Tendovaginitis

Description:

The inflammation of a tendinous vagina arising at penetration into it of pathogenic microflora or owing to dystrophic changes of synovial membranes of sinews. Distinguish an infectious and aseptic tendovaginitis. On a clinical current allocate an acute and chronic tendovaginitis.

Tendovaginitis symptoms:

The acute infectious nonspecific tendovaginitis develops after penetration of pathogenic pyogenic microflora in a synovial vagina at its damage. It is more often observed in vaginas of sinews of sgibatel of fingers of a brush — a so-called thecal whitlow. It is characterized by accumulation in a cavity of a synovial vagina of serous, and then purulent exudate with the subsequent disturbance of blood supply of a sinew. It is clinically shown by the fervescence, sharp pains in the field of defeat amplifying in attempts of the movement by the affected finger, regional lymphadenitis. Hypostasis and the forced fixed position of a finger develop. At a purulent tendovaginitis of I and V fingers distribution of pus in beam and respectively elbow synovial bags of a brush with development of a tenobursitis is possible. As approximately in 80% of cases beam and elbow synovial bags have the message, development of V-shaped phlegmon of a brush is possible. Clinically at the same time note high temperature of a body, a fever, sharp hypostasis of a brush, severe pains in the field of the corresponding synovial bag, the bent, forced position of fingers. At untimely or inadequate opening of phlegmon there can come the sinew necrosis because of a prelum of its mesentery.
The chronic infectious tendovaginitis  is caused by specific microflora (tubercular mycobacteria, brucellas, spirochetes) more often. Tuberculosis of synovial vaginas arises at ekzo-and endogenous defeat. It is characterized by slowly increasing, low-painful swelling in a projection of tendinous vaginas and joint bags. Tendinous vaginas of sgibatel are surprised approximately twice more often than razgibatel. Tubercular process has in the beginning limited character (the synovial membrane is surprised) and only then passes to sinews and surrounding fabrics.
The brucellous tendovaginitis sometimes proceeds as acute infectious, but the primary and chronic form meets more often. Damage of sinews of razgibatel with gradual restriction of mobility of fingers is characteristic. Extremely seldom defeat of synovial membranes of sinews at gonorrhea and syphilis meets.
  Refer dystrophic defeats of tendinous covers, a posttraumatic and so-called reactive inflammatory tendovaginitis to an aseptic tendovaginitis. A dystrophic tendovaginitis most often develops owing to chronic microtraumatization (typists, pianists, etc.) also are characterized by a chronic recurrent current. Morbidity on the course of the struck covers of sinews (more often on a forearm), crepitation or a crunch at the movement of the corresponding sinews is clinically noted. A special clinical form of this tendovaginitis is the jerk finger of which partial blocking of movements in the osteofibrous channels which are in the basic in the field of brushes and anklebones is characteristic. Allocate several syndromes connected with jerk fingers. The syndrome of a carpal tunnel arises at a stenozirovaniye of the last in the field of the palmar surface of a radiocarpal joint with a prelum of a median nerve and sinews of muscles of sgibatel of fingers. Pains and paresthesias in a zone of an innervation of a median nerve (I, II, III fingers, the internal surface of the IV finger) are noted, force of fingers of a brush and ability to the thin and exact movements decreases.

Stenosing is tendosinovit by de Quervena — a tendovaginitis long taking away and short extensive muscles of the I finger of a brush in the place of their passing via the osteofibrous channel at the level of an awl-shaped shoot. It is characterized by pains and a swelling in the field of "an anatomic snuffbox". Stenozirovaniye leads to disturbance of the movements I of a finger.

The stenosing tendovaginitis of fingers (a thicket of I, III and IV) is caused by sclerous processes in ring ligaments of a tendinous vagina. A peculiar difficulty at extension of a finger ("the clicking finger") is characteristic.
The posttraumatic tendovaginitis develops at bruises and stretchings of the copular device of a brush, sometimes with hemorrhage in a tendinous vagina.

Tendovaginitis reasons:

the disease has the infectious or dystrophic nature.

Treatment of the Tendovaginitis:

Treatment of a spur of an infectious nonspecific tendovaginitis is carried out in a hospital and consists in perhaps early opening of a vagina of a sinew, removal of exudate, audit and sanitation of a cavity. At a necrosis and fusion of a sinew its resection is shown. The finger immobilization in functionally advantageous position and the directed antibiotic treatment with the subsequent rehabilitation after stopping of pyoinflammatory process is necessary.
Treatment of a chronic infectious tendovaginitis consists in the general specific therapy, at considerable restriction of movements — excision of the changed covers of sinews, pathological granulations, introduction of antibiotics of the directed action.
At treatment of an aseptic tendovaginitis in the acute period the immobilization of the affected sinew a plaster splint in functional situation is necessary. Appoint anti-inflammatory drugs (Butadionum, Rheopyrinum  , etc.), physiotherapeutic treatment (an electrophoresis with novocaine and potassium iodide, фонофорез with a hydrocortisone), applications of Dimexidum. Novocainic blockade with a hydrocortisone are effective. After subsiding of the acute phenomena mud applications (ozokerite), other types of resorptional therapy against the background of the dosed occupations are shown by physiotherapy exercises. Gradual increase in load of the affected extremity is important. At inefficiency of conservative treatment excision or a section of the changed tendinous covers is shown.