tenosynovitis
Introduction
Introduction to tenosynovitis Tenosynovitis is one of the most common hand surgery diseases in the clinic, also known as the "keyboard player." Mainly refers to the tendon movement in the short-term or excessive force or chronic cold stimulation, resulting in inflammatory reaction of fibrosis tissue, fibrosis, thickening of the tendon sheath, causing sheath stenosis, tendon movement in the sheath is restricted, and inflammatory response A type of disease that causes local pain at the same time. Tenosynovitis occurs between 30-50 years old, with more women than men, with a ratio of 10:1. basic knowledge The proportion of illness: 0.005% Susceptible people: good between 30-50 years old Mode of infection: non-infectious Complications: swelling
Cause
Cause of tenosynovitis
Trauma factors (30%):
It can be caused by injuries, excessive strain (especially in the hands and fingers), osteoarthritis, some immune diseases, and even infections.
Occupational factors (35%):
Some occupations that require long-term repeated strained joints, such as typists, instrumentalists, cargo handling, or industries that require long periods of computer operation, can cause or exacerbate the disease. Common affected areas include wrists, fingers, shoulders and other positions.
Disease factors (35%):
Women and diabetics are more susceptible to this disease. The patient will feel joint pain, morning stiffness, and usually the feeling of morning stiffness of the joint is most obvious after getting up, and the symptoms will not be relieved obviously with frequent activities. The affected joints are swollen and even bounced, and joint movement is impaired.
Prevention
Tenosynovitis prevention
1. When doing housework such as washing, cooking, knitting sweaters, cleaning, etc., pay attention to the correct posture of the fingers and wrists. Do not bend or stretch excessively; do not overweight the items; do not use too much force on your fingers or wrists.
2, feel the body joints fatigue can take a hot bath, relieve the tight muscles, or hot compresses in the sore parts.
3, when washing clothes in winter, it is best to use warm water, snow after snowing, but also wear cotton gloves to prevent cold hands.
4, the wrist joint to do 360-degree rotation; or the palm of the hand to force the fist to relax, do more than a few times back and forth; or put a finger back pressure or palm back pressure, can effectively relieve the pain of the hand.
5, for long-term office workers, should use the correct working posture, try to balance the hands, the wrist can touch the real thing, do not hang.
Complication
Tenosynovitis complications Complications swelling
The most common disease is the chronic aseptic inflammation caused by the long-term mechanical friction of the tendon sheath in the tendon sheath. The pathological changes are mainly the inflammatory cells in the periorbital tissue. The fiber is degenerated and the tendon sheath is narrow.
Symptom
Tendon sheath inflammation Common symptoms Thumb unexplained pain Joint swelling and pain Joint pain Joint pain Aging joint swelling Swelling Wrist wrist pain on the thumb side Nodule trigger fingering fascia pain
Tenosynovitis varies from symptom to site. Commonly used in the clinic are tendon stenosis of the sacral styloid process, tenosynovitis of the flexor tendon, and tenosynovitis of the plantar flexor.
The stenotic tenosynovitis of the sacral styloid process is located at the bony prominence (sacral styloid process) on the side of the thumb of the wrist. It is characterized by obvious pain around the bony prominence and blocked thumb movement and local tenderness. During self-examination, the thumb can be gripped in the other four fingers, and the wrist is flexed to the inside of the wrist, and severe pain occurs at the styloid process of the humerus.
Flexor tenosynovitis occurs mostly in the palm of the thumb and middle finger. It is especially noticeable when waking up in the morning. The affected finger is characterized by flexion and extension dysfunction. The pain sometimes radiates to the wrist. The flexion of the knuckle is tender and can reach the thickened tendon sheath. a nod that looks like a pea. When bending the finger, suddenly stay in the semi-bend position, the finger can not be straightened, and can not flex, like being suddenly "snapped", with the other hand assisted to move, the finger can move again, resulting in a bolt like a bolt It is called "trigger finger" or "snap finger".
The long-term standing and walking of the plantar flexor tendon sheath in the state of wearing high heels is a woman with plantar flexor tenosynovitis. The center of gravity of the body moves forward, and the gravity of the whole body is concentrated in the front part of the sole. Over time, the friction between the tendon sheath and the tendon, inflammation and oozing, etc. induce stenosis or inflammation of the tendon sheath.
1. Pain
Most of them can't clearly point out the location of the pain, only the joints are "awkward", and the joints are sore or unable to exert force during exercise. Sometimes I feel banded pain.
2, local swelling
The onset tendon will have a cable-like bulge, varying degrees.
3, dysfunction
Tenosynovitis, which occurs in the wrists of the upper limbs, affects the strength of the players. Sometimes, when the ball is hit, the movement deformation occurs. The tenosynovitis that occurs in the ankle and foot will feel pain and affect the movement at the pace of exercise. The tendon sheath is a sheath-like structure that surrounds the tendon. The outer layer is fibrous tissue attached to the bone and adjacent tissues to fix and protect the tendon. The inner layer is a synovial membrane that nourishes the tendon and secretes synovial fluid to facilitate the sliding of the tendon. Due to repeated excessive friction, inflammation and edema of the tendon and tendon sheath are caused, and the wall of the sheath is thickened to form a narrow ring. Fibrosis and thickening of the tendon cause difficulty in sliding the tendon in the sheath, which is stenotic tenosynovitis.
Examine
Tenosynovitis examination
1, local swelling: see early symptoms of tenosynovitis;
2, local tenderness: tenderness in the tendon sheath around the wound and around;
3, anti-resistance test positive: due to inflammation or swelling of the diseased tendon sheath, the joint will be exacerbated when the joint is overextended or over-flexion, such as stenosis or stenosis of the sacral styloid process will increase the pain, there will be Finkelstein sign Positive.
The diagnosis of this disease mainly depends on its clinical manifestations and physical examination, often using the tendon palpation:
Palpation of tendon: palpation of the wrist muscles are mainly the radial flexor digitorum, palmar long muscle, ulnar wrist flexor; the wrist muscles are mainly the temporal wrist length, short extensor muscle and ulnar wrist extensor; palpation The finger muscles were examined in turn for the total extensor tendon, the extensor tendon of the index finger, and the extensor tendon of the little finger. Then, the thumb long muscles, the short extensor muscles, and the long extensors of the thumb were palpated. Pay attention to whether the muscle tension changes, whether there is tenderness, and the movement is barrier-free.
The auxiliary examination is less used, but the X-ray examination shows that the tendon and its tendon sheath have calcium deposits. Also contribute to the diagnosis of this disease.
Diagnosis
Diagnostic identification of tenosynovitis
Diagnostic method one
1. The sacral styloid process is uplifted and painful. It can radiate pain to the forearm and thumb. When the wrist and thumb are active, the pain is aggravated and the weight cannot be lifted.
2, the tibial styloid process is markedly tender, sometimes touching the hard nodules. The wrist and thumb activities are slightly limited.
3, the fist ulnar deviation test (Finkelstein sign) is positive.
Diagnostic method two
1. Local tenderness: tenderness in the tendon sheath and around the wound.
2, anti-resistance test positive: due to inflammation or swelling of the diseased tendon sheath, the joint will be exacerbated when the joint is overextended or over-flexion, such as stenosis or stenosis of the sacral styloid process, the pain will be aggravated, such as the styloid process Stenotic tenosynovitis has a positive Finkelstein sign.
3, local swelling.
4, the joints of the ring: Tenosynovitis of the finger part of the phenomenon of "snap", called the "board machine".
It should be differentiated from the following conditions:
A ganglion cyst: a cystic mass that occurs near the tendon sheath or joint capsule. The outer layer of the cyst wall is composed of fibrous tissue, the inner layer is covered with a white smooth endothelium, and the cyst has a thick mucus-like substance. Cysts can be divided into single rooms and multiple rooms, generally more common in single room. The cause of the disease is not fully understood, but it is often associated with trauma or some regular movement. It is good for young adults, and women are more common. Most of the back of the wrist, the back of the foot, the armpit and other parts, the cyst is a round or oval smooth mass, the growth is slow, the cyst is soft at the beginning, according to the slight fluctuation of the sense, a little discomfort during exercise. The ganglion cyst usually does not require treatment and can disappear on its own. Some patients can be used for cyst puncture, first use an empty syringe to pump out the fluid inside the capsule, and then inject a proper amount of glucocorticoid, which can be cured in most patients. If the cyst is large or invalid after the above treatment, or repeated authors, it can be removed by surgery.
