Tenosynovitis

The tendonitis ( tenosynovitis, also peritendinitis or paratenonitis ) is an inflammation of the tendon sheaths. It manifests itself in strong pungent or drawing pains. Tenosynovitis occur mainly in the wrist, but eg also in the ankle area. In principle, they are everywhere possible where the tendon sheaths exist.

Causes

Non-infectious causes

Tenosynovitis occur primarily by rapid increases in stress or load duration in sports. This concerns, for example, (ski) cross-country skiers, the tendon sheaths of the foot stirrup and the Fußbeuger.

A tendonitis can also be caused by long -term overuse of the wrists. Examples of such causes are poor posture or a unergonomic facilities on computer workstations - sometimes colloquially referred to, as " mouse arm " can cause repetitive strain injury syndrome - and similarly monotonous stressful activities and continued overuse of the wrist.

Previously, tendonitis in secretaries very often, as a higher effort than was required in modern keyboards when typing on mechanical typewriters.

New studies on the diseased tendon material show that the fibroblasts increased the unstable type 3 collagen produce instead of the more stable collagen type 1. This indicates degenerative processes.

Commonly affected occupational groups are clerical workers, computer scientists, musicians, bakers, cooks, hairdressers, masseurs and physiotherapists as well as technicians, designers, florists, painters and finishers.

In September 2006, a landmark decision of the Administrative Court of Göttingen has been released, the tendonitis a path switch - official recognized as an occupational disease ( Az: 3 A 38/ 05). The basis for the ruling was the German occupational disease regulation, which applies to all legally socially insured employees in the private sector. Jurisdiction in disputes relating to the statutory accident insurance in Germany are usually the social courts, except for civil servants.

In chronic complaints of a RSI ( repetitive strain injury ) is spoken.

Infectious causes

Infections occur mainly due to random injuries that lead to an opening of the tendon sheath and colonization with bacteria. The infestation of Synoviaepithels of the tendon sheaths is also known for pathogens that can cause post-infectious arthritis. The most common pathogens in open wounds are staphylococci and streptococci. The treatment is based on the all soft tissue infections. Principles are the immobilization, surgical relief and the administration of an antibiotic.

In addition, the synovial epithelium that lines both tendonitis and joint cavities, even of chlamydia, mycoplasma, gonococcus are affected, inter alia, directly or they can trigger immunological cross-reactions. Antibiotic therapy is dependent on the pathogen and the serological evidence of active infection events effectively. It is also suggested that chlamydia, mycoplasma, diarrhea pathogens are involved (eg Yersinia ), Borrelia and other chronic rheumatologic and gradients. You can trigger a post-infectious arthritis. The primary infection may be partially show a nearly asymptomatic, so that the symptoms are often not associated with infection and instead are often attributed to an overload situation there.

In the following, only the much more common non-infectious tenosynovitis is described, but not the rheumatology and acute- ulcerous forms.

Symptoms

In acute inflammation, a pressure pain along the tendon and muscle curve is typical. Often there are also a warmth and redness as signs of inflammation. In severe cases, rest pain is present, very little improvement is observed after the immobilization overnight.

The chronic forms do, in part, noticeable only by nodular thickening of the affected tendon, sometimes with painful, palpable " crunch " and rubbing of the tendon. This can result in the phenomenon of so-called fast finger ( stenosing tenosynovitis ) are: The thickened tendon initially plugged into the tendon sheath, with stronger muscle pull it slides then suddenly from the throat out (especially with extension movements ). In Switzerland also " Spickfinger " said.

The clinical examination shows a typical zone of pressure pain, which adheres to the anatomical boundaries of the affected tendon and muscle. There is also a pain with passive hyperextension of the tendon (see below: Finkelstein test) and during active contraction of the muscle against resistance.

Have to be defined, inter alia, joint pain (arthralgia, arthritis ), pain at the tendon insertion in the bone ( insertion tendinopathy, such as tennis elbow) and bottleneck syndromes of peripheral nerves (eg Supinatorlogen syndrome). In tendons that have no tendon sheath, while a paratenonitis may be present, such as at the Achilles tendon.

Therapy

For severe pain may be useful to an immobilization of the affected muscle (rail, plaster cast ). Often a supportive dressing is applied and administered an anti-inflammatory ointment. NSAIDs also relieve pain and reduce inflammation.

In the medium may be useful velcro rail that relieves complaints about the compression. Occupational therapy and an adjustment of the workload are also useful, such as through another work unit or longer breaks during work, etc. For musicians helps loose hot games or warm-up exercises of the hands and wrists before the game to prevent the tendonitis.

For chronic ailments and local anesthetic ( local anesthetics ) can be injected, and occasionally cortisone preparations are used. Especially when stenosing form an operating division of the tendon sheath is possible. In chronic inflammation, as opposed to acute inflammation, heat usually perceived as more comfortable than cold.

Some medical studies show Extracorporeal shock wave therapy ( ESWT) that 70-80 % of patients specified a significant relief of symptoms after three months. However, it is generally to be expected after this time with a high rate of improvement even without therapy. Other studies show no effect, the procedure is not widely recognized. In Germany it is a self-payer benefit, the treatment is not covered by health insurance because of a lack of studies of good quality.

Special form

Tenosynovitis stenosing de Quervain ( de Quervain's disease ) of the first tendon compartment. This pass the tendons of the thumb muscle abductor pollicis longus and extensor pollicis brevis. Cause is usually an overload of tendons due to frequent abduction ( movement of the thumb away from the palm ) and predisposition. An increased incidence is observed in mothers who often hold with powerful Daumenabspreizung a baby, and more recently at extremely frequent typing SMS messages.

Clinically the Finkelstein test ( according to Harry Finkelstein, 1865-1939 ) is usually positive, which corresponds to a passive stretching of the tendons.