Stenosing tenosynovitis of radial styloid process
Introduction
Introduction to stenotic tenosynovitis of the sacral styloid process Tenosynovitis refers to chronic aseptic inflammatory changes caused by mechanical friction of tendon sheath. Tenosynovitis is a common disease in orthopedics. It is more common in manual laborers, especially those who repeatedly perform stretching, flexing, pinching and gripping with fingers. The disease is more common in women than in men. The tendon sheath is a kind of tendon assisting device. It is a double-layered cannula-like structure surrounding the tendon that is formed by the connective tissue around the tendon. It is often found in the long and active parts of the wrist, ankle, finger and toe. . The tendon sheath is divided into two layers, the outer side is a fibrous tendon sheath, which is thickened by the transverse and oblique fibers of the deep fascia, attached to the bone and joint capsule, restraining and supporting the tendon, and the effect of the pulley and the tensile force. The inner layer is a synovial tendon sheath, which is located in the fibrous tendon sheath. The synovial sheath is divided into two layers of dirt and wall. The wall layer is lined with the inner surface of the fibrous tendon sheath. The folded part of the bone surface is called the vasosystem. The layer on the surface of the tendon is the dirty layer. Dirty, the wall layer of the synovial membrane is closed at both ends as a blind cavity, which contains a small amount of synovial fluid to lubricate and maintain the activity of the tendon. basic knowledge The proportion of illness: 0.004%-0.008% Susceptible people: This disease is common in housework and manual operators. Mode of infection: non-infectious Complications: swelling
Cause
Causes of stenotic tenosynovitis of the sacral styloid process
(1) Causes of the disease
There is a narrow and shallow bone groove in the styloid process of the humerus. The bottom surface is uneven. The sulcus is covered with the transverse ligament of the wrist, forming a fibrous fibrous sheath, which constitutes the first tendon sheath of the wrist, and the long abductor tendon and the extensor tendon of the thumb. After passing through the sheath, it is folded into a certain angle and stops at the first metacarpal and the proximal phalanx of the thumb respectively. When the tendon slides, a large frictional force is generated. When the thumb and the wrist are active, the folding angle is increased, thereby increasing The tension between the tendon and the sheath wall can cause tenosynovitis for a long time, which causes the sheath wall to thicken, the tendon to thicken locally, and gradually produce stenosis symptoms, especially the long abductor tendon, which participates in the palm movement of the thumb, and has more activities. The role of the disease is greater, because the female tendon angle is large, so the incidence is higher than that of men. In addition, sometimes there are vagus tendons in the sheath (mostly extensor tendons), and this anatomical variation can also produce symptoms of stenotic tenosynovitis.
(two) pathogenesis
In daily life and work, due to frequent activities, the excessive friction between the tendon of the thumb and the extensor tendon of the thumb and the tendon sheath, combined with the change of the direction of the tendon, form a larger angle, which further increases the mechanical friction between the tendon and the tendon sheath. The synovial sphincter secretion function is degraded, and the symptoms are more likely to occur. The pathological changes are early, such as congestion, edema, exudation and other aseptic inflammatory reactions. Repeated stimulation or prolonged, chronic fibrous connective tissue hyperplasia, hypertrophy, adhesion The thickness of the tendon sheath can be increased from 1 mm or less to 2 to 3 mm at normal time, resulting in stenosis of the tendon sheath, degeneration and deformation of the tendon, and stenotic tenosynovitis may also be some quiescent or subclinical connective tissue disease (such as rheumatism). The consequences of rheumatoid arthritis, the hyperplastic stenosis tendon sheath is like a tight band to compress the tendon, so that the adjacent unstressed tendon is edematous and swollen into a gourd shape. In severe cases, the tendon adheres, hyperplasia, and becomes thick, forming an intermediate enlargement. The normal spindle shape at both ends, the clinical manifestations of pain, tenderness and limited activity in the affected area, when the tendon passes through the narrow tendon sheath, Kind of trigger occurs, such as interlocking, snapping and bounce.
Prevention
Prevention of stenotic tenosynovitis of the sacral styloid process
The disease is related to fatigue injuries. Sudden increase in the labor intensity of the hands and wrists can induce the disease. Washing clothes and knitting sweaters at one time is a common predisposing factor. The workload of middle-aged and elderly people should be appropriate to avoid a sudden increase in the amount and intensity of labor.
Complication
Complications of stenotic tenosynovitis of the sacral styloid process Complications swelling
A small number of patients may have a sound.
Symptom
Stenosis of the sacral stenosis of the sacral tendon sheath common symptoms sacral styloidal localized pain severe pain
1. General symptoms The disease is common in housework and manual operators. Middle-aged and elderly women are more common. The ratio of female to male is about 6:1. The onset is slow. The main manifestations are: localized pain in the styloid process of the humerus, bulge; The thumb is limited, and the thumb produces pain when it is stretched and flexed. It can be radiated to the hands, elbows, shoulders, etc.
2. Local symptoms examination showed mild swelling at the styloid process of the humerus, local tenderness was obvious, sometimes it could touch an induration at the local part, or there was friction and friction sound when the thumb was abducted, and a few could have a flick, Finkelstein The positive sign is the thumb, and the other four fingers hold the thumb in the palm. At this time, the wrist is tilted to the ulnar side. The severe pain in the styloid process of the humerus is positive, which is the unique sign of the disease. According to the medical history, clinical symptoms, signs and unique signs - positive Finkelstein sign, can establish a diagnosis.
Examine
Examination of stenotic tenosynovitis of the sacral styloid process
The fist test is biased and the bone is auscultated.
Diagnosis
Diagnosis and diagnosis of stenotic tenosynovitis of the styloid process
The main manifestation is pain in the wrist, which can be radiated to the hands and forearms. The thumb is weak. The pain is obvious when pouring the thermos. There are bounces and locks. Locally visible small bulges, and can reach small induration, tenderness. The Finkelstein test is a fist-to-handle experiment: the thumb is held in the palm of the hand, then the fist is made, and the wrist is gently erected. The sacral styloid process is positive for severe pain.
