Tendovaginitis

Synonyms

• Tendinitis
• Peritendinitis
• Paratendinitis

introduction

In the medical jargon under the term Tendovaginitis known disease is a Inflammation of the tendon sheaths. In most affected patients, it manifests itself in the appearance of severe, stabbing pain that is aggravated by movement and decreased by immobilization.
In principle, tendovaginitis can affect any tendon in the body. In everyday clinical practice, however, it becomes clear that tendons in heavily stressed areas of the body are particularly affected. Typical sites of tendovaginitis are Ankle joints and Wrists.

causes

The causes of a Tendovaginitis can be very different. In the majority of cases, the occurrence of tendinitis can be attributed to overuse or improper use of the Joints to be led back. The reasons for the development of tendovaginitis can be divided into two main groups. In medicine one broadly differentiates between non-infectious and infectious causes.

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Infectious causes

In order to understand the causes of tendovaginitis, one has to learn about the structure and function of a Tendon sheath be clear. As a double-walled sheath filled with synovial fluid, the tendon sheath lies on the outside of the tendons.
Roughly, it consists of a tight one Connective tissue layer (Stratum fibrosum) and a synovial part (Synovial stratum). In healthy people, the tendon sheath is a closed system that primarily has a protective function.

In addition, the forces and friction involved in movement processes should be absorbed by the tendon sheath. Due to the structure of the tendon sheaths, it is usually not possible in a healthy organism for the tissue to be infected by pathogens (for example bacteria) is damaged.
In the case of traumatic injuries, such as a stab wound, on the other hand, the tendon sheath barrier is penetrated and bacterial colonization is possible. Among the most common bacterial pathogens that trigger a Tendovaginitis apply, belong Staphylococci and Streptococci. Furthermore, damage in the area of ​​the tendon sheaths can also occur Chlamydia, Mycoplasma and Gonococci caused. In this case too, tendovaginitis with severe, sharp pain and impaired joint function can develop.

Non-infectious causes

The infectious or purulent Tendovaginitis is generally less common than non-infectious Forms of tendinitis.
The main causes include long-term incorrect or excessive mechanical loads that lead to irritation of the tendon tissue. Accordingly, it is precisely long-lasting, monotonous sequences of movements and serious posture errors that ensure that the tendon sheaths are particularly strong over the bone rub and thus be damaged. Over time, the abrasion is followed by a roughening of the collagen fibers, which can lead to the development of inflammatory processes.
For this reason, non-infectious tendovaginitis mainly affects office workers and athletes. In most cases, tendovaginitis occurs on the tendon sheaths hand- and Ankles, i.e. in those places that have to withstand a high level of stress. Risk factors are primarily unergonomic work devices (e.g. keyboards) at the desk.

Symptoms

Patients who participate in a Tendovaginitis sufferers generally complain of severe stabbing pain in the area of ​​the affected tendon sheath. In addition, many sufferers report pain on pressure along the course of the tendons, which also extends into the muscle can forward. In many cases, overheating of the joint and reddening of the skin areas over the tendon sheath can also be determined.
Pain occurs at rest only in very pronounced cases. Resting pain is rather untypical for tendovaginitis. For long-lasting (chronic) In the course of tendovaginitis, there may also be nodular thickening, palpable crunching and rubbing of the tendon. In addition, the pain phenomenon in the presence of tendinitis can be triggered by passive stretching of the tendon.

diagnosis

Since the causes for the development of tendovaginitis can be infectious as well as non-infectious, a comprehensive diagnosis must be made before the choice of the appropriate therapy.
One of the most important points in the diagnosis of tendovaginitis is the detailed one Doctor-patient conversation (anamnese) represent.

The attending physician receives an initial one from the patient’s descriptions Suspected diagnosis. In addition to the description of the type, intensity and location of the pain, information on professional activity is also very important.
In addition, by palpating the affected area, the doctor can draw further conclusions about the underlying disease. If the findings are unclear, it is then possible to initiate further examinations. Inflammation markers im blood (especially increased white blood cells and the so-called CRP value) indicate an inflammatory process. In addition, the blood should be examined for a specific rheumatoid factor. Also making one X-ray or one MRIs (Magnetic resonance imaging) can be useful in diagnosing tendovaginitis.

In medical terminology, inflammation of the tendon sheaths is called Tendovaginitis (Synonyms: Tendinitis, Peritendinitis, Paratendinitis). In most cases, tendovaginitis manifests itself as severe stabbing pain in the area of ​​the affected tendons. In severe cases even redness and overheating develop.
In principle, a Tendovaginitis occur on all tendons of the body, but in everyday clinical practice it is mainly the Ankle joints and Wrists are affected. The most common causes of tendovaginitis include mechanical overloading or incorrect loading. An inflammation of the tendon sheaths can, however, also be caused by bacterial pathogens (especially by Strepto- and Staphylococci) to be triggered. If symptoms occur repeatedly or for a long time, other possible causes of pain (so-called Differential diagnoses) urgently need to be clarified.

Differential diagnosis

The differential diagnoses of tendovaginitis include various arthritic diseases and inflammation of the stylus processes (styloiditis).
The disease known by the technical term styloiditis is inflammation-related pain phenomena that particularly often affect the bones of the ulna, the radius or the metacarpal. Similar to tendovaginitis, styloiditis manifests itself in the appearance of sharp pain in the area of ​​the wrists.
In addition, many patients describe tenderness over the affected stylus process. Above all, ulna styloiditis, which affects the bony ulna, is a differential diagnosis to tendovaginitis. Furthermore, in the case of patients who frequently complain of complaints in the area of ​​the wrist, a degenerative joint disease should be considered in the differential diagnosis.

The joint disease known under the technical term rhizarthrosis mainly affects the wrist and thumb saddle joint and for this reason can easily be confused with tendovaginitis. In contrast to tendinitis, however, rhizarthrosis patients suffer from the typical sharp pain and sometimes severe swelling in the area of ​​the affected joint. Furthermore, joint function is severely restricted in affected patients. In addition, the differential diagnosis of rizarthrosis can be made with the help of an X-ray, which shows clear signs of osteoarthritis. Wrist arthrosis is also a common differential diagnosis of tendovaginitis. In the case of wrist osteoarthritis, there are signs of wear and tear of cartilage tissue on joint-forming bone surfaces. Cartilage wear can have many causes, but no reason for wrist osteoarthritis can be found in the majority of affected patients. The main symptoms include pain and swelling around the affected joint. In addition, many patients complain of severe limitations in joint function and also show visible deformations.

Read more on the topic: Pain in the metacarpal boil

Diagnosis for treatment approach

With regard to the various possible causes of tendovaginitis, the diagnosis plays a decisive role in the choice of the best possible therapy strategy.
While infectious Forms mostly with the help of a Antibiotic can be treated, require the non-infectious Tendovaginitis types one more extensive treatment. The most important point in the diagnosis of tendovaginitis is an extensive doctor-patient discussion (anamnese) represent.
By asking the patient about the quality, intensity and location of the pain, the attending physician can already gain initial indications of the presence of tendovaginitis. In addition, the Broadcast pain over the muscle adjacent to the inflamed tendon is a feature of tendovaginitis.
In addition, special tests are usually carried out for diagnosis, which indicate the presence of tendinitis with a high degree of probability.

Finkelstein test

In the so-called Finkelstein test, the doctor includes the thumb of the patient and tries the hand fast towards Cubit to move. If tendovaginitis is present, severe pain occurs in the area of ​​the spoke on.

Eichhoff test

During the Eichhoff test, the patient is asked to place the thumb of the painful hand on the palm of the hand and enclose it with the other fingers. After that, the hand is directed by the doctor in the direction of the little finger emotional. Patients with tendovaginitis put one in their arms for this test radiating intense pain.

In addition to the description of the symptoms, information about professional activity and possible leisure activities is also very important. It tends to happen Office workers, Musicians and Athletes tendovaginitis is much more common.
The second step in diagnosing tendovaginitis is a physical examination of the patient. By the Scan In the affected body region, the pain usually increases in intensity.
In addition, so-called "grinding noises" can often be detected when moving the affected joint Rub the inflamed tendon sheath arise over the bone.
If the findings are unclear, it may also be necessary to initiate further examinations. In addition to the physical findings and the symptoms, a Blood test can be used to detect specific inflammation markers. If tendovaginitis is present, there are mainly elevated levels in the blood White blood cells and CRP levels. In addition to the classic signs of inflammation, there is also a blood analysis with evidence of a special one Rheumatoid factor Information about the diagnosis.
Also making one X-ray or one MRIs (Magnetic resonance imaging) can be useful in diagnosing tendovaginitis.

therapy

Choosing the appropriate therapy of the Tendovaginitis is primarily dependent on their causes.
Infectious forms usually require antibiotic treatment, whereas non-infectious Types to be treated through relief, pain relief, and physical therapy are. Furthermore, the treatment of tendovaginitis depends on both the extent and the frequency with which the symptoms occur.
In the majority of affected patients there is one medical therapy perfectly sufficient to eliminate the symptoms.

Especially such painkillers (Analgesics) belonging to the class of Nonsteroidal anti-inflammatory drugs can help to effectively relieve the sharp pain in the area of ​​the affected joint. When choosing the analgesic, anti-inflammatory drugs should be the means of choice.
In addition to relieving pain, these are able to contain the course of the disease and bring about rapid recovery of the tendon sheaths.
In addition to relieving pain, immobilizing the affected joint also plays a significant role in this Tendovaginitis therapy.

Applying supportive bandages and using anti-inflammatory ointments or creams is found helpful by most patients.
In the case of chronic forms of the disease or those patients who frequently develop tendovaginitis, a so-called Chain rail become necessary. A chain splint is a splint that is tailored to the symptoms of mechanical stress and relieves the symptoms of external compression of the affected area.
Another not to be neglected point in treating a Tendovaginitis is the adaptation of working conditions.

Patients who work a lot with the computer should convert to ergonomic keyboards and mice. Ultimately, the non-infectious tendovaginitis- Forms can only be counteracted by reducing incorrect and overloading. In the case of chronic forms of the disease, the introduction of local anesthetics or Cortisone-containing preparations should be considered.

Surgical corrections of the tendon sheath apparatus are necessary in rare cases. This treatment option mainly affects those patients for whom despite being adequate Pain therapy and changes in living conditions, no or only a slight improvement in the pain problem is achieved.
By splitting the affected tendon sheath, permanent relief can be achieved in the majority of cases Tendovaginitis - Symptoms guaranteed.

Prognosis of tendovaginitis

The prognosis for tendovaginitis (tendinitis) is generally very good. Although the course of this disease and thus the painful intervals can be very lengthy, tendovaginitis can be treated well and effectively with comparatively simple means.
In this sense, however, it is essential to get to the bottom of the exact cause of the development of the tendinitis. Only a therapy that is precisely tailored to the underlying problem can combat the inflammatory processes in the tendon sheath in the long term and thus lead to a good prognosis.
An essential factor for successful healing is avoiding activities that are particularly stressful for the joints and can trigger renewed attacks of inflammation. Tendovaginitis that is not treated promptly can lead to the symptoms becoming chronic. In medical terminology, the clinical picture resulting from this phenomenon is called “Repetive Strain Injury” (RSI for short). In addition, tendovaginitis that persists over a long period of time can lead to inflammatory processes, thickening and loss of function in the area of ​​the finger flexors (technical term: tendovaginitis stenosans). In patients who suffer from tendovaginitis and who also have rheumatic side effects, the prognosis is slightly worse.

prophylaxis

The creation of a Tendovaginitis can be prevented by adhering to less simple rules of conduct. The most important factor in prophylaxis is avoiding long, steady movements that cause the Joints excessively strain. In addition, a wrong posture during sport, of Making music and the Office work be avoided.
For this reason, typists or office workers should think about purchasing ergonomic work equipment. Simple cushions that are placed in front of the keyboard at the workplace can already achieve great effects. It has also been proven that a keyboard that is as flat as possible on the table is particularly gentle on the joints and tendon sheaths. In addition, taking regular breaks between writing intervals can be seen as a suitable prophylaxis for tendovaginitis.

During these breaks, various muscle-relaxing exercises should be carried out, thus preventing the development of inflammatory processes. Regular stretching and warming of the stressed tendon sheaths also contributes effectively to prophylaxis of tendovaginitis.