Tendinitis of the foot. Tendinitis - description, causes, diagnosis, treatment Tendinitis on the foot according to the ICD

Foot tendinitis is a common disease characterized by inflammatory and degenerative processes in tendon tissue. As the disease progresses, the pathology spreads to the tibialis and plantaris muscles. ICD 10 code for tendonitis of the foot is M76.6 (tendonitis of the calcaneal tendon).

Causes

With the development of the pathological process, there is a risk of damage to all tendons of the foot and leg or just one. More often, the inflammatory process is localized in the ligament that attaches the triceps muscle to the heel bone.

The main causes of tendonitis:

• Physical activity - the disease develops in athletes who receive injuries during exercise, which lead to ligament deformation and dislocations, damage to the knee joint and ankle;
• Injuries - bruises of the foot can provoke degenerative-dystrophic deformation in cartilage and tendons;
• Disturbance of metabolic processes in the body - lack of nutrients or difficulty in their supply to the muscles and tendons of the foot (bone growths are formed that interfere with normal movement);
• Joint pathologies – gout or rheumatism;
• Flat feet or curvature of the spinal column;
• Genetic predisposition – congenital pathology of the musculoskeletal system (hip dysplasia, short leg syndrome) can provoke tendonitis.

In older people, tendonitis develops for physiological reasons. With age, degenerative processes in organs, tissues and joints are inevitable, so disease prevention is carried out (vitamin complexes, chondroprotectors as recommended by a doctor).

Classification of tindinitis

Based on the type of localization of inflammation, the disease is divided into the following types:

• Achilles tendonitis (the source of inflammation is located in the ankle area);
• Tendinitis of the posterior tibial muscle (pathology is localized in the area of ​​the lower leg and ankle).

The disease occurs in two forms - acute and chronic. The first is characterized by a sudden onset with acute symptoms, and the second is characterized by a blurred clinical picture, alternating remission with relapses.

The acute form of the disease is divided into two types:

• Aseptic - as a result of injury to surrounding tissues, a hematoma is formed, ruptures of nerve fibers, tendons and blood vessels. The resulting defects in the tendons are filled with granulations, which gradually turn into scar tissue;
• Purulent - develops as a result of infection in the tendon, followed by necrosis and melting of the surrounding tissue.

The chronic form of tendinitis occurs in two types:

• Fibrous. Fibrous connective tissue forms at the site of pathology, often developing after prolonged stress on the tendon or repeated stretching;
• Ossifying. Salts are deposited on the tissue changed due to the disease, which leads to ossification of the tendon. Tendinitis develops as a result of open fractures of wounds.

Separately, tendonitis of the extensor toes is distinguished. The disease rarely develops after injury to a limb while running, is easily treatable after confirmation of the diagnosis, and most often affects the little toe.

Symptoms

To make a preliminary diagnosis and carry out differential diagnosis, symptoms of foot tendinitis are identified:

• Pain of varying intensity occurs when moving the foot or when touching the source of inflammation. As the disease progresses, the pain syndrome is disturbing at rest, becomes aching in nature, and radiates to the foot or lower leg;
• Hyperemia of the skin in the area of ​​inflammation (the symptom indicates the spread of degenerative processes to the bone and cartilage tissue of the foot);
• Swelling of the leg in the ankle area;
• The appearance of crepitus in the affected tendon (crunching is heard both during movement and with the help of a phonendoscope).

Discomfort worsens after a night's rest or when trying to transfer body weight from the sole to the toes, so women find it difficult to wear high-heeled shoes.

When tendinitis of the ankle with rupture of the tendon, a hematoma appears with severe pain and limited mobility of the limb.

On a note!

In the chronic form of tendonitis in purulent form, additional signs of the disease are hyperthermia and intoxication (weakness, nausea).

Diagnostics

As prescribed by a doctor, the following diagnostic methods are used to confirm the diagnosis:

• Laboratory research. With purulent tendonitis of the ankle joint, an increased level of ESR and leukocytes is noted, an infectious pathogen is identified, followed by the selection of drugs to destroy it;
• Magnetic resonance therapy can identify damaged or strained muscles, torn ligaments, and broken bones;
• Radiography. In the photo of foot tendonitis, the presence of bone growths, their location and shape are visually determined. Using the image, the doctor determines the presence and degree of degenerative processes in the bone;

• Ultrasound examination: allows you to identify structural changes in the tendons in the affected limb.

In addition to instrumental diagnostic methods, a rheumatologist or traumatologist examines and palpates the limb to determine the location of the pathology and assess the severity of the patient’s condition.

Drug therapy

After confirmation of the diagnosis, drug treatment of ankle tendinitis is carried out.

Main groups of medicines:

• Non-steroidal anti-inflammatory drugs (Diclofenac, Movalis) eliminate the symptoms of inflammation, prescribed by injection or orally;
• Antibiotics (Flexid, Tavanic) are used to treat tendinitis of the foot, the source of which is infection or injury. The drugs have antimicrobial and anti-inflammatory effects, help prevent the development of sepsis and pathological complications;
• Corticosteroids (Mitepred) are a decongestant and anti-inflammatory drug, prescribed when treatment is ineffective or in patients in serious condition.

The effectiveness of treatment for tendonitis of the foot increases when medications are combined with physiotherapy.

During therapy, it is necessary to apply an immobilizing bandage to the foot and ankle to limit the load on the injured limb and prevent its injury.

Physiotherapeutic treatment

The goal of physiotherapy is to stimulate metabolic processes that will relieve inflammation and accelerate regeneration processes. Patients with traumatic tendonitis are prescribed 3-5 procedures. For tendon ruptures, the healing process takes 1-2 months.

Basic methods of physiotherapy:

• Laser therapy (has an analgesic effect, activates restoration processes at the cellular level);
• Magnetotherapy (improves the absorption of medications, accelerates metabolism);
• Ultrasound therapy (prevents tissue ossification and the spread of inflammatory processes);
• Electrophoresis (eliminates swelling, helps relieve restrictions on joint mobility).

Physiotherapy procedures are prescribed after relieving acute pain and inflammation, combined with massage of the lower leg and foot, and swimming.

Folk remedies

The use of traditional methods in combination with medications and physiotherapy is carried out at the discretion of the doctor and consists of using the following recipes:

• Compresses with saline solution;
• Alcohol infusion: pour 1 glass of walnut partitions with 500 ml of vodka and leave for 14 days. Take the finished product 3 times a day, 1 tsp.
• Potato compress: mix grated potatoes with chopped onion and clay in equal proportions, apply the resulting mixture to the sore foot and wrap it with a cloth, leaving it overnight.

An effective anti-inflammatory remedy for foot tendonitis is ginger infusion or turmeric, which is added to dishes as a seasoning.

Interesting!

Surgical intervention is carried out when conservative therapy is ineffective, and consists of dissecting the affected tendon with its subsequent excision for surgical restoration of the ligaments and allowing the regeneration of surrounding tissues.

Forecast

Timely diagnosed tendinitis of the foot can be effectively eliminated with conservative treatment methods. The rehabilitation period is 1 month.

If surgical intervention is necessary, the limb is immobilized for 2 months, and full recovery and restoration of motor function of the foot returns after massage, gymnastics and physiotherapy.

To prevent relapses and tendonitis, it is necessary to strengthen the lower leg muscles and wear special shoes that prevent injury to the foot and ankle during training.

Unstable hip joint

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Tenosynovitis: treatment with medications, folk remedies at home

Tenosynovitis is an inflammation of the inner lining of the fibrous sheath of the muscle tendon (synovium). This synovial membrane helps facilitate the sliding of the corresponding tendon in the osteofibrous canals when working in muscles and joints.

People are interested in the treatment of tenosynovitis:

But, in fact, the pathological process is localized precisely in the inner synovial membrane of the muscle tendon.

The ICD 10 code correlates tenosynovitis:

1. for lesions of synovial membranes and tendons - code M65-M68,
2. synovitis and tenosynovitis - code M65,
3. other synovitis and tenosynovitis - code M65.8.

Tenosynovitis can be acute or chronic.

Acute tenosynovitis is manifested by swelling of the synovial membrane and accumulation of fluid in the cavity of the synovial membrane.

Chronic tendovaginitis is accompanied by thickening of the synovial membrane and accumulation of effusion with a high fibrin content in the synovial cavity. Over time, as a result of the organization of fibrinous effusion, the so-called “rice bodies” are formed, and the lumen of the tendon sheath narrows.

Depending on the nature of the inflammatory process, serous, serous-fibrinous, and purulent tendovaginitis are distinguished.

Today we will look at the treatment of tendovaginitis of the wrist, hand, foot, tendon, finger, ankle, forearm at home with official drugs, medications, procedures and folk remedies.

Tenosynovitis: types, examples, symptoms

Infectious tenosynovitis

It can be acute or chronic, serous or purulent.

An example of infectious tenosynovitis is tendon panaritium (tenosynovitis of the finger). With it, the sore finger is evenly enlarged, slightly bent and painful. Pressure over the tendon sheath and an attempt to cause passive movements are accompanied by sharp pain.

The entire vagina becomes infected within a few hours. The general condition of the patient is serious due to intoxication.

Crepitant tenosynovitis

Aseptic inflammation of the tendon sheath or (more often) the tissue surrounding the tendon. Crepitating tendovaginitis develops on the extremities (usually the upper ones - the forearm, wrist joint) mainly in connection with physical work, as an occupational disease (milkmaids, laundresses, volleyball players) or, conversely, when performing long-term unusual physical work.

Stenosing tenosynovitis

Aseptic inflammation of the annular ligament of the finger (“spring finger”, “snapping finger”) or the dorsal ligament of the wrist. In the etiology of this type, acute or chronic trauma is of great importance. More often, the disease develops in women 30–50 years old.

Tenosynovitis: causes

Depending on the causes of the development of the disease, the following groups of tendovaginitis can be distinguished:

First group: Independent aseptic tendovaginitis, the occurrence of which is a consequence of prolonged microtraumatization and overstrain of the synovial sheaths of tendons and adjacent tissues in persons of certain professions (carpenters, mechanics, loaders, typists, pianists, hosiery workers, brick molders, workers in the heavy metallurgical industry), performing the same type of movements for a long time, in which a limited group of muscles takes part; in addition, such tendovaginitis can appear in athletes (skiers, speed skaters and others) during overtraining.

Second group: Infectious tendovaginitis:

1. specific tendovaginitis in some infectious diseases (such as gonorrhea, brucellosis, tuberculosis, and so on), in which the spread of pathogens often occurs hematogenously (through the bloodstream);
2. nonspecific tendovaginitis during purulent processes (purulent arthritis, felon, osteomyelitis), from which inflammation directly spreads to the synovial vagina, as well as with wounds;

Third group: Reactive tendovaginitis, the appearance of which accompanies rheumatic diseases (rheumatism, ankylosing spondylitis, rheumatoid arthritis, systemic scleroderma, Reiter's syndrome and others).

Tenosynovitis: manifestations and symptoms

Acute nonspecific tendovaginitis is characterized by an acute onset and rapid development of painful swelling at the location of the affected synovial membranes of the tendon sheaths.

Most often, acute tenosynovitis is observed in the tendon sheaths on the dorsum of the feet and hands, and more rarely in the synovial sheaths of the fingers and in the sheaths of the flexor tendons of the fingers.

Swelling and tenderness typically spread from the foot to the shin and from the hand to the forearm. There is a restriction of movement, and the development of flexion contracture of the fingers is possible.

If the inflammatory process becomes purulent, the body temperature quickly rises, chills appear, regional lymphadenitis (enlarged lymph nodes due to inflammation) and lymphangitis (inflammation of the lymphatic vessels) develop.

Purulent tenosynovitis most often develops in the area of ​​the flexor tendon sheath.

Acute aseptic (crepitating) tenosynovitis is characterized by damage to the synovial sheath on the dorsum of the hand, less often to the foot, and even less often to the intertubercular synovial sheath of the biceps (biceps brachii).

The onset of the disease is acute: a swelling forms in the area of ​​the affected tendon, and when palpated, a crepitus (crunching) sensation is felt. There is limited movement of the finger or pain when moving. Transition to a chronic form of the disease is possible.

Chronic tendovaginitis is characterized by damage to the sheaths of the flexor and extensor tendons of the fingers in the area of ​​their retinaculum. Symptoms of chronic tendovaginitis of the common synovial sheath of the flexor fingers are often observed - the so-called carpal tunnel syndrome, in which a tumor-like painful formation of an elongated shape is determined in the area of ​​the carpal tunnel, which has an elastic consistency and often takes on the shape of an hourglass, shifting slightly with movement. Sometimes you can feel the "rice bodies" or determine fluctuation (the sensation of a transmission wave caused by the accumulation of fluid). Characteristic limitation of tendon movements.

A special form of chronic tendovaginitis is distinguished - the so-called stenosing tenosynovitis, or de Quervain's tenosynovitis, which is characterized by damage to the sheath of the extensor brevis and abductor pollicis longus tendons.

In this form of tendovaginitis, the walls of the vagina thicken, and the cavity of the synovial vagina, accordingly, narrows.

De Quervain's tenosynovitis is manifested by pain at the location of the styloid process of the radius, which often radiates to the first finger of the hand or to the elbow, as well as swelling. Increased pain occurs if the patient presses the first finger against the palmar surface and bends the remaining fingers over it; if at the same time the patient moves the hand to the elbow side, the pain is sharp. An extremely painful swelling is detected by palpation along the vagina.

Tuberculous tenosynovitis is characterized by the formation of dense formations (“rice bodies”) along the extensions of the tendon sheaths, which can be palpated (felt).

Complications

Purulent radiation tenobursitis is, as a rule, a complication of purulent tendovaginitis of the thumb. It develops when purulent inflammation spreads to the entire sheath of the flexor pollicis longus tendon. Characterized by severe pain along the palmar surface of the thumb and further along the outer edge of the hand to the forearm. If the disease progresses, the purulent process may spread to the forearm.

Purulent ulnar tenobursitis is, as a rule, a complication of purulent tendovaginitis of the little finger of the hand. Due to the peculiarities of the anatomical structure, the inflammatory process quite often passes from the synovial sheath of the little finger to the common synovial sheath of the flexor muscles of the hand, and less often to the synovial sheath of the flexor pollicis longus tendon. In this case, the so-called cross phlegmon develops, which is characterized by a severe course and is often complicated by impaired functioning of the hand. Characterized by severe pain and swelling of the palmar surface of the hand, thumb and little finger, as well as significant limitation of finger extension or its complete impossibility.

Carpal tunnel syndrome: its occurrence and clinical manifestations are caused by compression of the median nerve in the carpal tunnel.

Characterized by sharp pain and a feeling of numbness, tingling, crawling in the area (paresthesia) of the 1st, 2nd, 3rd fingers, as well as the inner surface of the 4th finger.

There is a decrease in the muscle strength of the hand, and the sensitivity of the tips of these fingers decreases.

The pain intensifies at night, which leads to sleep disturbance.

Some relief may occur when you lower your hand down and wave it. Quite often there is a change in the skin color of the painful fingers (blueness of the tips, pallor).

There may be a local increase in sweating and a decrease in pain sensitivity. When you feel the wrist, swelling and pain are detected. Forced flexion of the hand and raising the arm up can cause aggravation of pain and paresthesia in the area of ​​innervation of the median nerve.

Carpal tunnel syndrome is often combined with Guyon's canal syndrome, which is very rare on its own. With Guyon's canal syndrome, as a result of the ulnar nerve being compressed in the area of ​​the pisiform bone, pain and a feeling of numbness, tingling, crawling in the fourth and fifth fingers occur, swelling in the area of ​​the pisiform bone and pain when palpated on the palmar side are determined.

Laboratory diagnostics and examination

Tenosynovitis can be diagnosed by the characteristic localization of the pathological process and the data obtained during clinical examination (cord-shaped, painful lumps in typical places, impaired movement, identification of “rice bodies” upon palpation).

During a laboratory examination for acute purulent tendovaginitis, a general blood test (CBC) reveals leukocytosis (increased white blood cells over 9 x 109/l) with an increase in the content of band forms of neutrophils (over 5%), an increase in ESR (erythrocyte sedimentation rate).

Pus is examined by bacterioscopic (examination under a microscope after special staining of the 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 the course of acute purulent tenosynovitis is complicated by sepsis (when the infectious agent spreads from a purulent focus into the bloodstream), a blood test is performed for sterility, which also makes it possible to establish the nature of the pathogen and determine its sensitivity to antibacterial drugs.

X-ray examination is characterized by the absence of pathological changes in the joints and bones; only thickening of the soft tissues in the corresponding area can be determined.

Differential diagnosis

Chronic tenosynovitis should be differentiated from Dupuytren's contracture (painless progressive flexion contracture of the fourth and fifth fingers), acute infectious tenosynovitis - with acute arthritis and osteomyelitis.

Treatment of acute tendovaginitis is divided into general and local.

General treatment

General treatment for nonspecific acute infectious tenosynovitis involves fighting the infection, for which protobacterial agents are used, and measures are also taken to strengthen the body's defenses.

For tuberculous tenosynovitis, anti-tuberculosis drugs (streptomycin, ftivazide, PAS and others) are used.

General treatment of aseptic tenosynovitis involves the use of non-steroidal anti-inflammatory drugs (aspirin, indomethacin, butadione).

Local treatment

Local treatment for both infectious and aseptic tendovaginitis in the initial stage is reduced to ensuring rest of the affected limb (in the acute period of tendovaginitis, immobilization is carried out with a plaster splint), the use of warm compresses. After the acute phenomena have subsided, physiotherapeutic procedures (ultrasound, UHF, microwave therapy, ultraviolet rays, electrophoresis of hydrocortisone and novocaine), and physical therapy are used.

In case of purulent tenosynovitis, the tendon sheath and purulent leaks are urgently opened and drained. In the case of tuberculous tendovaginitis, a local injection of streptomycin solution is performed, as well as excision of the affected synovial sheath.

In the treatment of chronic tendovaginitis, the above methods of physiotherapy are used, and paraffin or ozokerite applications, massage and lidase electrophoresis are also prescribed; Physical therapy classes are conducted.

If the chronic infectious process progresses, puncture of the synovial vagina and administration of targeted antibiotics are indicated.

For chronic aseptic tendovaginitis, non-steroidal anti-inflammatory drugs are used; local administration of glucocorticosteroids (hydrocortisone, metipred, dexazone) is effective. In cases of chronic crepitant tendovaginitis that are difficult to treat, radiotherapy is sometimes used. In some cases, if conservative therapy for stenosing tenosynovitis is ineffective, surgical treatment is performed (dissection of the narrowed canals).

Tenosynovitis accompanying rheumatic diseases is treated in the same way as the underlying disease: anti-inflammatory and basic drugs are prescribed, electrophoresis of non-steroidal anti-inflammatory drugs, phonophoresis of hydrocortisone.

In the case of timely and adequate treatment, tenosynovitis is characterized by a favorable prognosis. However, with purulent tenosynovitis, persistent dysfunction of the affected hand or foot can sometimes remain.

Folk remedies for treating tendovaginitis at home

Spiny leaf (stemless thorn). Can be used as an external remedy for the treatment of boils and tendovaginitis. Boil 50 g of finely ground root in 500 ml of water for 30 minutes. Leave for 1 hour, strain. Use in the form of baths, compresses and bandages.

Cleavers. The raw material is the flowering aerial part, which is dried, ground into powder and sprinkled on the area of ​​the abscess or boil, covering with a bandage.

Woodruff fragrant. Apply a paste of leaves and aerial parts under a bandage to the area of ​​the abscess or for tenosynovitis. Change 2 times a day.

Tartarus prickly (thistle). It is used topically in the form of a paste from the aerial parts. It is useful to moisten napkins with juice and apply to a sore spot.

Sweet clover officinalis. This plant is used as a pain reliever for inflammatory skin diseases and abscesses. For external use (compresses, rinsing), use a hot infusion of 2 tablespoons of raw material per 500 ml of boiling water. Leave for 1 hour, strain. A paste of leaves and flowers can be applied under a bandage for abscesses and boils.

Lily is white. The plant bulbs are used to treat abscesses, boils, and tendovaginitis (in the form of a paste, changing every 4–6 hours). To treat wounds and bruises, use tincture of white lily flowers (2 tablespoons per 100 ml of vodka). Leave for 3-4 days.

Tenosynovitis of the wrist joint treatment

More information about the disease and the reasons for its development

The pathology affects the tendon sheaths. They pass in large numbers through the wrist joint.

The tendons are located on the side of the palm. Additionally, they are held in place by a tight ring.

To facilitate the sliding of tendons, so-called sheaths, or synovial membranes, are provided. This is a kind of case that is made of connective tissue.

There is synovial fluid inside the vagina.

Photo. Tenosynovitis of the hand

Tenosynovitis of the hand is a disease in which the walls of the tendon sheaths become inflamed. You can see what the affected joint looks like in the photo.

Most often women are affected by this disease. It has been noted that factors such as short stature and excess weight contribute to the development of the disease.

Types of tenosynovitis of the hand

Clinicians use a classification that is based on the etiology, nature of inflammation, as well as the duration of the pathological process.

• infectious;
• aseptic. This type includes crepitant tendovaginitis of the forearm, as well as reactive tendovaginitis (with systemic pathologies).

Schematic representation of tenosynovitis

According to the nature of inflammation:

• purulent tendovaginitis. 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 sheath;
• serous. 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 coating is formed on the surface of the membrane layers. It causes increased friction of the tendon.

From the duration of the flow:

• acute – up to 30 days;
• subacute – from one month to six months;
• chronic – over 6 months.

In accordance with ICD-10, the disease has code M 65.9. Tenosynovitis of the wrist joint can be acute or chronic. In the latter case, it is most often associated with ongoing stress and insufficiently active treatment of the primary acute process.

According to the etiology, inflammation of the tendon sheaths of the hand can be non-infectious (aseptic) and infectious. Aseptic tendovaginitis can be professional, reactive, post-traumatic and secondary. And infectious – specific and nonspecific.

Symptoms

Taking into account the clinical course, clinicians distinguish between acute and chronic forms of the pathology.

Acute

When inflammation of the wrist joint occurs, this phenomenon is called Carvin's syndrome. As the disease progresses, the tendons on the thumb and hand thicken. The disease develops rapidly, and if left untreated, the tendons become dead.

With tenosynovitis, pain in the area of ​​the wrist joint is bothersome, which intensifies when performing finger movements and usually has a zone of greatest intensity.

In this area, symptoms of acute inflammation are often detected: swelling, swelling and redness of soft tissues, a slight increase in skin temperature. Characteristic is limited mobility of the hand with a forced position of the fingers; this condition is called contracture.

When moving the fingers, crunching and crepitus are possible. If enlargement of the vagina and tissue swelling lead to compression of the neurovascular bundle of the wrist, numbness of the fingers, chilliness and discomfort in the hand may occur.

Diagnosis and treatment

At the first signs indicating the onset of the inflammatory process, you should immediately consult a doctor. In order for the treatment to have a successful outcome, it is necessary to carefully follow medical recommendations.

The first step is to carry out a diagnosis, which is done using MRI of the joints or ultrasound. To relieve pain, the patient is prescribed NSAIDs and other medications. Moreover, you need to limit the load on the affected limb

Tenosynovitis is treated with the following medications:

1. ointments that have an anti-inflammatory effect;
2. NSAIDs;
3. Glucocorticosteroids.

Moreover, it is useful for the patient to do such procedures as:

Treatment is often medicinal, but in many cases physiotherapeutic procedures are used, which are indispensable for joint inflammation.

Tenosynovitis can be prevented by regular exercise. It is important that the load is uniform and affects different muscle groups.

When examining a patient with complaints of pain in the wrist joint, the doctor conducts a differential diagnosis. This allows us to exclude diseases such as fractures, sprains and tears of ligaments, arthritis of various origins, osteomyelitis of the metacarpal bones and forearm bones, and stenosing ligamentitis.

In addition, it is important to identify possible infectious diseases (tuberculosis, brucellosis and others) and conditions that affect the body’s reactivity, especially endocrine diseases.

During the initial consultation, a surgeon, traumatologist or orthopedist conducts a thorough survey of the patient, identifies the presence of occupational hazards and the history of the development of the disease.

Observation of this disease is carried out by a traumatologist-orthopedist, and in the presence of characteristic symptoms - also by a neurologist. As a rule, to make a diagnosis, symptoms and the presence of factors that could provoke the development of pathology are sufficient.

Additional studies are carried out using radiography and ultrasound. It is important to rest the wrist joint during treatment.

Drugs are prescribed based on symptoms.

So, if painful sensations are present, pain-relieving blockades are recommended. Antiseptic compresses will help relieve swelling, redness and other signs of joint infection.

Usually, with such a diagnosis, you need to fix the wrist with a bandage or plaster. The development of the inflammatory process as a result of infection of the body by harmful bacteria is stopped with the help of antibiotics.

More radical therapeutic measures: UHF, laser therapy.

If there are purulent foci in the tendon sheaths, they must be drained. If this is not done, the infection will continue to spread and may affect all tendons.

In the absence of noticeable treatment results, surgical intervention is indicated. This measure allows you to remove the affected tendon sheaths.

The result is achieved quickly, but if the factors contributing to the development of such a pathology are not excluded, after some time the degenerative processes return.

At the stage of restoring the functionality of the joint, physical therapy and massage are recommended.

It is important to remember that in this case the exercises should not be dynamic, but static.

1. Calendula ointment. Take the flowers of the plant, mix them with baby cream in equal parts and rub them into the skin on the wrist.
2. Shepherd's purse grass. Prepare an infusion: 200 ml water, 1 tbsp. l. raw materials. The components are mixed, poured into a thermos and left alone for 2 hours. Then compresses are made; it is recommended to leave them overnight.
3. Ointment prepared on the basis of wormwood. Take 30 g of raw material and combine it with lard (100 g). The mixture is boiled, then cooled and used as a rub.

You can relieve inflammation with wormwood infusion. Prepare 2 tbsp. l. raw materials and 200 ml of boiling water. The ingredients are combined and left for 2 hours. Then the medicine is filtered and drunk 2-3 times a day before meals.

Treatment

The treatment tactics for tendovaginitis directly depend on the type of pathology, as well as on the clinical picture.

Aseptic treatment:

• apply a plaster splint to the affected tendon;
• anti-inflammatory drugs;
• physiotherapeutic procedures with novocaine blockades;
• mud applications.

Using a splint for tenosynovitis

Treatment of infectious type of pathology:

• if purulent exudate has accumulated in the synovial vagina, it is indicated to immediately open it and drain the tendon;
• application of a plaster splint;
• therapy for the underlying illness that provoked tenosynovitis;
• antibiotics;
• antiseptics;
• anti-inflammatory drugs;
• physiotherapy.

Treatment of the chronic form:

• broad-spectrum antibiotics;
• non-steroidal anti-inflammatory drugs;
• paraffin applications;
• massage;
• physiotherapy.

Treatment of tendovaginitis should begin with the creation of functional rest for the affected tendon. In addition, you can use warming ointments and compresses.

Drug treatment

Treatment of the disease will depend on its type. For infectious tendovaginitis the following are prescribed:

Antibacterial drugs have many side effects. If these medications are used irrationally, dysbacteriosis may develop, fungal skin diseases, and much more may occur.

Therefore, antibiotics must be used strictly as prescribed by the doctor. It is also necessary to remember that medications must be taken according to the schedule.

At the same time. While taking antibiotics, drinking alcoholic beverages is prohibited.

Immunomodulators. To increase immunity, a multivitamin complex is prescribed:

When detecting tenosynovitis of the wrist joint, it is very important to ensure rest of the affected hand. For this purpose, bandages, elastic bandages or special orthoses are used.

The patient is provided with a certificate of incapacity for work to exclude occupational hazards. During the acute period of the disease, it is advisable to use the hand as little as possible, avoiding repetitive movements performed quickly and with force.

To reduce inflammation, non-steroidal anti-inflammatory drugs are prescribed; they are applied topically (in the form of ointments and gels) and systemically (in the form of tablets and injections).

Additionally, painkillers are used; they do not have a therapeutic effect, but they alleviate the patient’s condition. And severe pain syndrome can be relieved with the help of novocaine blockades and corticosteroid drugs.

Tenosynovitis

ICD-10 code

Associated diseases

Titles

Description

Symptoms

Chronic infectious tendovaginitis is often caused by specific microflora (tuberculous mycobacteria, Brucella, spirochetes). Tuberculosis of the synovial vagina occurs with exo- and endogenous lesions. It is characterized by a slowly increasing, slightly painful swelling in the projection of the tendon sheaths and joint capsules. The flexor tendon sheaths are affected approximately 2 times more often than the extensors. The tuberculous process is initially limited (the synovial membrane is affected) and only then spreads to the tendons and surrounding tissues.

Brucellous tenosynovitis sometimes occurs as an acute infectious type, but the primary chronic form is more common. Damage to the extensor tendons with gradual limitation of finger mobility is typical. Damage to the synovial membranes of tendons is extremely rare in gonorrhea and syphilis.

Aseptic tendovaginitis includes dystrophic lesions of the tendon sheaths, post-traumatic and so-called reactive inflammatory tendovaginitis. Dystrophic tendovaginitis most often develops as a result of chronic microtraumatization (typists, pianists) and is characterized by a chronic relapsing course. Clinically, there is pain along the affected tendon sheaths (usually on the forearm), crepitus or crunching when the corresponding tendons move. A special clinical form of these tendovaginitis is stenosing tendovaginitis, which is characterized by partial blocking of movements in the osteofibrous canals, located mainly in the area of ​​the hands and ankles. There are several syndromes associated with stenotic tendovaginitis. Carpal tunnel syndrome occurs when there is stenosis of the latter in the area of ​​the palmar surface of the wrist joint with compression of the median nerve and tendons of the finger flexor muscles. Pain and paresthesia are noted in the area of ​​innervation of the median nerve (I, II, III fingers, the inner surface of the IV finger), the strength of the fingers and the ability to make fine and precise movements decrease.

De Quervain's stenosing tenosynovitis is tenosynovitis of the abductor longus and extensor brevis muscles of the first finger at the point where they pass through the osteofibrous canal at the level of the styloid process. It is characterized by pain and swelling in the area of ​​the “anatomical snuffbox”. Stenosis leads to impaired movement of the first finger.

Stenosing ligamentitis of fingers (usually I, III and IV) is caused by sclerotic processes in the area of ​​the annular ligaments of the tendon sheath. Characterized by a peculiar difficulty in straightening the finger (“snapping finger”).

Post-traumatic tendovaginitis develops with bruises and sprains of the ligamentous apparatus of the hand, sometimes with hemorrhage into the tendon sheath.

Causes

Treatment

Treatment of chronic infectious tendovaginitis consists of general specific therapy, with significant limitation of movements - excision of altered tendon sheaths, pathological granulations, and administration of targeted antibiotics.

When treating aseptic tenosynovitis in the acute period, immobilization of the affected tendon with a plaster splint in a functional position is necessary. Prescribe anti-inflammatory drugs (butadione, reopirin), physiotherapeutic treatment (electrophoresis with novocaine and potassium iodide, phonophoresis with hydrocortisone), dimexide applications. Novocaine blockades with hydrocortisone are effective. After the acute phenomena subside, mud applications (ozokerite) and other types of absorbable therapy are indicated against the background of dosed exercise therapy. A gradual increase in the load on the affected limb is important. If conservative treatment is ineffective, excision or dissection of the altered tendon sheath is indicated.

The meaning of victory

Pain is present not only during movements, but also at rest. Takes on a pulsating or twitching character. Purulent tendovaginitis is a very dangerous disease, as it can quickly spread to neighboring tissues: hands, feet, forearms and legs, contributing to the development of phlegmon.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. The consequences of tendon tendonitis can be very serious. A tendon is a dense, non-elastic connective tissue formation that connects muscles and bones or two bone structures.

It is also called septic or purulent tendovaginitis. Treatment in this case is only surgical; amputation of the limb is not excluded. Another symptom that may indicate this problem is the appearance of a specific crunching or clicking sound in this area during movements (crepitating tenosynovitis).

What is tenosynovitis and how to deal with it

A special clinical form of the chronic version of this disease is stenosing tenosynovitis, or de Quervain's tenosynovitis. Treatment measures primarily depend on the cause of tendovaginitis and can be conservative or surgical. The patient has symptoms of the disease that caused tenosynovitis.

As a result, injury and inflammation of the contacting tissues occurs. In those areas where this interaction occurs, the tendons are protected by special sheaths of the vagina. Diagnostics. In order to promptly and correctly treat the disease tenosynovitis, it is necessary to carry out a diagnosis as soon as possible.

Tenosynovitis of the foot and ankle

Treatment can be conservative or surgical. As tenosynovitis develops, the pain becomes so severe that the person can no longer ignore it and begins treatment. Therefore, with this form of the disease, it is necessary to consult a doctor as soon as possible and begin treatment.

This is a very common disease, especially among women and workers who, due to the nature of their work, are forced to perform the same type of hand movements every day. If the acute form responds well and quickly to treatment, then the chronic form can lead to dysfunction of the hand, which is why you even have to change your place of work.

This is a colossal load that would lead to damage to the bone of this soft tissue formation and its rupture. Between the two membranes there is a small amount of synovial fluid, which reduces the force of friction and impact.

The process can be due to many reasons, including infectious and aseptic. Due to swelling and accumulation of inflammatory fluid inside the tendon sheaths, all movements become difficult, become painful, and the function of the limb suffers. Such intensive work leads to depletion of synovial fluid reserves, increased friction, microtraumatization of connective tissue and the development of aseptic inflammation.

Chronic tenosynovitis

They can penetrate directly from the external environment during injuries and open wounds or be carried through the blood and lymphatic fluid from other foci of infection in the body. Pain appears with active and passive movements of the hand. Most often this is the area of ​​the thumb and wrist joint (damage to the flexor tendons of the 1st and 2nd fingers).

Acute tenosynovitis

In the acute purulent form, pronounced signs of inflammation appear. With the development of purulent complications, the patient’s general condition worsens significantly; signs of inflammation from one finger spread to the entire hand and/or forearm. It may have a primary chronic course or be a complication of the acute form of the disease if it is not treated. The diagnosis of tenosynovitis is purely clinical.

Crepitant tenosynovitis of the tendons is aseptic and develops as an independent disease. In the chronic form of tenosynovitis, the symptoms are less pronounced. Aseptic tendovaginitis is divided into professional and reactive forms of the disease. Tenosynovitis is an inflammation of the tendon tissue and the sheath that covers it (tendon sheath). The prognosis for tendovaginitis is favorable provided that treatment is started on time and its volume is adequate.

Tenosynovitis - causes, symptoms, treatment options and prevention

Under certain factors, the inner membrane covering the tendons may become inflamed. In this case, the doctor can diagnose a number of diseases, including tenosynovitis.

As a rule, tenosynovitis can affect not only the wrist joints, but also the shoulder and forearm joints, ankles and feet. Another feature of this disease can be considered its development only in the sheathed areas of the tendons.

What other features of the disease tendovaginitis, how to diagnose and treat it, read on.

Tenosynovitis

Tenosynovitis is an inflammation of the inner (synovial) membrane of the fibrous sheath of the muscle tendon. Occupational paratenonitis, tenosynovitis, crepitant tenosynovitis occur in typists, seasonal workers, ballerinas, athletes, etc.

The sheath covering the tendons is called the tendon sheath. If, under the influence of certain factors, its inflammation begins, spreading to other articular tissues and the tendon itself, a disease such as tenosynovitis develops. Tenosynovitis is often confused with tendon, a common inflammation of the tendon itself that does not affect the sheath.

The difference between tenosynovitis is that it develops only in those parts of the tendon that are covered with a sheath. The following areas are usually affected:

• Forearm and shoulder;
• Wrist joint and hand;
• Ankle and foot.

Tenosynovitis of the hand is very common among women and workers who daily perform repeated, similar movements that involve the wrist joint (for example, sewing, cutting, packaging, food processing). In women, the cause of illness is the daily performance of household chores.

In acute form, if you consult a doctor in a timely manner, treatment of the disease is almost always successful and quite quickly. But if it becomes chronic, treatment of the tendon can be protracted.

Tendons are dense and inelastic connective tissue located between a bone or bones and muscles. When muscle tissue contracts when moving an arm or leg, the tendons also move along with it. Researchers have recorded that the tendon of the wrist joint makes more than 10 thousand movements per day.

This is a huge burden. If the surface of the tendon were not covered with a protective synovial membrane, it would be severely injured by the bone, which would inevitably eventually lead to its rupture.

This sheath, or tendon sheath, consists of two parts. The inner sheath tightly encloses the tendon. And the external one forms a kind of capsule around the tendon.

Vibrations and friction during movements are reduced by synovial fluid, which fills the space between the two sheaths of the tendon sheath. All this provides optimal protection of the tendon from mechanical damage.

With tenosynovitis, the inflammatory process involves both the tendon sheath and the tendon itself.

The nature of the inflammation can be either infectious or aseptic. The accumulation of fluid in the tendon sheath causes swelling, and the swelling causes limited mobility of the limb and pain.

The inflammatory process occurring in the synovial membranes of the fibrous sheath of muscle tendons is called tenosynovitis. It can develop as an independent disease and as a consequence of various infectious diseases.

According to ICD 10, tenosynovitis refers to lesions of the synovial membranes and tendons - code M65-M68, synovitis and tenosynovitis - code M65, other synovitis and tenosynovitis - code M65.8.

Tenosynovitis is an inflammation of the tendon tissue and the sheath that covers it (tendon sheath). Unlike tendonitis (simple inflammation of the tendon), tendovaginitis develops only in certain anatomical places, where the tendons are covered with a sheath: the area of ​​​​the forearm, wrist joint, hand, ankle joint and foot.

This is a very common disease, especially among women and workers who, due to the nature of their work, are forced to perform the same type of hand movements every day. The consequences of tendon tendonitis can be very serious.

If the acute form responds well and quickly to treatment, then the chronic form can lead to dysfunction of the hand, which is why you even have to change your place of work. According to ICD-10 (International Classification of Diseases, 10th revision), tenosynovitis has the code M65.9.

A tendon is a dense, non-elastic connective tissue formation that connects muscles and bones or two bone structures. During muscle contractions, these structures move relative to the tissues surrounding them. According to official medical data, the tendon in the area of ​​the wrist joint makes 10 thousand movements or more per day.

This is a colossal load that would lead to damage to the bone of this soft tissue formation and its rupture. But in the area where the tendons come into contact with the surrounding tissues, there are special protective sheaths, sheaths. They consist of 2 synovial membranes.

The inner one fits tightly to the tendon, and the outer one encloses it all in a kind of capsule. Between the two membranes there is a small amount of synovial fluid, which reduces the force of friction and impact. Thus, the tendon is perfectly protected from damage due to friction.

With tenosynovitis, both the tendon itself and its sheath become inflamed. The process can be due to many reasons, including infectious and aseptic. Due to swelling and accumulation of inflammatory fluid inside the tendon sheaths, all movements become difficult, become painful, and the function of the limb suffers.

If the disease is not treated, it can become chronic with the development of specific complications, and in the case of purulent inflammation, the infection can spread to neighboring tissues with the development of phlegmon and sepsis.

Types of tenosynovitis

Regardless of location, the disease can be divided according to etiology into two groups:

• Infectious tendovaginitis;
• Aseptic tendovaginitis.
• Infectious form

This form of the disease is often called septic or purulent. Inflammation is caused by pathogenic microorganisms that get inside the tendon coupling. The infection can come from outside, through injury or surgery. Or it can get inside the tendon along with blood or lymph from other infected organs.

Purulent tendovaginitis is very dangerous. Pus can extend beyond the tendon sheath, and then the infection can spread to the entire limb. In severe cases, when conservative treatment turns out to be ineffective due to delay, an arm or leg has to be amputated.

There are two types of purulent tenosynovitis:

1. Nonspecific, provoked by the growth of opportunistic microorganisms such as staphylococci, streptococci, and E. coli.
2. Specific, caused by tuberculosis, syphilitic, gonorrheal, brucellosis infection.

In the first case, treatment is carried out using antibiotics, in the second case, treatment is aimed at eliminating the underlying disease that caused such a complication as tenosynovitis.

Nonspecific - occurs as a result of damage to the membranes of the muscle tendon sheath by pathogenic coccal microorganisms.

The disease develops for the following reasons:

• injuries: cut, splinter, burn;
• panaritium (purulent focus in the tissues of the finger);
• osteomyelitis of the phalanx of the finger, bones of the foot or hand;
• arthritis with discharge of pus;
• distant source of infection (through the blood) with gangrene of the lung, liver abscess and others.

Specific. Occurs against the background of diseases such as:

In this case, tenosynovitis develops as a result of damage to the synovial vagina by the pathogens that caused these diseases. The patient has symptoms of the disease that caused tenosynovitis.

According to etiology, the disease can be:

Depending on the cause that led to the development of infectious tandevaginitis, specific and nonspecific ways of occurrence of the disease are distinguished.

Aseptic tendovaginitis is divided into professional and reactive forms of the disease.

Professional. Occurs in individuals engaged in professional activities that require frequent similar movements. With intensive work of muscles, and therefore tendons, the amount of synovial fluid, which softens tissue friction, decreases. As a result, injury and inflammation of the contacting tissues occurs.

Reactive. Occurs as a consequence of diseases that provoke toxic reactive inflammation:

• rheumatism;
• Reiter's syndrome;
• scleroderma;
• Bekhterev's disease;
• rheumatoid arthritis.

The inflammatory process with tendovaginitis occurs:

• serous (accumulation of serous exudate in the tendon capsule);
• serous-fibrinous (transformation of serous exudate into fibrinous);
• purulent (presence of purulent pathogenic contents).

According to the clinical manifestations of tenosynovitis, they are distinguished:

The acute form occurs as a result of infection, injury or overload of the hand or foot. The onset of the disease is acute. Serous or purulent exudate forms in the synovial cavity, which disrupts the blood supply to the tendon. Accompanied by severe pain and swelling of the tissue along the synovial vagina.

More often it occurs on the back of the feet or hands. If treatment is not timely, tissue nutrition may be disrupted with further development of tendon necrosis.

The chronic form can arise as complications from the acute form or develop independently. It is most often found in the common synovial sheath of the digital flexor muscles, located in the wrist and elbow joints. The disease is not characterized by sharp and pronounced symptoms, but it is more difficult to treat.

The disease develops in various forms, which can be grouped into four basic types:

1. Acute infectious tenosynovitis. The disease is provoked by pyogenic microflora that has penetrated into the vagina. Purulent and serous exudate accumulates in the synovial tendon tissue, and the blood supply is disrupted. In the photo, the pathology looks creepy.
2. Chronic infectious tendovaginitis. As in the previous case, the process is triggered by foreign (but already specific) microflora - spirochetes, tuberculosis, etc.
3. Brucellosis type. Its character resembles an acute infection, but there is also a primary chronic form. The main feature is penetration into the extensor tendons. After this, finger movements become limited. There are problems with the hands.
4. Aseptic (non-infectious) varieties. It is a consequence of constant microtraumatization (musicians, typists), as well as sprains and bruises of the carpal ligament apparatus.

If the key clinical symptom is a crunch, then you are faced with an occupational type of the disease - crepitant tenosynovitis. This pathology of the musculoskeletal system is a very common phenomenon. Among the main causes of this lesion are strong muscle tension in the forearm, frequently repeated wrist movements, and an uneven rhythm of work.

• locksmiths;
• carpenters;
• carpenters;
• turners;
• polishers;
• blacksmiths;
• hand milking milkmaids;
• grinders;
• ironers;
• typists.

Causes of the disease

Specific aseptic tenosynovitis occurs as a result of minor injuries to the synovial membrane that occur during prolonged muscle strain, overwork, muscle strains, and prolonged exposure to low temperatures.

The occurrence of infectious tenosynovitis is associated with specific and nonspecific infections. Purulent arthritis, infected wounds, osteomyelitis can act as a source of nonspecific infection. A specific infectious process is characterized by the entry of pathogens of various infectious diseases (brucellosis, tuberculosis) into the tendon sheath.

Also, the cause of tenosynovitis can be a reactive type of inflammation due to rheumatism or infectious arthritis.

The main symptoms of the disease are swelling of the tendon sheath, soreness of the tendons, hyperemia and swelling of the skin. If we are talking about infectious tendovaginitis, there is an increase in body temperature, enlarged lymph nodes, chills, and weakness.

Tendon diseases occur in both the upper and lower extremities after sudden overload, especially after vacation (when maladaptation occurs), preparation for competitions, etc. Tendon ruptures rarely occur, for example the heel tendon in ballerinas, but it should be remembered that, as a rule, pathologically altered tendons rupture. All types of tendon pathology are pathogenetically interrelated.

In the area of ​​attachment to the joint, the tendons are covered with hard fibers of connective tissue - the synovial membrane. On the one hand, such a “fastening system” performs protective functions, preventing tendon ruptures in its most vulnerable area, where it is constantly subject to load am.

But the relative rigidity of the connective tissue, in turn, does not provide adequate elasticity, and with regular loads on the same area of ​​the tendon in the connective tissue microdamages appear on the fibers - the main cause of non-infectious tendovaginitis.

The infectious form of the disease, tendovaginitis, most often develops as a result of infection of wounds and systemic infectious diseases, in which the pathogen penetrates into the membrane of the dry skin. housing with blood flow.

Tendons are a dense and non-elastic soft tissue formation that connects human muscles and bones. Thanks to tendons, when muscles contract, bone structures move.

In those areas where this interaction occurs, the tendons are protected by special sheaths of the vagina.

• When tissues move relative to each other, friction occurs, which is softened by the synovial fluid located inside the capsule (vagina).
• As a result of inflammation of the synovial sheath of the tendon, the amount of fluid decreases, and tissue friction increases, which leads to injury.
• Since the synovial vagina is an oblong capsule or channel with fluid, the inflammatory process spreads along the entire cavity within a few hours. From the finger, palm to forearm (for the little finger and thumb) and to the base of the second, third and fourth fingers. After a day or two, the adjacent synovial vagina may become infected.
• The spread of inflammation in the foot also depends on the anatomy of the location of the damaged tendon capsule.

Symptoms of tendon tenosynovitis manifest differently depending on the etiology and form of the disease.

Most cases of tendinitis occur in middle-aged or older people as the tendons become more susceptible to damage. However, tendinitis also occurs in younger people who exercise too intensely or in those who perform repetitive movements.

Certain tendons, mainly the tendons of the hand, are particularly susceptible to inflammation. Inflammation of the tendon that extends the thumb is called Kuervain's disease. The inflammation can block the tendons that flex the other fingers, causing the characteristic syndrome (snapping finger). Inflammation of the long head of the biceps (biceps muscle of the arm) causes pain when bending the elbow and rotating the forearm.

The Achilles (heel) tendon and the tendon that runs along the back of the foot are also often inflamed. Tendon sheaths can also be affected by joint diseases such as rheumatoid arthritis, scleroderma, gout, and Reiter's syndrome. In gonorrheal infections in young people, especially women, tenosynovitis can be caused by gonococci, usually affecting the tendons of the shoulders, wrists, fingers, thighs, ankles and feet.

Symptoms of tenosynovitis

Most often, clinical signs of the disease appear in the common synovial sheath of the fingers, located in the carpal tunnel. In this place, an elastic tumor with an oblong shape can be felt. By palpating the tumor, fluctuation can be detected. The tendons are painful and their mobility is limited.

Stenosing tenosynovitis is one of the forms of the disease. In this case, the tendon sheaths of the extensor brevis and abductor pollicis muscles are affected. As a result, the lumen of the synovial cavity decreases.

The first symptom of chronic tendovaginitis is pain in the area of ​​the styloid process of the radius. Palpating the tendon sheath, a tumor is detected; palpating it causes acute pain in the patient. When the thumb is abducted and flexed, pain appears, radiating to the area of ​​the forearm and shoulder.

Clinical signs of stenosing tenosynovitis are similar to those of stenosing ligamentitis. With stenosing inflammation of the ligaments, the inflammatory process spreads to the entire ligamentous apparatus of the hand. The disease occurs as a result of injuries, overexertion, and infectious diseases.

The localization of inflammation is the area of ​​the collateral ligaments of the interphalangeal and metacarpophalangeal wrist joints. Movement and palpation of these joints cause pain, and the site of inflammation is characterized by swelling, redness and swelling. The disease can cause necrosis of some part of the ligamentous apparatus, which is accompanied by a decrease in tendon gliding and difficulty in moving the finger.

Tenosynovitis in tuberculosis is diagnosed by palpation. In the tendon sheaths, so-called “rice bodies” of dense consistency are found.

Inflammation of the tendon is usually accompanied by pain with movement and touch.

Even minor movements in a joint close to the tendon can cause severe pain. Tendon sheaths often become swollen due to fluid accumulation and inflammation. In the absence of fluid, friction produces a characteristic sensation or sound that can be heard with a stethoscope as the joint moves.

All symptoms: sharp pain when touched, pain when moving the joint, swelling over the affected tendon, creaking over the tendon.

When to see a doctor

• For pain in the joint when moving, swelling in the joint area.
• When there is a feeling or noise of friction in the joint when moving.
• With redness of the skin over the joint, pain on palpation.

Taking into account the clinical course, acute and chronic tenosynovitis are distinguished. Let's look at the characteristic signs of these variants of the disease.

Acute tenosynovitis - an acute aseptic form develops after overload of a certain area of ​​the body (hand or foot). The most commonly affected muscles are the forearm flexor tendons. Swelling or slight smoothing of the contours appears in the diseased area, so not all patients pay attention to this.

Skin color does not change. Pain appears with active and passive movements of the hand. Its location depends on which tendon is affected. Most often this is the area of ​​the thumb and wrist joint (damage to the flexor tendons of the 1st and 2nd fingers).

Another symptom that may indicate this problem is the appearance of a specific crunching or clicking sound in this area during movements (crepitating tenosynovitis).

In the acute purulent form, pronounced signs of inflammation appear. The sore finger turns red, the skin over it is hot, tense, shiny, and may have a bluish tint. Pain is present not only during movements, but also at rest. Takes on a pulsating or twitching character.

At the same time, signs of general malaise appear:

• reactive inflammation of regional lymph nodes;
• fever;
• general weakness;
• headache;
• lack of appetite.

With the development of purulent complications, the patient’s general condition worsens significantly; signs of inflammation from one finger spread to the entire hand and/or forearm. Septic shock may occur.

Chronic tendovaginitis - develops only with aseptic lesions. It may have a primary chronic course or be a complication of the acute form of the disease if it is not treated.

As a rule, such patients complain only of pain that occurs when performing certain movements. There is also pain on palpation along the inflamed area, and sometimes crepitus can be detected.

A special clinical form of the chronic version of this disease is stenosing tenosynovitis, or de Quervain's tenosynovitis. With it, the inflamed tendon is compressed in the osteofibrous canal, which leads to constant and quite severe pain.

Nerves that pass nearby can also become damaged, leading to complications such as carpal tunnel syndrome. As we already know, tenosynovitis can be acute and chronic. The set of symptoms in both cases will be slightly different.

• swelling (severe) of the synovial membrane;
• rush of blood;
• painful swelling (in the tendon sheath area);
• limited movement;
• crunching (observed when moving a finger);
• contracture (cramping of fingers);
• chills (with purulent inflammation);
• temperature increase;
• inflammation of the lymph nodes and nearby vessels.

The chronic form is usually associated with a person’s professional activity and mainly affects the wrists, elbows and hand joints.

• pain (occurs with active movement);
• decreased joint mobility;
• crunching or clicking (observed when squeezing the hand and moving the wrist).

Diagnosis and risk factors

By palpation, local pain is determined in case of tenosynovitis, and the diagnosis of crepitant tenosynovitis is based on the sensation of a crunching sensation in the tendons in the lower third of the forearm while moving the fingers. Tendon diseases are accompanied by neurotrophic disorders - increased sweating or dry skin of the fingers or toes, pastosity.

The doctor makes a conclusion about tendovaginitis based on the patient’s complaints, the results of a physical examination and the characteristic signs that are characteristic of this disease.

Depending on the suspected cause of inflammation of the tendon sheaths, the following diagnostic procedures may be prescribed:

• x-ray (to confirm thickening of tendon tissue);
• laboratory blood tests if an infectious nature of the disease is suspected.

If the patient has a history of tuberculosis, syphilis, brucellosis, or gonorrhea, he will be prescribed additional examination by a dermatovenerologist, infectious disease specialist or pulmonologist, with additional diagnostic procedures.

Tenosynovitis of the foot or hand is detected only clinically. There are no special studies that would help accurately diagnose this disease. For an experienced doctor, a visual examination of the patient is enough to determine it.

In case of doubt, if the symptoms are mild, the following examinations are performed:

1. Various tests using different movements to determine which tendon is affected.
2. X-ray of the diseased limb.
3. Computed tomography or MRI.
4. Clinical blood and urine tests.

Additionally, an examination by a neurologist may be necessary if injury to nerve endings is suspected.

In order to promptly and correctly treat the disease tenosynovitis, it is necessary to carry out a diagnosis as soon as possible. For infectious and aseptic tendovaginitis, it will differ, since for the first it is necessary to determine the type of pathogen, as well as to exclude diseases that could provoke the development of the inflammatory process in the vagina of the joints.

Diagnosis is carried out on the basis of the clinical picture, laboratory and instrumental studies (blood tests, urine tests, x-rays of the hands and feet).

The diagnosis of tenosynovitis is purely clinical. There is not a single method that would accurately confirm it. An experienced doctor will immediately see this pathology. But in some cases, additional examinations are required to rule out similar diseases.

Risk factors for the development of tendovaginitis include specific professional activities, which are characterized by: lifting weights; constant repeated loads on the same muscle group (working on a computer, typing, shorthand, playing musical instruments, etc.).

Participation in some types of sports: speed skating; athletics (running, jumping); skiing Under some circumstances, tendovaginitis can develop for reasons that seem not to contribute to the disease.

For example, a mother or father does not notice the efforts they make to take the child out of a crib with high sides. By repeating this action several times a day, the baby’s parents may notice the first symptoms of the disease after some time.

Treatment of tendovaginitis

To relieve the symptoms of tendinitis, rest, immobilization with a splint or plaster cast, exposure to high temperature or, conversely, cold are prescribed. All of these measures can have a therapeutic effect. Nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, reduce pain and inflammation; they are taken from 7 to 10 days.

Sometimes corticosteroids and local anesthetics are injected into the tendon sheath. This procedure is especially effective in treating trigger finger. In rare cases, the injection causes an exacerbation of the disease, which lasts less than 24 hours and is relieved with cold, compresses and analgesics.

Treatments usually have to be repeated every 2-3 weeks for a month or two before the inflammation completely subsides. Chronic tendonitis, which can occur, for example, with rheumatoid arthritis, often requires surgical treatment to remove the inflamed tissue.

Physiotherapy is necessary after surgery. Surgery is usually necessary to treat chronic snapping finger or to remove calcium deposits in areas of chronic tendinitis, such as around the shoulder joint.

Whatever the cause of the disease tendovaginitis, the task of primary importance in its treatment is to eliminate the causes that caused the inflammation. Therefore, when any systemic disease is detected (infectious, inflammatory, degenerative, etc.), therapy is carried out under the supervision of a specialist doctor I am undergoing treatment for this disease.

In most cases, when treating tendovaginitis, immobilization of the joint located next to the inflamed tendon is prescribed. To do this, a splint or splint is placed on the hand, foot, elbow, knee joint, completely limiting the movements of the joint and tendon, which allows eliminating the traumatic factor of the burning.

Based on the results of diagnosing tendon tendonitis, the doctor prescribes treatment and gives general recommendations for combating the disease. Treatment can be conservative or surgical.

Among the medications used are:

• painkillers;
• non-steroidal drugs (to eliminate inflammation);
• antibiotics (for bacterial etiology of the disease);
• enzyme preparations (do not allow adhesions to form).

Physiotherapy procedures are used to treat tendovaginitis:

Therapeutic measures can be supplemented with folk methods of combating the disease. In this case, you need to consult a doctor about the advisability of using this or that remedy.

Symptoms and treatment of different types of tenosynovitis according to location (foot, ankle, hand, wrist joint, fingers), form and course of the disease (crepitating, stenotic, purulent) have their own distinctive characteristics.

Treatment methods for tendovaginitis can be divided into general and local. In acute cases of the disease, the limb must be fixed (immobilized).

After this, various methods of physiotherapy are prescribed (warming compresses with paraffin, ozokerite are used, electrophoresis is performed using a dimexide solution). For the treatment of chronic tendovaginitis, UHF therapy and the use of Rosenthal paste are effective.

Drug treatment consists of the use of antibacterial and anti-inflammatory drugs. In addition, painkillers and vitamin preparations are used.

When choosing a method of therapy, you need to take into account the characteristics of the course of tenosynovitis. Treatment of specific tendovaginitis is carried out taking into account the characteristics of the underlying pathology. Treatment of nonspecific tendovaginitis is often carried out surgically.

The success of treatment of the disease is influenced by the stage of the inflammatory process during tenosynovitis. Therefore, the chances of a complete recovery in patients who seek help from a specialist when the first symptoms of the disease appear will be significantly higher than in patients with an advanced form of tenosynovitis.

It is necessary to understand that if you consult a doctor in a timely manner, the risk of complications and the possibility of tenosynovitis transitioning from an acute to a chronic form are reduced.

Therapy for the chronic form of inflammation of the tendon sheath is carried out using physiotherapy methods, applying paraffin compresses, and taking mud baths. Patients are prescribed electrophoresis using lidase and massage. To restore joint function, therapeutic physical training is recommended.

If the pathological process intensifies, then it is necessary to perform a puncture of the synovial vagina. In this case, antibacterial and non-steroidal anti-inflammatory drugs are prescribed. In addition, hydrocortisone and novocaine are injected into the area of ​​inflammation.

If chronic tendovaginitis does not respond particularly effectively to therapy, then positive dynamics in the treatment of the disease is achieved with the help of x-ray therapy sessions. However, their number should be no more than two. In order to expand the lumen of the tendon sheath in case of stenosing tenosynovitis, it is advisable to dissect a certain area of ​​it.

Purulent tenosynovitis may be accompanied by complications: persistent changes in the functions of the feet or hands. Treatment measures primarily depend on the cause of tendovaginitis and can be conservative or surgical.

Treatment of acute and chronic forms

General medical and local procedures are used. Immune defense is strengthened. Antibacterial drugs are administered. If tuberculous tenosynovitis is detected, the patient is prescribed anti-tuberculosis therapy.

When treating the aseptic form, the patient uses NSAIDs (acetylsalicylic acid, indomethacin, butadione). Local therapy involves the application of a plaster splint and warm compresses.

When the disease declines, therapeutic tactics change. The patient is transferred to physiotherapeutic procedures:

• ultrasound;
• microwave.

In case of a purulent lesion, the tendon sheath is urgently opened, and the surgeon performs drainage.

All the procedures we described in the previous section also apply to chronic tendovaginitis. Also added:

• massage;
• physiotherapy;
• paraffin and mud applications;
• electrophoresis.

The chronic infectious process should not progress. If this happens, doctors perform a vaginal puncture, after which the following drugs are administered:

• NSAIDs;
• targeted antibiotics;
• local solution of hydrocortisone (mixed with novocaine).

The persistent progress of crepitant tenosynovitis forces specialists to resort to radiotherapy (1-2 sessions).

If the disease is treated competently and in a timely manner, the doctors' prognosis will be favorable. The exception is purulent lesions, since there is a high probability of maintaining functional disorders of the hands and feet.

Non-drug treatment

For the treatment of chronic tendovaginitis and recovery after an acute form of the disease, the following physiotherapy methods are used:

• UHF therapy;
• paraffin applications and baths;
• electrophoresis with the use of medications (painkillers, anti-inflammatory, vitamin-mineral);
• ozokerite.

Therapeutic physical education is contraindicated in the acute form of the disease or in case of exacerbation of the chronic course of the disease. A set of exercises that helps stretch and strengthen muscles, and also helps to “train” muscles and ligaments to correctly distribute loads, can be shown at the rehabilitation stage - after how the drug treatment was carried out and the symptoms of the disease were removed.

Traditional medicine in the treatment of non-infectious forms of the disease tenosynovitis has confirmed its effectiveness with alcohol compresses applied to the area of ​​the inflamed tendon.

Please note: traditional treatment should be carried out only with the approval of the attending physician and in parallel with medical treatment, but not as a replacement for it! Without contacting a doctor and using only traditional treatment for the disease, you risk getting complications!

Folk recipe for rubbing: to increase the effectiveness of alcohol or alcohol tinctures, it is recommended to add 3-4 drops of geranium essential oil or apply the oil as a standalone preparation: 3-4 to Mix a drop of essential oil with drops of any vegetable oil and rub this mixture into the area of ​​inflammation.

Prevention

Treatment of occupational tendon diseases comes down to creating rest, for which finger movements are prevented by applying a plaster splint from the fingertips to the upper third of the forearm for a period of 7-10 days, anti-inflammatory drugs are prescribed; physiotherapeutic procedures used until complete recovery.

Surgical treatment is indicated for patients with tendon ruptures. To prevent occupational tendon diseases, exercises and loads in strength and rhythm should be increased gradually.

Regular self-massage can be a strong preventive measure. To do this, select an area located just above the affected area (suction self-massage). Stroking alternates with squeezing.

When starting repeated stroking actions, try to get closer to the problem area. Add kneading to the complex. All manipulations should be performed 3-4 times. The next stage is straight rubbing.

With each subsequent exercise cycle, the pressure on the affected area should increase. If a painful syndrome suddenly appears, stop the procedure. Don't forget about warming and healing ointments - they will perfectly complement the therapy. You can also use thermal means (bath, compresses, hot baths, heating pads).

All of the above methods will gradually give positive results.

Striated muscles have a formation at the end that serves as an attachment for the muscle to the skeletal bones. This structure is based on collagen fibers interspersed with rows of fibrocytes that form tendons.

As a result of traumatic or other impact, this tissue can become inflamed - most often this occurs in the area of ​​​​the transition from tendon to muscle or in the immediate place of attachment of muscle to bone.

Essentially, joint tendonitis is an acute or chronic inflammation of the tendon, which can also affect the tendon bursa or tendon sheath. Inflammation of the entire tendon rarely spreads; as a rule, this indicates an advanced chronic process, when degenerative processes have the greatest impact.

This disease, depending on the etiology and location, may have an ICD 10 code M65, 75, 76, 77.

The causes of tendonitis are excessive physical activity, which can be either one-time or regular. As a result, the tendon fibers receive micro-tears. Most often, professional athletes and people engaged in monotonous physical labor are susceptible to the disease.

Tendinitis can be recognized by painful physical activity, increased temperature in the affected area combined with hyperemia, as well as slight swelling of the soft tissues.

If tendonitis has acquired the character of a chronic disease, then stopping exacerbations will be an important area of ​​treatment. Treatment can include both medication and surgery.

Symptoms of tendinitis

Tendons are attached in close proximity to the joint. Therefore, when the tendon becomes inflamed, pain will be felt near the joint, which often makes a person think that the problem lies in the joint. Regardless of location, all tendinitis will have the following symptoms:

• At rest, the tendon does not bother you, but as soon as you start moving the affected limb, pain will immediately manifest itself. In addition, the affected tendon will respond painfully to palpation.
• When touched, the skin over the affected area may be red and feel warmer to the touch in the localized area.
• If you listen or use a phonendoscope, the tendon will make a characteristic crunching sound when active.

Depending on the location, each type of tendinitis will have its own specific characteristics.

Tendonitis is characterized by a gradual onset of symptoms. This may result in an increase in pain.
Initially, tendon soreness manifests itself exclusively in peak load situations and most patients do not attach any importance to this, maintaining their usual mode of activity.

During development, pain syndromes become more pronounced and the degree of stress gradually weakens to feel them. The patient begins to experience discomfort in everyday activities. A mild swelling of the soft tissue may form at the site of the lesion.

Types of disease

The inflammatory process of the tendon varies depending on the location. In each case, characteristic features of tendinitis can be identified.

Achilles tendonitis

When the heel tendon becomes inflamed, it is called Achilles tendonitis. Occurs due to poor quality metabolism and impaired tissue conductivity.

When the tendon tissue begins to crack and then scar, the preconditions for the formation of tendonitis gradually develop. Ultimately, it is even possible for the tendon to separate from the heel bone. In addition to the tendon itself, the adjacent tissues of the articular apparatus may be involved in the inflammatory process.

There are cases when the cause of the development of the disease lies in an imbalance of substances that cause the deposition of calcium salts in the tendon tissues. Ultimately, there is a chance of developing a heel bump called plantar fasciitis.

Achilles tendinitis can develop over several months. May manifest itself when going up and down stairs or an inclined plane. The pain is felt after sleep and does not go away after warm-up exercises. Soreness appears after sleep. The patient cannot rise to his toes, which clearly indicates a tendon injury.

Shoulder tendinitis

Near the shoulder joint there are tendons that provide attachment for a large number of muscles, because to ensure such freedom of action, good support is needed.

If the loads and operating mode are not observed, the tendon of the rotator cuff, which includes the tendons of the supraspinatus, teres minor, subscapularis and infraspinatus muscles, is the first to suffer. The second most popular is tendinitis of the biceps brachii or biceps muscle. The supraspinatus is most often affected.

This problem is especially troubling for manual workers and athletes, because they have to immobilize the joint during the rehabilitation period. For those who are familiar with chronic tendonitis, it is very important to properly develop the affected tendons and prevent injury.

Men over 40 are also characterized by calcific tendinitis, which is based on metabolic disorders. Calcium salts trigger pathological degenerative processes in tissues. If left untreated, the processes spread to adjacent joint tissues and muscles. The muscles, subacromial bursa, and shoulder joint capsule suffer.

Knee tendinitis

Jumper's knee is also known as patellar tendonitis. It is this tendon that receives the maximum load during the pushing activity of an athlete. The quadriceps muscle experiences enormous load during jumping, which leads to regular microtrauma.

The disease develops slowly and tends to be chronic. If you do not pay attention and continue to load the knee, you end up with a serious inflammatory process.

Knee tendinitis in the initial stages is successfully treated with conservative methods and physiotherapy. However, in advanced cases it is necessary to perform surgical intervention when the inflamed or torn part of the tendon is excised. The operation is performed using small incisions endoscopically. Healing will require time and constant development of the knee joint, otherwise mobility may be limited.

This pathology is also called “pes anserine tendinitis” because of the shape of the tendon. Sometimes it can be found in adolescents and children, who, due to the immaturity of the ligamentous apparatus, are at risk of receiving a similar injury.

Inflammation of the tendons in the ankle area is a real scourge for athletes and women who prefer high heels.

Tendinitis of the ankle joint develops against the background of regular injuries - dislocations, subluxations, bruises.

During treatment, it is very important to fix the joint and give the limb complete rest. This can be problematic, since the ankle is under load from its own body weight. If it is necessary to completely immobilize a limb, not only splints, but also crutches can be used.

Overweight people will also be at risk. Firstly, this is an additional load on the ankle tendons, and secondly, it is often an incorrect metabolism, which provokes an acceleration of the destruction of the collagen fiber of the tendon.

Treatment of the ankle requires the use of all resources to speed up the rehabilitation of the limb. If surgical intervention is necessary, the joint will be developed and the tendons will be adapted.

In addition, we must not forget that in the foot, as in the hands, there is also a large number of tendons responsible for the work of the fingers and the shock-absorbing properties of the foot when walking. The inability to support in case of inflammation will also require prompt intervention from a doctor.

Tendinitis of the elbow joint

When tendonitis occurs, the elbow joint may show signs characteristic of other common diseases - osteoarthritis or polyarthritis. It is very important to correctly diagnose the problem. It is necessary to find out by palpating the tendon area whether there is tunnel syndrome, supination or valgus, varus syndrome. These are also inflammatory processes, but not related to this case.

Elbows are often subject to stress when playing sports, where it is necessary to constantly keep tense arms bent or when carrying heavy objects. In this situation, it is necessary to avoid overloading the tendons, otherwise you can get an unpleasant chronic problem.

Biceps tendinitis

The biceps or biceps muscle provides flexion of the arm at the elbow joint, as well as rotation of the forearm, that is, the movement of turning the arm with the palm up or down.

Tendonitis of the biceps brachii muscle develops due to excessive sports stress or heavy physical work. This pathology is common among those whose job functions require them to hold their arms above their heads - swimmers, throwers, tennis players.

Biceps tendinitis can develop from a fall on the top of the shoulder. When the adjacent ligamentous apparatus is destroyed, the joint may become hypermobile and begin to fall out, causing dislocations and subluxations.

A distinctive feature of the fingers is that there is no muscle tissue inside. There are muscles only in the hand. The tendons are thin and long; due to them, the fingers move freely and can perform various manipulations.

Today, a very common problem is inflammation of the finger flexors. This is due to the fact that the hands and fingers are constantly under tension when it is necessary to hold or type something. Large loads on the use of fine motor skills make this disease very common.

You should not neglect the problem, since the tendon is thin, and the destructive effect of the disease occurs on it much faster. It is necessary to study therapy as early as possible so as not to suffer in the future. This pathology is inherent in those who work a lot with their hands - from musicians to adjusters.

Tendinitis of the hip

Tendons are attached to the femur at both the knee and hip joints. This is a large bone and a lot of stress falls on its tendons.

If the femoral tendons are torn, the pain, as in most cases, will increase gradually. It is characteristic that if a person begins to perform simple warm-up exercises, the pain disappears, but as soon as an increased load is given, the pain returns in a much more serious form.

A person, subconsciously protecting the injured area, soon begins to limp, his gait frankly changes. Lameness develops gradually, intensifying. When performing hip abduction, flexion, or walking, crunching sounds may be heard.

The quadriceps tendon is often affected, but clicking may simply be an anatomical feature of the tendon when its attachment slips. Such phenomena occasionally occur when the fastener slips to the greater trochanter of the gluteus maximus tendon. Sometimes this feature occurs in young women and does not cause any problems.

Temporal tendinitis

The temporal tendon can become inflamed due to the strain that occurs in the jaw muscles due to an incorrect bite. The second reason is the habit of gnawing hard food - crackers, nuts. The symptoms that accompany this form of the disease often force you to contact a dentist or neurologist.

Tendinitis in the area of ​​the temporal joint causes headaches and toothaches; when talking, the gums may hurt, and the longer the need to speak, the more sensitive the pain. Patients complain of discomfort when eating.

This form of tendinitis is characterized by irradiation of pain to the temporal and occipital region, and neck. If the patient seeks help in a timely manner, then this form of the disease can be perfectly treated with conservative methods. Physiotherapy has a good effect.

Gluteal tendinitis

When the tendons of the gluteal muscles become inflamed, a person may experience difficulty moving and changing body position.

The dystrophic nature of the pathology is expressed in atrophy and severe weakness of the muscles of the buttocks. When moving, clicks are heard and the person is unable to move normally.

Treatment

Considering the nature of the occurrence and course of tendonitis, it is worth warning that treatment with all kinds of folk remedies in this case can be more likely to cause harm. Because a tendon rupture can be much more serious than you might imagine. In cases where avulsion occurs, the surgeon excises the inflamed part and applies sutures.

Ointments for tendinitis play a supporting role when it is necessary to use not only oral NSAIDs, but also to promote local healing of the tendon. You won't be able to heal tendinitis quickly at home. On average, treatment takes 6 weeks, and if an operation was performed to excise part of the tendon, then rehabilitation can take up to six months.

After the diagnosis, the doctor builds a scheme and determines how to treat tendonitis in a particular case. It should be noted that surgery is an extreme case; most often, such a disease responds well to drug treatment.

The scheme resembles the general algorithm for treating joints and connective tissues:

• The joint must be immobilized with a bandage, splint or elastic bandage.
• Analgesics are prescribed for pain relief. This allows the patient to relax and not experience discomfort. For the purpose of relaxation, after the acute phase has passed, massage is prescribed for tendinitis.
• Corticosteroids and non-steroidal anti-inflammatory drugs are used to relieve inflammation. The doctor will select one so that in your case the likelihood of side effects is zero.
• In parallel, physiotherapy with the administration of medicinal drugs can be used.
• Exercise therapy is another method of rehabilitation for tendonitis. Physical education helps strengthen muscles and ligaments, and at the same time activate blood circulation in the tendon area, providing nutrition to the connective tissue.
• If the tendon is inflamed due to infection, antibiotics will be prescribed. You should not be afraid of this; on the contrary, such therapy will protect nearby joints.

Surgery is indicated for severe inflammation, when it is necessary to clean the tendon.

The main task for preventing the disease is careful control of the load and avoidance of injuries. If the last condition fails, then it is necessary to take care of adequate medical care and methodical implementation of all rehabilitation conditions.

To avoid sprains and dislocations that could injure the tendons, athletes use elastic fixing bandages. This allows you to reduce the load and minimize the number of micro-tears in the tendon. Also, a diet to replenish collagen reserves helps restore the elasticity of the tendon body, which also prevents the likelihood of tearing and the development of inflammation.

Considering the length of the recovery period for tendonitis, it is quite normal to be meticulous and play it safe. Compliance with safety precautions will help maintain the health of not only joints, but tendons and ligaments.

Tendinitis- inflammation of the tendon tissue, usually observed at the point of attachment to the bone or in the area of ​​the muscle-tendon junction; usually combined with inflammation of the tendon bursa or tendon sheath.

Code according to the international classification of diseases ICD-10:

Causes

Etiology. Increased motor activity and microtrauma. Diseases of a rheumatic nature.. Rheumatoid arthritis.. Gout.. Reactive arthritis.

At-risk groups. Athletes. Manual workers.

Pathomorphology. Degenerative changes in tendons: presence of fibrinoid, mucoid or hyaline degeneration of connective tissue. Clinical picture

Pain.. With active movements made with the participation of the affected tendon, while similar passive movements are painless.. With palpation along the affected tendon.

Hyperemia, hyperthermia over the area of ​​the affected tendon.

Crepitus when the tendon moves, audible at a distance or only through a phonendoscope.

The most common localization.. Tendinitis of the rotator cuff, tendinitis of the biceps tendon (see Periarthrosis humeroscapular)... Lateral epicondylitis (tennis elbow) - tendinitis of the wrist extensor muscles (brachioradialis, extensor carpi radialis longus and brevis) ... Pain with palpation of the area of ​​the lateral epicondyle of the humerus... Thomsen's test: when the patient tries to hold the hand clenched into a fist in the position of dorsiflexion, it lowers, moving to the position of palmar flexion... Belsh's test: the patient is given the command to simultaneously extend and supinate both forearms located on chin level in a position of flexion and pronation, while the affected side lags behind the healthy one.. Medial epicondylitis (“golfer’s elbow”) is tendinitis of the flexor and pronator muscles of the forearm (pronator teres, flexor carpi radialis and ulnaris, palmaris longus). .. Pain on palpation of the area of ​​the medial epicondyle of the humerus... Pain when flexing and pronating the forearm, radiating along its inner edge... Concomitant neuropathy of the ulnar nerve (25-50% of patients) .. Stenosing tenosynovitis of the extensor brevis and abductor longus muscles finger of the hand (de Quervain's disease), accompanied by narrowing of the first canal of the dorsal ligament of the wrist... Pain when extending and abducting the thumb... Pain when palpating the styloid process of the radius... Elkin's test: pain when bringing the tip of the thumb together with the tips index finger and little finger.. Stenosing tenosynovitis of the extensor ulnaris (ulnar styloiditis) is accompanied by narrowing of the VI canal of the dorsal ligament of the wrist... Pain in the area of ​​the styloid process of the ulna... Swelling in the same area.. Tendinitis of the patellar ligament... Pain in the area of ​​the tibial tuberosity when walking, running, going down stairs... Swelling in the area of ​​the tibial tuberosity.. Tendinitis of the Achilles tendon and plantar tendons (talalgia)... Pain when stepping on the heel and when flexing the plantar... Local swelling - with concomitant achillobursitis and subcalcaneal bursitis.

Children and teenagers. The most common form is patellar tendonitis associated with inflammation of the tibial apophysis (Osgood-Schlatter disease).

Diagnostics

Research methods. Laboratory tests: changes are observed only with concomitant rheumatic pathology. X-ray examination.. Possible calcium deposits in the tendons.. Heel spurs - with tendonitis and tendobursitis of the Achilles tendon or plantar tendon.. With tendonitis of the patellar tendon, signs of aseptic necrosis of the tibial tuberosity (Osgood-Schlatter disease) are possible. Special studies.. Echography of the tendon - contraction of the tendon, changes in its structure. It is necessary to ensure that the ultrasound wave does not cross the tendon along the oblique diameter. CT/MRI is informative for identifying tendon ruptures, but is not very informative in diagnosing stenosing tenosynovitis.

Differential diagnosis. Tendon rupture. Bursitis (it should be remembered that it is often combined with tendonitis). Infectious tenosynovitis (usually on the arm; pain on palpation and swelling are located along the tendon sheath, and not at the point of attachment to the bone).

Treatment

Treatment. Management tactics... In the acute phase - rest, immobilization... Shoulder sling or splints for the upper extremities... Braces, cane and/or crutches for the lower extremities... Plasters tightly applied to the forearm slightly distal to the elbow joint - when epicondylitis.. Exercise therapy. Drug therapy... NSAIDs... Piroxicam 10 mg/day... Indomethacin 25 or 50 mg 3 times a day... Ibuprofen 1800-2400 mg/day... Ointments with NSAIDs, for example ibuprofen, 3 times a day. GC (injection into painful areas) ... 40 mg of methylprednisolone with 4-6 ml of 1-2% lidocaine solution... 1-20 mg of hydrocortisone with the same volume of 1-2% procaine solution. It is necessary to avoid insertion into the tendon sheath; in case of medial epicondylitis, the proximity of the ulnar nerve should be taken into account. After periarticular injections, despite a significant reduction in pain intensity, it is recommended to avoid physical activity due to the risk of tendon rupture. Surgical treatment - dissection of tendon aponeuroses, is used in the absence of the effect of conservative treatment, in the presence of signs of stenosing tendinitis, in Osgood-Schlatter disease.

Complication- tendon rupture.

Forecast favorable.

ICD-10 . M65.2 Calcific tendinitis. M75.2 Biceps tendinitis. M75.3 Calcific tendonitis of the shoulder. M76.0 Tendinitis of the gluteal muscles. M76.1 Tendinitis of the lumbar muscles. M76.5 Patellar tendinitis. M76.6 Tendinitis of the heel [Achilles] tendon. M76.7 Peroneal tendinitis. M77.9 Enthesopathy, unspecified

Tendinitis of the foot is an inflammatory process in the tendon, when the process involves the plantar muscles and the posterior tibial muscle, which connects the tibia and fibula and holds the arch of the foot.

As a rule, it is accompanied by painful sensations during active sports, walking, jumping and when lifting heavy loads.

ICD-10 code

M76.6 Heel [Achilles] tendinitis

Causes of foot tendonitis

Tendinitis often occurs as a result of injury or increased physical activity with constant stress on the foot and lower leg muscles. With regular and significant load, tendon fibers and cartilage at the sites of muscle attachment are subject to degenerative-dystrophic damage.

As a result of acquired tissue ischemia, zones of necrotic lesions are formed, tendon and cartilage tissue are structurally degenerated, and their partial mineralization occurs. Microtraumas of tendon fibers are accompanied by the deposition of mineral salts at the site of injury: a rather dense calcification formation develops, which can increase trauma to nearby tissues.

Degeneration and calcification of cartilage tissue contributes to the formation of osteophytes and bone growths.

Pathological processes in the tendons signal an increased load on them. This often happens in athletes and physically active people.

Symptoms of foot tendonitis

Symptoms of foot tendonitis can be almost invisible or pronounced:

• painful sensations of varying intensity when a particular tendon is loaded, while other movements of the foot do not cause pain;
• visible redness of the skin, possible increase in local temperature in the affected area of ​​​​tissue;
• crunching in the tendon, which can be heard both externally and through a phonendoscope;
• palpation may feel pain in the lower part of the leg;
• often tendonitis develops against the background of an inflammatory process of nerve trunks;
• slight swelling of the tissues of the foot and lower leg;
• discomfort when pressing on the heel and flexing the foot.

Walking in uncomfortable shoes and high heels significantly aggravate the discomfort in the back of the lower leg. The pain is especially pronounced when walking and trying to stand on tiptoes. The discomfort is aggravated in the morning when getting out of bed, after a long immobility of the lower extremities, and may be accompanied by swelling of the skin in the Achilles tendon area.

In the chronic course of tendonitis, clinical manifestations may be permanent.

Diagnosis of foot tendonitis

Diagnosis of foot tendinitis is based on the patient's history and visual examination.

The examination involves palpating the lower leg, especially in the area of ​​the Achilles tendon. There may be some tenderness, but it is most important to rule out tendon damage and measure the range of flexion of the foot.

If the tendon fibers are directly ruptured, swelling of the lower leg and foot should be noticeable, and significant bleeding into the soft tissue may be observed. If a void formation is found along the tendon, this may be the site of a rupture. With significant swelling, it is quite difficult to find it.

X-ray examination for tendonitis of the foot is not informative; it can only indicate the presence of calcification. An alternative method is ultrasound diagnostics, which provides visual access to the soft tissues of the lower extremities and tendons. This is a less expensive method compared to MRI.

Treatment of foot tendonitis

Treatment for foot tendinitis, depending on the severity of the process, may include:

• immobilization of the foot or ankle joint using bandages, bandages, splints. Absolute rest should be provided to the limbs;
• prescribing anti-inflammatory drugs that significantly alleviate the patient’s general condition. Oral administration of drugs, injection, as well as external use of a variety of ointments and compresses are possible. This therapy is usually prescribed for a period of no more than 14 days; longer use of non-steroidal drugs is undesirable due to the adverse effects on the gastrointestinal tract;
• prescription of antimicrobial agents for the infectious nature of tendinitis;
• the use of physiotherapy at the final stage of tendinitis treatment (high-frequency, microwave therapy);
• the use of massage procedures, elements of therapeutic exercises (yoga, gentle exercises that stretch and warm up the muscles);
• if conservative treatment is ineffective, it is possible to use surgical intervention, which consists of surgical excision of aponeuroses and affected tissues.

Conservative treatment of the inflammatory process in the tendon is quite long, up to two months, and with surgical intervention – up to six months.

Traditional methods of treating inflammation of the tendons of the foot include mainly anti-inflammatory and analgesic effects:

• compresses made from strong saline solution;
• lotions from a decoction of bird cherry fruits;
• massage the affected area of ​​the foot with ice cubes, especially effective immediately after an injury;
• internal intake of ginger infusion, as well as turmeric as an effective anti-inflammatory agent;
• using tincture from walnut partitions (0.5 liter glass of 40% vodka, leave for two weeks in a dark place, take orally).

Prevention of foot tendonitis

Preventing foot tendonitis in healthy individuals is not particularly difficult. When choosing shoes, you need to pay attention to their comfort and the absence of discomfort when walking and moving. During active sports, it is unacceptable to use ordinary everyday shoes - for this there are special sports models with reliable fixation of the ankle joint, with an adequate last.

Women need to treat shoes with unstable heels with great caution.

With prolonged foot strain, contrast baths and massage treatments usually help.

Immediately before training, sudden joint movements should not be allowed without first warming up the muscles by warming up.

Swimming strengthens the calf muscles well, while being gentle on joints and tendons.

Prognosis of foot tendinitis

The prognosis for foot tendinitis, which was diagnosed in time and adequately treated, is often favorable. Drug treatment is usually quite effective. The rehabilitation period after conservative therapy is about one month. If you follow your doctor's recommendations and eliminate the underlying cause of the pathological condition, relapses of tendinitis are unlikely.