Crepitant Tendovaginitis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Crepitant tendovaginitis

Crepitant tendovaginitis is an inflammation of the inner wall of the synovial sheaths of the tendons, accompanied by a characteristic crunch. Most often, crepitant tendovaginitis develops in people who are engaged in physical labor, accompanied by a pronounced uniform load on a certain group of tendons.

Inflammation with crepitant tendovaginitis is aseptic, that is, it is not accompanied by the addition of bacterial flora. In the cavity of the synovial sheaths of the tendon, exudate of serous-hemorrhagic or fibrinous origin accumulates. This process is accompanied by the accumulation of fibrin deposits, which explain the appearance of a soft crunch when pressed on the inflamed area.

Content:

• Causes of crepitus tendovaginitis
• Symptoms of crepitant tendovaginitis
• Diagnostics of the crepitant tendovaginitis
• Treatment of crepitant tendovaginitis
• Therapeutic gymnastics with crepitant tendovaginitis
• Forecast and prevention of crepitant tendovaginitis

Causes of crepitus tendovaginitis

The causes of crepitus tendovaginitis can be as follows:

• Repetitive movements of the fingers and toes. Moreover, they may not be accompanied by pronounced physical exertion or sharp muscle tension. In terms of the development of inflammation, it is the frequency that is important.
• Severe tension in the muscles of the ankle and forearm for a long time. The fingers in this case may not be involved.
• Abrupt transitions in the technique of work and in its rhythm.

People of the following professions are at risk for the development of crepitus tendovaginitis of the hand: carpenters, locksmiths, operators, blacksmiths, milkmaids, grinders, typists, packers, ironers, violinists, etc. Although sometimes even prolonged hand washing or preparation for exams in music school.

Crepitant tendovaginitis in the area of the Achilles tendon manifests after a long march, skiing or skating (the likelihood of developing inflammation increases if the hard back of the boot presses on the soft tissues, pressing them tightly to the Achilles tendon). Tap dancers, ballerinas, athletes (skiers, runners, speed skaters), etc. are at risk for the development of crepitant tendovaginitis of the lower extremities.

Symptoms of crepitant tendovaginitis

The symptoms of crepitant tendovaginitis are as follows:

• Manifests tendovaginitis most often acutely. The inflammation can last 4-15 days, then it fades away. However, a relapse of the disease cannot be ruled out.
• Sometimes there is a subacute course of tendovaginitis. In this case, the pathological symptoms grow slowly, over 2-3 weeks. The pain in the limb will be aching, debilitating. Possibly increased weakness and fatigue.
• Pain in the area of inflammation. It becomes more intense while performing movements. In the acute phase of the disease, it is burning, so it does not allow a person to perform his usual duties, for example, working with levers or typing.
• Swelling along the tendon. The extensor surface of the hand and forearm most often suffers. Less commonly, crepitus tendovaginitis affects the feet, lower legs, and the Achilles tendon.
• When palpating the inflamed area, you can hear a crunch, which doctors call crepitations. Also, the crunch always accompanies the movements of the diseased limb. It is heard very clearly.
• The general condition of the patient is not disturbed, as is the case with purulent tendovaginitis. Body temperature remains within normal limits.

The disease is almost always one-sided, that is, inflammation develops on one arm or one leg. It should be noted that it is the tendons of the right hand that become inflamed more often than others.

Separately, experts note the influence of the meteorological factor on the course of the disease. That is, when the weather conditions change, the soreness may increase. However, this is not observed in all patients.

Diagnostics of the crepitant tendovaginitis

Crepitant tendovaginitis is not difficult to diagnose. The doctor can inform the patient about his problem already during the first visit. The specialist will build on the history and typical symptoms characteristic of this pathology - this is an acute onset, pain, tendon crepitus.

A clinical and general blood test does not indicate any abnormality. Perhaps the appointment of an X-ray examination to the patient. However, it is indicated only in order to exclude the presence of bone or articular pathology. In terms of detecting tenosynovitis, this study is of little information.

Treatment of crepitant tendovaginitis

Treatment of crepitant tendovaginitis is reduced to conservative measures. The affected limb is immobilized without fail. Immobilization can take place using a splint or plaster cast. This measure is indicated in the first days from the manifestation of inflammation. To reduce pain, the patient undergoes novocaine blockade. If it does not allow you to get rid of painful sensations, then it can be repeated after 2-3 days. In parallel, the patient is prescribed drugs from the NSAID group.

As the inflammatory process fades away (starting from 3-4 days), heat is applied to the sore spot. It can be warming compresses, alcohol lotions, heating pads.

Physiotherapy procedures have proven themselves well:

• UHF.
• Quartzization.
• Paraffin applications.
• Double irradiation with a Solux lamp. The duration of each procedure should be 20 minutes.
• Mud applications are performed at a temperature of 42-46 ° C. The duration of the procedure is also 20 minutes. The number of sessions is 4.
• Reception of fresh baths with a water temperature of 36-37 ° C.

In the future, the patient is recommended to practice therapeutic and gymnastic complexes, a visit to the massage therapist's office. Active and passive movements of the affected limb should be performed no earlier than 5-6 days after the start of treatment. The immobilization device can be completely removed no earlier than 6 days from the start of treatment.

For 14 days, the patient must be under medical supervision. This will minimize the risk of recurrence of the disease and maximize recovery. Therefore, at this time, a person must be on sick leave.

A separate issue is the prescription of antibiotics. Most experts are of the opinion that prescribing antibacterial drugs against the background of aseptic crepitant tendovaginitis should not be, since the disease is not caused by pathogenic flora. Other experts insist that antibiotics should be impregnated with a course, since against the background of tendovaginitis there is always a risk of developing purulent inflammation. The drug of choice in this case is Ceftriaxone.

The indications for surgical intervention are stenosing and long-term current forms of the disease, which cannot be corrected with the help of conservative treatment. The operation is carried out in a planned manner, carefully preparing the patient for it. The tendon sheath, which has undergone inflammation, is completely excised, the subcutaneous tissue and skin are sutured. After the performed intervention, the limb is immobilized, and the patient is prescribed a course of prophylactic antibiotics.

Therapeutic gymnastics with crepitant tendovaginitis

Remedial gymnastics helps to strengthen the muscles and tendons of the limb. This reduces the risks of developing tendovaginitis and its transition to a chronic form.

Therapeutic gymnastics with tendovaginitis of the upper extremities:

• Hands are stretched out in front of you, after which they begin to smoothly squeeze and unclench the palms. You need to perform the exercise 10-15 times, 2-3 times a day.
• Exercise "fan" for which you need to touch the tips of all fingers in one direction and vice versa with the tip of your thumb. You need to perform the exercise 5-7 times. In this case, the arms can be bent at the elbow joint.
• Exercise "lock". Fingers should be tightly clasped with each other, hands should be placed at chest level. Alternately rotate with brushes to the right and to the left. Perform 10-15 rotations in both directions.
• The arms are bent at the elbows, while the palms are clenched into a fist. Rotational movements are performed in the elbow joint in one direction and the other.

Therapeutic gymnastics with tenosynovitis of the foot:

• The leg is bent at the knee joint, the foot is rotated in a circle in one direction and the other. At the same time, the person sits on a chair, and the leg should be slightly raised.
• The leg is bent, the sock should be pulled towards you until a slight soreness is felt. Repeat the exercise 5 times for one leg and 5 times for the other leg.
• Lying on the floor with outstretched legs, you need to squeeze and unclench your toes as much as possible.
• During sedentary work, you can roll a bottle or other suitable object with your toes.

Forecast and prevention of crepitant tendovaginitis

Relapse of the disease occurs on average in 16-20% of patients who received quality treatment. If a person has not consulted a doctor, then the likelihood of re-development of tendovaginitis increases. It is noteworthy that immobilization of a limb alone is not enough to minimize the risk of recurrent inflammation. The use of novocaine blockade is important. In addition, the patient must spend sufficient time on sick leave (at least 14 days).

Surgical intervention against the background of chronic, often recurrent tendovaginitis gives good results. After a while, the functionality of the limb can be fully restored.

Prevention of the development of crepitant tendovaginitis is primarily reduced to limiting the motor activity that provoked the inflammation. If this happened due to professional responsibilities, then you need to seriously think about changing your profession. A person who ignores this recommendation is at risk of disability. In the future, in any case, he will have to abandon the chosen work, since frequent relapses of tendovaginitis will lead to a complete disruption of the functionality of the limb.

Do not self-medicate. Tenosynovitis is a disease that carries a risk of disability. Therefore, you need to get rid of it in a timely manner and under medical supervision.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.