Tendinitis

Tendinitis

Tendonitis is an inflammation of the tendon tissue, traditionally observed at the point of attachment to the bone or in the zone of the muscle-tendon junction; traditionally combined with inflammation of the tendon bag or tendon sheath. Etiology

• • Increased motor activity and microtraumatization
  • Diseases of a rheumatic nature
  • Rheumatoid arthritis
  • Gout
  • reactive arthritis.

At-risk groups

• • Athletes
  • Physical workers. Pathomorphology. Degenerative changes in the tendons: the presence of fibrinoid, mucoid or hyaline degeneration of the connective tissue.

Clinical picture

• • Pain
  • With active movements performed with the participation of the affected tendon, while similar passive movements are painless
  • On palpation along the affected tendon.
  • Hyperemia, hyperthermia over the area of ​​the affected tendon.
  • Crepitus during movement of the tendon, audible at a distance or only through a phonendoscope.
  • Most common localization
  • Tendonitis of the rotator cuff of the shoulder, tendonitis of the tendon of the biceps muscle (see Periarthritis of the humeroscapular).
  • Lateral epicondylitis (tennis elbow) – tendonitis of the extensor muscles of the wrist (brachioradialis, long and short radial extensor carpi)
  • Pain on palpation of the lateral epicondyle of the humerus
  • Thomsen’s test: when the patient tries to keep the hand clenched into a fist in the position of dorsiflexion, it falls, moving into the position of palmar flexion
  • Boelsch test: the patient is given a command to simultaneously unbend and supinate both forearms, which are at the level of the chin in the position of flexion and pronation, while the affected side lags behind the healthy one.
  • Medial epicondylitis (golfer’s elbow) – tendinitis of the flexor and pronator muscles of the forearm (pronator teres, flexor carpi radialis and ulnaris, palmar longus)
  • Pain on palpation of the medial epicondyle of the humerus
  • Pain during flexion and pronation of the forearm, radiating along its inner edge
  • Associated neuritis of the ulnar nerve (25-50% of patients).
  • Stenosing tendovaginitis of the short extensor and long abductor muscles of the thumb (de Quervain’s disease), accompanied by narrowing of the I canal of the dorsal carpal ligament
  • Pain during extension and abduction of the thumb
  • Pain on palpation of the styloid process of the radius
  • Elkin’s test: pain when bringing the tip of the thumb to the tips of the index finger and little finger.
  • Stenosing tendovaginitis of the ulnar extensor of the hand (ulnar styloiditis) is accompanied by narrowing of the VI channel of the dorsal ligament of the wrist
  • Pain in the area of ​​the styloid process of the ulna
  • swelling in the same area.
  • Tendinitis of the patellar ligament
  • Pain in the area of ​​the tibial tuberosity when walking, running, going down stairs
  • Swelling in the region of the tuberosity of the tibia.
  • Tendinitis of the Achim tendon and tendons of the plantar muscles (thalalgia)
  • Pain when stepping on the heel and when bending the sole
  • Local swelling – with concomitant Achilles bursitis and subcalcaneal browning.
  • Children and teenagers. The most common form is patella tendinitis associated with inflammation of the tibial apophysis (Osgood-Schlatter disease).

Research methods

• • Laboratory studies: changes are observed only with concomitant rheumatic pathology
  • X-ray examination
  • Possible calcium deposits in the tendons
  • Heel spurs – for tendinitis and tendobursitis of the Achilles tendon or tendon of the plantar muscle
  • At

tendinitis of the patellar ligament, signs of aseptic necrosis of the tibial tuberosity (Osgood-Schlatter disease) are possible

• • Special Studies
  • Sonography of the tendon – reduction of the tendon, a change in its structure. It is necessary to ensure that the ultrasonic wave does not cross the tendon along the oblique diameter.
  • CT/MRI is informative for detecting tendon ruptures, it is not very informative in diagnosing stenosing tenosynovitis.

Differential Diagnosis

• • Tendon tear
  • Bursitis (be aware of the frequent combination with tendinitis)
  • Infectious tendosynovitis (usually on the arm; pain on palpation and swelling are located along the tendon sheath, and not at the point of attachment to the bone).

Treatment:

• • Tactics of conducting
  • In the acute phase – rest, immobilization
  • Shoulder sling or upper limb splints
  • Braces, canes and/or lower limb crutches
  • Patches tightly applied to the forearm slightly distal to the elbow joint – with epicondylitis.
  • Physiotherapy.
  • Drug therapy
  • NSAIDs
  • Piroxicam 10 mg/day
  • Indomethacin 25 or 50 mg Sr/day
  • Ibuprofen 1,800–2,400 mg/day
  • Ointments with NSAIDs – long (5% ibuprofen) 2-3 cm 3 r / day.
  • Glucocorticoids (injection into painful areas)
  • 40 mg methylprednisolone with 4-6 ml 1-2% lidocaine solution
  • 1-20 mg of hydrocortisone with the same volume of 1-2% solution of novocaine. Insertion into the tendon sheath should be avoided; in case of medial epicondylitis, the proximity of the ulnar nerve should be taken into account. After periarticular injections, despite a significant decrease in pain intensity, it is recommended to exclude physical activity due to the risk of tendon rupture.
  • Surgical treatment – dissection of tendon aponeuroses, is used in the absence of the effect of conservative treatment, in the presence of signs of stenosing tendinitis, in Osgood-Schlatter disease.

The complication is tendon rupture. The prognosis is favorable. See also Osgood-Schlatter disease, Bursitis ICD M75-M77 Specified tendonitis