TENDOVAGINITIS (tendovaginitis; lat. tendo a sinew + vagina a vagina + - itis) — an inflammation of a synovial vagina of a sinew. From T. it is necessary to distinguish an inflammation of a cover of a sinew (peritendinitis) or surrounding it friable connecting fabric (paratendinitis) which is localized out of a synovial vagina on a forearm, a shin in a calcaneal (akhillov) sinew, etc., and also an inflammation of ligaments of joints (tendovaginitis).
On etiol. to signs distinguish infectious and aseptic T. Infectious nonspecific T. develop as a result of penetration into synovial vaginas of sinews (see) pyogenic microflora at wounds, distribution of purulent process of the next suppurative focuses (e.g., at purulent arthritises, osteomyelitis, a felon, etc.); activators specific T. (tubercular mycobacteria, spirochetes, etc.) are more often transferred to vaginas of sinews in the hematogenous way. Quite often T. arises also as a reactive inflammation of toxic character at rheumatism (see), a pseudorheumatism (see), Bekhterev's diseases (see Bekhterev a disease), diseases of Reuters (see Reuters a disease). Aseptic T. (acute crepitant T., chronic stenosing T., etc.) result more often from traumatization and an overstrain of vaginas of sinews and the fabrics surrounding them (see the Microtrauma) at persons of the certain professions (musicians, typists, etc.) which are carrying out long time the uniform movements in to-rykh the narrow group of muscles (a so-called professional tendovaginitis) participates; they can be observed also at an overtraining at skaters, skiers and other athletes.
Morphologically acute nonspecific T. it is characterized by hypostasis, a sharp hyperemia of a synovial membrane (a synovial layer) and cellular infiltration of fabrics; in a synovial cavity the serous, serofibrinous or purulent exudate which is squeezing a mesentery of a sinew (meso-tendinitis) and quite often causing its necrosis is found. At acute aseptic (so-called crepitant) a tendovaginitis find adjournment of fibrin on the surface of a sinew (peritendinitis); quite often inflammatory process is localized in okolosukhozhilny cellulose (paratendinitis), sometimes — between a fascia of a muscle and an aponeurosis. At chronic T. the thickening and a loosening of a synovial membrane, accumulation in a synovial cavity of the liquid of yellow color rich with fibrin is observed, from to-rogo so-called rice bodies gradually form (see the Synovitis), fibrinous unions between parietal and visceral parts of a synovial vagina of a sinew are formed. At tubercular T., meeting quite seldom, distinguish four forms of defeat: serous (a tubercular edema, a tubercular hygroma), characterized by accumulation in a synovial vagina of plentiful serous exudate and a thickening of walls of a vagina, to-rye become covered by granulations; serous fibri-noznuyu (a hygroma with rice bodies), at a cut in a synovial vagina a small amount of serous exudate and mass of rice bodies is found; granulating with wrinkling of a synovial vagina, at a cut strongly to a vask lyari-zovanny granulyatsionny fabric can fill all gleam of a vagina and pass to the next fabrics; granulating with suppuration, at a cut in a synovial vagina are available pus (cold abscess) and tvorozhisto the regenerated granulations.
On clinical signs distinguish acute and chronic T. Clinical picture acute infectious nonspecific T. it is characterized by the acute beginning with bystry development of a painful swelling in the affected vaginas of sinews. Acute process is more often observed in vaginas of sinews of a dorsum of brushes and feet, is more rare — sgibatel of fingers of a brush, synovial vaginas of fingers of a brush (see the Felon). The painful swelling and hypostasis extend to a forearm (or respectively a shin). Restriction of movements, sometimes a flexion contracture of fingers is noted. At emergence of a purulent inflammation the septic state with high temperature of a body, a fever, the phenomena of regional lymphadenitis (see) and a lymph-ngiita quickly develops (see). Purulent process meets in synovial vaginas of sinews of a sgibately brush more often. The purulent beam tenobursitis is usually a complication purulent T. a thumb of a brush when inflammatory process extends to all vagina of a sinew of a long sgibatel of a thumb of a brush; sharp morbidity in the field of the palmar surface of a thumb above on the outer side of a brush is noted up to a distal part of a forearm. During the progressing of a disease the suppurative focus can extend to a forearm in fascial space of Pirogov (see the Forearm). The purulent elbow tenobursitis arises usually as a complication purulent T. little finger of a brush. Because the synovial vagina of a little finger approximately in 94% of cases is reported with the general synovial vagina of a sgibately brush, inflammatory process passes often from a finger to the general synovial vagina, and sometimes and on a vagina of a sinew long to the sgi-father of la of a thumb, causing development so-called cross (or U-shaped) phlegmons with a heavy current, a frequent complication the cut is dysfunction of a brush. Sharp morbidity and puffiness of a palmar surface of a brush, a little finger and thumb, restriction or impossibility of extension of fingers is noted. The disease can be complicated by break of pus in kletchatochny space of a forearm.
Acute aseptic, so-called crepitant, T. usually affects the synovial vaginas located on a dorsum of a brush, is more rare — feet, sometimes — an intergrumous synovial vagina of a biceps of a shoulder. The disease begins sharply: in the affected sinew the swelling quickly is formed, at a palpation the cut during the movement of a sore finger is defined crepitation (see); the movements of a finger are limited and painful. Quite often the disease passes in hron. form.
Chronic T. are observed most often in vaginas of sinews of razgibatel and sgibatel of fingers in the field of their retinaculums. A wedge, a picture chronic the T is most characteristic. the general synovial vagina of sgibatel of fingers located in the channel of a wrist (a so-called syndrome of a carpal tunnel). At this disease in the field of the channel of a wrist painful tumorous formation of oblong shape is defined, an elastic consistence, a cut has often the form sand, hours, is a little displaced at the movements. At a palpation fluctuation is sometimes noted, rice bodies are probed; the movements of sinews are limited. Peculiar form hron. T. is so-called hron. stenosing T., described by de J. de Qnervain, characterized by damage of a vagina of sinews of a long abductor and short razgibatel of a thumb of a brush, wall to-rogo are thickened, and the synovial cavity is narrowed. A wedge, displays of a disease begin with pains in the field of an awl-shaped shoot of a beam bone. On the course of a vagina sharply painful swelling is palpated; there is a pain at assignment and extension of a thumb irradiating in a forearm and a shoulder. Close to a jerk finger on clinical manifestations there is a stenosing tendovaginitis — a reactive inflammation of the copular device of a brush. The stenosing tendovaginitis results from a functional overstrain, an injury, infectious diseases (flu, etc.). More often collateral sheaves metacarpophalangeal and interphalangeal joints of a brush are surprised. The disease is characterized by the pains arising at the movement and a palpation, a swelling, pastosity and erubescence in the field of defeat. Sometimes there is a partial necrosis of sheaves with disturbance of sliding of a sinew and difficulty during the bending and extension of a finger, to-rye are made with a characteristic poshchelkivaniye (see. The clicking finger).
At tubercular T. on the course of expansion of vaginas of sinews dense educations — rice bodies are palpated.
Diagnosis of T. the wedge, researches is based on characteristic localization of process and data (painful shnurovidny consolidations in characteristic places, disturbances of the movement, palpation of rice bodies, etc.). Acute infectious T. differentiate with osteomyelitis (see) and acute arthritis (see Arthritises), and crepitant T. — with a change (see Changes). At a tendovaginitis unlike the listed diseases on roentgenograms do not find changes from bones and joints, are absent morbidity in a bone and deformation of a joint. Apply a ligamentografiya to an exception of the stenosing tendovaginitis (see). Exclude the general diseases, to-rye could become the reason of T. (brucellosis, tuberculosis, etc.).
Treatment acute T. provides use of the general and local to lay down. actions. At nonspecific acute infectious T. the general treatment is directed to fight against an infection by use of antibacterial means and strengthening of protective forces of an organism. At tubercular T. use medicamentous anti-tubercular therapy (streptomycin, PASK, Ftivazidum), etc. At aseptic T. use non-steroidal anti-inflammatory drugs (acetilsalicylic to - that, indometacin, Butadionum). Topical treatment as at infectious, and aseptic T. in an initial stage includes the rest, an immobilization of an extremity a plaster splint warming compresses. After subsiding of the acute phenomena appoint physiotherapeutic procedures (microwave therapy, ultrasound, UVCh, UV rays, an electrophoresis of novocaine and a hydrocortisone) and LFK. At purulent T. urgent opening and drainage of a vagina of a sinew and purulent zatek is shown. At tubercular T. enter locally solution of streptomycin, excise the affected synovial vaginas (see. Synovectomy ).
Treatment chronic T. includes, except the listed above physiotherapeutic methods, paraffin, ozokeritovy or mud applications (see Ozokeritolechepiye, the Paraffin therapy), massage, an electrophoresis of a lidaza, etc.; use also LFK. During the progressing hron. infectious process make a puncture of a synovial vagina and enter antibiotics of the directed action. At hron. aseptic T. appoint non-steroidal anti-inflammatory drugs, locally enter solution of novocaine with a hydrocortisone. In persistent cases hron. crepitant T. appoint 1 — 2 session of a roentgenotherapy. At stenosing T. sometimes resort to a section of the narrowed site of a vagina of a sinew with economical excision of the struck segment, at the stenosing tendovaginitis — to partial (2 — 3 mm) to excision of the affected ligaments.
The forecast at timely and correct treatment of T. favorable. At purulent T. quite often there are permanent dysfunctions of a brush (foot).
See also Bursitis .
Bibliography: V.P. humpbacks. The stenosing tendovaginites of a back ligament of wrist and ring-shaped ligaments of fingers, L., 1956; Grigoryan A. V., Gifts V. K. and Kostikov B. A. Purulent diseases of a brush. M, 1978; - D about r about N G. Ya. and Oak E. D. Rentgenoterapiya of an acute professional tendovaginitis, Vestn. rentgenol. and radio-gramophones., t. 11, century 3, page 278, 1932; M and N the expert I am A. M N. A brucellous exudative tendovaginitis, It is new. hir. arkh., No. 3, page 103, 1958; P and l of l about L. N. and Slavin A. M. Bolezn Forestye, Zdra-vookhr. Belarus, No. 7, page 63, 1978; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 2, page 504, M., 1964; Skripnichenko of F., Mazurik M. F. and D I eat with N yu to D. G. Acute purulent diseases of a brush, Kiev, 1981; V. I Pods. General surgery, M., 1983; At with about l c e in and E. V. and Mashka-r and K. I. Hirurgiya of diseases and damages of a brush, L., 1978; E r I am l and with the Item C^> and Astapenko M. G. Extraarticular diseases of soft tissues of a musculoskeletal system, M., 1975; H an u with k tiber die sogenannte Tendovaginitis crepitans, Langenbecks Arch. klin. C'hir., Bd 128, S. 815, 1924; Quervain F. Uber das wesen und die Behandlung der stenosierenden Tendovaginitis am Processus styloideus radii, Miinch. med. Wschr., S. 5, 1912.