
The patient with tendovaginity shows complaints to the pain amplifying at the movements. Hypostasis usually is absent. At a palpation morbidity on the course of a sinew and a crunch or a krepitation comes to light during movements.
Special form of a chronic aseptic tendovaginit is stenoziruyushchiya tendovaginit at which the sinew is partially blocked in the bone and fibrous channel. There are several syndromes caused by stenoziruyushchy tendovaginita.
The syndrome of a carpal tunnel develops when narrowing this channel which is on the palmar surface of a luchezapyastny joint. At the same time sinews of sgibatel of fingers and a median nerve are squeezed. At survey pains on the course of sinews and violations of sensitivity in area I-III and the internal surface of the IV fingers, loss of ability to the exact and thin movements and decrease in force of a brush come to light.
De Querven's disease – stenoziruyushchiya tendovaginit sinews of a short razgibatel and the long taking-away muscle of the I finger of a brush which are squeezed in the bone and fibrous channel located at the level of an awl-shaped shoot. Violation of movements, hypostasis and pain in the field of "an anatomic snuffbox" is noted.
At a stenoziruyushchy ligamentit I, III and IV fingers of a brush are surprised more often. The disease develops owing to sclerous changes in area of ring sheaves and is followed by some difficulty at extension of a finger – as though at some point it is necessary to overcome some obstacle for the further movement.
In the period of an aggravation of a tendovaginit carry out an extremity immobilization, appoint physical therapy ( with a hydrocortisone, an electrophoresis with iodide of potassium and novocaine), carry out therapy by anti-inflammatory medicines. At the expressed pain syndrome carry out blockade with glucocorticosteroids.
In the recovery period the patient with tendovaginity appoint ozokerite in combination with the dosed remedial gymnastics.
In the absence of effect of conservative therapy carry out a section or excision of the affected tendinous vaginas.
Jet tendovaginit develops at rheumatic diseases: syndrome of Reuters, Bekhterev's disease, system sklerodermiya, rheumatism and rheumatoid arthritis. Usually proceeds sharply. It is shown by pains and insignificant hypostasis in the affected sinew.
Treatment – rest, if necessary an immobilization, anti-inflammatory medicines and anesthetics.
Sharp nonspecific infectious tendovaginit
Infectious tendovaginit can arise at a drift of gnoyerodny microflora from the center located nearby (at a purulent inflammation) or from the external environment (at a trauma). Develops in areas of tendinous vaginas of sgibatel of fingers more often and in this case the tendinous felon carries the name.
In the beginning in a cavity of a tendinous vagina serous exudate collects. Then pus is formed. Hypostasis and squeezing by the accumulated pus cause sharp pains and break blood supply of a sinew.
The patient with tendovaginity shows complaints to an acute pain which when forming an abscess becomes pulling or pulsing, depriving of a dream. At survey considerable hypostasis, hyperaemia and sharp morbidity in the affected finger comes to light. Pain amplifies at the movements. The finger is in the compelled situation. Regionarny lymphadenitis comes to light. Unlike other types of a tendovaginit, at an infectious tendovaginit symptoms of the general intoxication come to light: temperature increase of a body, weakness, weakness.
If tendovaginit arose in the area V of a finger, pus can spread in an elbow sinovialny bag. At damage of the I finger distribution of purulent process to a beam sinovialny bag is possible. In both cases develops tenobursit. If elbow and beam bags are reported among themselves (such message is available approximately for 80% of people), brush phlegmon can develop.
Distribution of pus involves deterioration in a condition of the patient with substantial increase of temperature, a fever and the expressed weakness. Considerable hypostasis and the compelled provision of a brush is observed. Skin of the struck area crimson and cyanotic. The patient with tendovaginity complains of the sharp pains amplifying in attempt of movements.
At early stages (before formation of an abscess) treatment of an infectious tendovaginit conservative: immobilization plaster or plastic longety, novokainovy blockade, spirit lotions, UVCh and laser therapy. At suppuration surgical treatment – opening of a tendinous vagina with its subsequent drainage is shown. In to - and the postoperative period antibiotic treatment is carried out.
At a tenobursita and phlegmon of a brush the surgical treatment consisting in broad opening, washing and the subsequent drainage of purulent cavities against the background of reception of antibiotics is also necessary.
In the remote period after an infectious tendovaginit rigidity of a finger owing to cicatricial changes in area of a sinew can be observed. In case of fusion and death of a sinew the sgibatelny contracture of the affected finger develops.