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Tenosynovitis is a disease that is characterized by inflammation of the tendon and its surrounding sheath. Tendovaginitis develops only in the tendon that has the vagina (soft tunnel, which is represented by connective tissue).
There are many reasons for the development of tendovaginitis, among them: infections, rheumatic diseases, professional sports and more.
Tendovaginitis can have both acute and chronic course. Its main symptom is pain, which increases with movement. Therapy is reduced to medical correction. In advanced cases, it is not possible to do without surgery. Almost always it is necessary to resort to surgical intervention if tendovaginitis was caused by an infectious flora.
When tendovaginitis affects the tendon and its vagina, which are located in the forearm, wrist, hand, ankle, foot and Achilles tendon. A tendon is needed to connect bones and muscles to each other, or to connect bones to each other. All tendons, in fact, are dense strands that provide human movement. During the performance of certain actions, the muscles contract, and the tendon shifts. In the place where the tendon borders on the muscle, it is covered with a connective tissue bag. It moves from the muscles to the tendon itself.
These bags, or as they are also called, sheaths (vagina), are lined from the inside with a synovial membrane that produces fluid. This fluid is the guarantor of the soft sliding of the tendon at the time when a person makes certain movements. If an inflammatory reaction develops, then movements become difficult, signs of tendovaginitis appear.
According to statistics, tendovaginitis most often affects the tendons of the flexor muscles of the arms and legs. This happens in 32% of cases. The extensors are affected in 12% of cases.
Tendovaginitis requires emergency treatment, as it is associated with the development of severe complications. In this regard, inflammation of a septic nature is of particular danger, since the disease develops very quickly, involving the entire upper or lower limb in the process. In some cases, pathology can be accompanied by sepsis and threaten the patient with a fatal outcome. Therefore, all people diagnosed with tendovaginitis should be hospitalized. Knowing the main symptoms and causes of the development of the disease will help to avoid serious health consequences.
Causes of tendovaginitis
The reasons for the development of tendovaginitis are diverse, among them are the following:
Regular overloads, which are accompanied by microtrauma of the tendon and its surrounding membranes. Such inflammation is often associated with the professional activity of a person; pianists, people working at a computer, loaders, professional athletes (skiers, skaters, etc.) suffer from it.
Ligament and tendon injuries, such as severe bruises or sprains.
Rheumatic diseases.
An infectious lesion of the tendons is observed when there is an inflammatory purulent process next to them. Risk factors are diseases such as phlegmon, osteomyelitis, purulent arthritis, panaritium.
Pathogenic flora can penetrate the tendon structures with the blood stream. This happens against the background of brucellosis, gonorrhea, tuberculosis.
Depending on the factor that provoked the development of tendovaginitis, the following types are distinguished:
Aseptic tendovaginitis. It is divided into professional, reactive and traumatic.
Infectious tendovaginitis. It is divided into specific and non-specific.
Each of these types should be considered in more detail.
Aseptic tendovaginitis: causes
Aseptic tendovaginitis manifests itself after tendon overload. The dorsum of the hands and feet are most commonly affected.
Professional aseptic tendovaginitis. Professional tendovaginitis develops when a person performs the same type of movement for a long time. In addition to the above professions, sorters of various goods, dancers, accountants, etc. can suffer from the disease. During their work, the same muscles and tendons are constantly strained.
The synovial membrane does not have time to produce a sufficient amount of oily fluid, so the friction between the sheets of the tendon sheaths increases. The inflammation is aseptic in nature, which is accompanied by the accumulation of exudate. At first it will be serous, then hemorrhagic, and then fibrinous. If the exudate goes through all three of these transformations, then acute inflammation, as a rule, stops. However, this does not mean that the disease is completely resolved. Most often, tendovaginitis from the acute stage simply becomes chronic. After some time, the disease recurs.
There are several explanations for this fact:
The epithelium of the petals of the synovial bag undergoes deformation. Its normal cells are gradually replaced by connective tissue. The fluid produced by the remaining cells of the synovial bag will no longer be enough to ensure normal friction. As a result, a second and subsequent episodes of inflammation occur.
In addition, one case of inflammation is enough for adhesions to begin to form in the bag that surrounds the tendon. They contribute to increased friction between the shells of the capsule and provoke subsequent relapses of the disease.
Post-traumatic aseptic tendovaginitis. Post-traumatic tendovaginitis develops against the background of a previous injury. Bruises, sprains, falls on a limb can lead to inflammation. If treatment is started on time, it will be possible to avoid serious consequences and fully recover.
As for the chronic form of aseptic inflammation of the tendon and its synovial pocket, the disease develops as a result of a previous acute pathology. Separately, stenosing tendovaginitis should be distinguished. When it occurs, the tendon is blocked in the bone-fibrous canal.
Reactive aseptic tendovaginitis. The causes of reactive tendovaginitis lie in diseases such as:
Ankylosing spondylitis.
Reiter’s syndrome.
Systemic scleroderma.
Rheumatism.
Rheumatoid arthritis.
Infectious tendovaginitis: causes
Infectious tendovaginitis can be specific and nonspecific.
Specific infectious tendovaginitis. Specific infectious tendovaginitis develops when the tendon sheaths are affected by pathogenic flora, namely, bacilli of tuberculosis, syphilis or brucellosis.
Specific infectious tendovaginitis is a secondary inflammation, which is a consequence of the spread of infection throughout the body. It can even be called a complication of the underlying disease.
Nonspecific infectious tendovaginitis. Nonspecific infectious tendovaginitis may be the result of pathogenic microflora entering the synovial sac. Its source is the focus of purulent infection located in the immediate vicinity. Sometimes bacteria enter the tendon from the external environment when a person receives an injury. Infectious nonspecific tendovaginitis most often affects the flexor tendons of the fingers. In this case, doctors diagnose “tendon felon”.
A person can get a deep injury that can lead to the development of the disease when a leg is injured with a nail, when a splinter enters the foot, when cut or severely burned.
Another predisposing risk factor that can lead to the development of nonspecific infectious tendovaginitis is the performance of a manicure or pedicure. If the master uses a non-sterile tool, then any manipulation of the cuticle can lead to the development of persistent inflammation.
Bacteria can enter the synovial sac from within the body itself, for example, from osteomyelitis in the bones of the fingers or toes, or large bones of the upper and lower extremities. Such foci of inflammation as: liver abscess, retroperitoneal phlegmon, lung gangrene, etc. can become sources of infection. In this case, the pathogenic flora spreads through the body with blood flow. In this case, the symptoms of the underlying disease come to the fore, which most often lead to the death of the patient.
Symptoms of tendovaginitis
Symptoms of tendovaginitis, regardless of the location of the inflammation, have a similar picture.
The acute form of inflammation will be indicated by such signs as:
Pain. It is localized in the place where inflammation occurs. It can spread to adjacent structures, but as it moves away from the main focus, it will no longer be so intense. The pain is acute, has no connection with the time of day. If pus begins to accumulate in the cavity of the synovial bags, the patient will feel a pulsation. The pain intensifies when a person makes an attempt to move with the involvement of the inflamed tendon in this process.
Puffiness At the site of inflammation, the vessels expand, become more permeable, the fluid from them begins to seep out. It lingers in the tissues, which leads to the formation of edema. It is of considerable size, the limb is in tension. Sometimes cracks form on the surface of the skin due to swelling. The edema builds up rapidly as the synovial walls of the vagina constantly produce fluid. Sometimes tendovaginitis, which manifests itself in the area of the fingers, already after 2 hours leads to swelling of the entire limb.
Hyperemia of the skin. Redness of the dermis occurs due to overfilling of small vessels with blood. At first, the redness spreads over the skin, taking the form of the tendon that has undergone inflammation. Then the area of hyperemia becomes more and more extensive. If you touch the place that has the most intense color, you can hear a slight crunch.
Local increase in body temperature. This symptom is also explained by increased blood flow to the area of inflammation.
Limb dysfunction. If the inflammation is localized in the area of the flexor tendons of the muscles, then the leg or arm will not be able to bend. With the involvement of the extensors in the pathological process, the person will experience pain when extending the limb. When the tendon is at rest, the pain will be negligible.
If it is possible to stop the acute phase of tendovaginitis, then this does not exclude the possibility of the formation of contractures. Most often they are the result of acute inflammation. In this case, the tendon capsule will be shortened, the walls of the synovial bags will be covered with fibrin, which will later become hard. These will be the so-called contractures. It is also possible the formation of transverse strands in some places. All these pathological formations will lead to limitation of tendon mobility. In this case, the limb will completely or partially lose its ability to function.
Symptoms of different forms of tendovaginitis
Acute aseptic tendovaginitis manifests suddenly. Edema quickly develops in the area of inflammation. When pressing on it, a soft crunch is heard. If the patient seeks medical help in a timely manner, then after a few days the symptoms of the disease can be stopped. However, the risk of developing a chronic form of tendovaginitis remains high.
Acute post-traumatic tendovaginitis is characterized by pain and swelling in the place where the injury was received. Such tendovaginitis, with timely treatment, can be eliminated without health consequences.
Chronic aseptic tendovaginitis. A person complains of pain that increases in intensity during movement. Edema will be either minimal or absent altogether. The pain is aggravated by touch, and a crunch is heard during movement. With relapses of the disease, all symptoms intensify.
Reactive tendovaginitis develops and proceeds acutely with severe pain, but slight swelling.
In acute nonspecific infectious tendovaginitis, fluid begins to accumulate in the pockets of the vagina surrounding the tendon. At first it is serous, and then it becomes purulent. This causes severe pain, severe swelling and circulatory disorders. The more pus, the stronger the pulsation in the affected area. A person may lose the ability to sleep and lead a normal life. The limb is in a forced position. A distinctive feature of infectious tendovaginitis is the general intoxication of the body. The patient’s general body temperature rises, weakness develops. The spread of purulent masses leads to a deterioration in the well-being of a person. Puffiness increases all the time, the skin in the area of inflammation becomes purple-blue. The pain is severe, almost unbearable. The probability of formation of phlegmon of a bone increases.
Separately, it is worth paying attention to the features of the symptoms of tendovaginitis, depending on the location of the inflammation. Synovial bags of tendons are represented by cavities and canals, which always contain fluid. This causes the rapid spread of inflammation throughout the vagina with the transition to nearby tissues.
If the sheath of the palmar tendon leading to the little finger suffers, then the inflammation quickly spreads not only to the palm, but also to a third of the forearm. On the second day from the moment of manifestation of the disease, the synovial sheaths of neighboring fingers will be inflamed.
If the vaginas of the second, third and quarter fingers are initially affected, then the inflammation is limited only to the base of these fingers.
If the vaginas of the back of the hand become inflamed, then the process extends to the back of the wrist and to the metacarpal bones.
If the tendon sheath of the big toe becomes inflamed, then the edema will spread to its entire surface, up to the lower third of the lower leg. With inflammation of the synovial bags of the remaining fingers, the process is limited only to their base.
Classification of tendovaginitis
To systematize information, doctors use several classifications of tendovaginitis, which are based on various criteria.
Depending on the nature of the inflammation, there are:
Serous tendovaginitis. This is a mild (initial) form of the development of the disease. At the same time, the patient has a minimal set of symptoms: slight redness in the area of inflammation, slight swelling of the tissues.
Serous fibrous tendovaginitis. In the synovial vagina, effusion begins to accumulate, swelling is formed, pain intensifies.
Purulent tendovaginitis. Redness intensifies, pain becomes unbearable, a person needs emergency treatment.
Depending on the course of the disease, there are:
Acute tendovaginitis.
Chronic tendovaginitis.
Depending on the etiological factor that caused the development of the disease, there are:
Aseptic tendovaginitis, which is divided into professional, post-traumatic and reactive.
Infectious tendovaginitis, which can be specific and nonspecific.
Diagnosis of tendovaginitis
It is important that the diagnosis of tendovaginitis is not only high-quality, but also fast. The success of treatment and the likelihood of complications depend on this.
As a rule, the doctor does not experience difficulties in making a diagnosis. An external examination of the patient is enough for him to suspect tendovaginitis. The specialist starts from the signs of the disease described above. The patient has swelling, contractures, deformation of the tendon capsule.
With septic inflammation, the patient suffers from general intoxication of the body. The body temperature may exceed 38 ° C, there is increased sweating and chills.
Chronic tendovaginitis is more difficult to diagnose, since the symptoms of the disease are not pronounced enough, during the period of remission they may be completely absent. Therefore, patients who have had acute tendovaginitis once should be wary of their own health. As a rule, chronic tendovaginitis is confirmed by re-inflammation of the synovial bags.
To confirm the diagnosis, the following methods and laboratory tests can be applied:
Blood sampling for general analysis. With severe inflammation, an increase in ESR and leukocytosis is observed.
Collection of purulent contents of the tendon synovial sac for bacterioscopic examination. For this, a puncture is performed.
If sepsis is suspected, the blood will be tested for sterility.
CT allows you to visualize the thickening of soft tissues, the presence of adhesions.
X-ray examination in terms of detecting tendovaginitis is uninformative.
Treatment of tendovaginitis
Treatment of tendovaginitis can be medical or surgical. Also, physiotherapeutic procedures that can be practiced even during the acute stage of tendovaginitis have a good effect. The doctor must assess the patient’s condition, determine how intense the inflammation is.
Treatment of aseptic tendovaginitis. Aseptic tendovaginitis can be tried to be cured solely with the help of drugs. In this case, the patient is prescribed anti-inflammatory drugs, which are used not only locally, but also systemically. The doctor prescribes antibiotics at his own discretion.
Patients with acute septic tendovaginitis are advised to minimize the load on the affected limb. To do this, use orthoses or gypsum. Cold is applied to the site of injury. Analgesics are used to reduce pain. If the therapy is carried out adequately to the disease, then it is possible to completely get rid of it in a few days.
To avoid relapse, the patient is advised to minimize the load on the limb in the future. Shock wave therapy is one of the effective methods of treating aseptic tendovaginitis. Of the physiotherapeutic methods, phonophoresis with hydrocortisone, electrophoresis with novocaine and potassium iodide are also used.
If with the help of analgesics or physiotherapy it is not possible to stop the pain, then the patient is recommended to set up a therapeutic blockade with glucocorticosteroids (hormonal drugs). After the acute stage of the disease is eliminated, the patient will be prescribed a gymnastic complex, which is being developed jointly with the doctor.
In order to prevent an exacerbation of the disease, a patient with chronic tendovaginitis is prescribed ozocerite. If therapy does not bring the desired effect, the affected tendon sheaths are excised or dissected. What exactly to do in each case, the doctor decides on the spot.
Treatment of acute post-traumatic tendovaginitis. For the treatment of acute post-traumatic tendovaginitis, it is necessary to apply gypsum or a plastic splint to the damaged area. On the first day after the injury, it is necessary to apply cold to the sore spot, and starting from the second day, thermal procedures are recommended. UHF therapy has a good effect.
Reactive tendovaginitis requires complete rest for the affected tendon. If necessary, the limb is immobilized. In parallel, the patient is undergoing treatment with drugs from the NSAID group.
Treatment of acute nonspecific infectious tendovaginitis.
If the disease is diagnosed in the early stages, before the abscess has formed, then conservative treatment is possible. To do this, the limb is immobilized, novocaine blockade is administered to the patient, and alcohol lotions are applied. Of the physiotherapeutic methods, the use of UHF and laser therapy is shown.
If pus accumulates in the cavity of the synovial bags, then an operation is indicated. At the same time, the synovial vagina is widely opened, relieved of purulent masses, washed with antiseptic solutions. Before and after the operation, the patient must receive antibiotic therapy.
In the stage of remission of the disease, the patient must definitely perform therapeutic exercises. The load on the tendon should increase gradually.
Prophylaxis and prognosis
If the patient seeks medical help in a timely manner, then the prognosis for recovery is most often favorable. The treatment lasts about 14 days, after which another two weeks are taken to restore the function of the limb. In the future, the person will be able to return to the performance of their duties. If tendovaginitis is associated with professional activities, then the risk of recurrence of the disease is extremely high. In this case, the patient is recommended to change jobs, otherwise you can remain disabled. Violation of the function of the foot or hand most often occurs against the background of purulent inflammation, which required surgical intervention.
If there is no therapy at all, then the disease can result either in the disability of the patient, or complications in the form of blood poisoning. In the latter case, the probability of death is high.
In order to prevent the development of professional tendovaginitis, you should take breaks in work, observe a rest regimen. The limbs should warm up, a specially selected gymnastic complex helps in this regard.
It is also important to avoid injuries, treat all infections in a timely manner, and follow the rules of personal hygiene. When injured, all measures should be taken to decontaminate the damaged area in order to prevent its infection.