What are the main clinical symptoms of tenosynovitis

Some tendons are covered with a crust of fibrous tissue called a tendon sheath. Its function is to facilitate the gliding of tendons and to allow the fingers to flex and extend normally.

When the hand is moving, the tendon slides in the tendon sheath, and part of the tendon sheath gradually thickens due to this friction, narrowing, and as a result, the tendon movement is impaired, and local pain is also generated. This condition is called tenosynovitis, also known as stenosis tenosynovitis.

The most common sites of tendon sheath thickening and stenosis are at the beginning of the flexor tendon sheath of each finger, which corresponds to the distal palmar striae, and the tendon sheath located at the styloid process of the radius. If it occurs in the aforementioned area, it is called flexor tenosynovitis, and if it occurs in the latter part, it is called radial styloid tenosynovitis. Both are common.

Flexor tenosynovitis, most commonly in flexor tendon sheaths of the thumb, esopha, and middle fingers, occurs less often in patients without polydactyly and little fingers. After the onset of the disease, the patient feels:

Impairment of flexion and extension of the affected finger, especially in the morning, improves with more activity. There is local tenderness and induration, which is tender when pressed on the flexor surface of the metacarpophalangeal joint of the affected finger and induration can be palpable. Induration is the thickened part of the sheath.

In severe cases, it can produce a snapping sound, that is, when the affected finger moves, the muscle position passes through the tendon sheath in the narrow area and makes a "click" sound. This condition of tenosynovitis, also known as "snapping fingers". When the hand touches the induration and moves the affected finger, this popping sensation is more clear, and sometimes the affected finger can be seen bouncing.

Some patients suffer from finger flexion but cannot be extended or extended but cannot be flexed, and need to be helped to flex and stretch with the help of the hand, which is called the phenomenon of atresia.

In styloid tenosynovitis of the radius, there is a bony bulge on the radial side of the wrist (i.e., the side of the thumb) called the radial styloid process. It has a tendon sheath through which two tendons (extensor pollicis brevis tendon and abductor pollicis longus) pass. The tendon sheath is also often inflamed due to more movement of the thumb and wrist; This is called radial styloid tenosynovitis.

After the onset of the disease, the patient feels:

There is pain and swelling at the styloid process of the radius.

Difficulty moving the thumb, which is obvious in the morning, with occasional snapping. On examination, the radial styloid process is tender, sometimes palpable, and the patient is asked to clench the thumb into the palm of the hand, and then passively tilt the fist to the side of the little finger, if pain occurs around the styloid process, it indicates the presence of tenosynovitis.

The first method of this disease is intrathecal injection of hydrocortisone acetate or chloritazoxone once a week, in order to reduce the pain during injection, it can be mixed with 1% procaine or lidocaine hydrochloride and injected. Generally, 4 to 6 injections can be cured. It is very effective for early tenosynovitis.

Acupuncture, massage, Chinese herbal medicine and hand immobilization can also be used, all of which have certain curative effects. If the above ** is ineffective, surgery can be used**, that is, under sterile conditions, the narrow tendon sheath is incised, which is called healthy sheath incision. The result of the surgery is very good, not easy**.

Tenosynovitis can occur in the fingers, toes, wrists, and ankles, but is most common in the styloid process of the radius and the first metacarpal head. Fibrosis occurs due to tendon sheath strain injury, which thickens the tendon sheath, causes sheath stenosis, and restricts the movement of tendons in the sheath, so it is called tenosynovitis. The general symptoms of tenosynovitis are roughly as follows:

1. The patient is inconvenient, especially in the morning, but it improves after a few activities.

2. Local tenderness and induration.

3. In severe cases, it can produce a snapping sound, and the affected finger is flexed and difficult to stretch or stretched but cannot be flexed.

4. Pain, tenderness and localized swelling at the styloid process of the radius, sometimes palpable lumps.

5. Refers to the difficulty of moving, which is more obvious in the morning and occasionally plays.

Limitation of movement of the affected joint and local pain are all clinical symptoms of tenosynovitis. It is recommended to use Wanteric indomethacin liniment, which has a good pain-relieving effect and strong penetration, and the praise rate is still very high.

Localized pain, limited movement.

Pain, tenderness in the affected area. Patients get up early and have pain in their fingers, wrists, elbows, etc. Some patients also have radiating pain, which radiates from the tendon sheath lesion to the extremity ends.

Second, the affected joint has limited mobility. In particular, the fingers are stretched and cannot be bent back, or the fingers are not straightened after being bent. If it is not timely**, it will induce the formation of trigger fingers, affecting hand function.

In addition, some patients may also have systemic symptoms such as fever and arthritis.

Extended information] 1. The tendon sheath is a double-layer cannula-like closed synovial tube that is sleeved on the outside of the tendon, which is the synovial fluid sheath that protects the tendon. It is divided into two layers around the tendon, and a cavity between the two layers is the synovial fluid cavity, which contains the synovial fluid of the tendon sheath. The inner layer is closely attached to the tendon, and the outer layer is lined with the tendon fiber sheath, which is jointly combined with the bone surface and has the effect of fixing, protecting and lubricating the tendon from friction or compression.

If the tendon rubs too much on it for a long time, a damaging inflammation of the tendon and tendon sheath can occur, causing swelling and becoming known as tenosynovitis. If not, it may develop permanent immobility.

Two**. 1.Radius styloid stenosis tenosynovitis:

There are two tendons passing through the first fibrous sheath on the dorsal side of the wrist, namely the abductor pollicis longus and extensor pollicis brevis tendons, and the two tendons pass through the narrow sheath canal and form an angle with the sheath canal, terminating at the base of the first metacarpal bone and the base of the proximal phalanx of the thumb, respectively. When the wrist and thumb have a high range of motion, the tendon angle increases. Over time, the local synovium becomes inflamed, thickened, the tendon becomes thickened, the fibrous sheath wall also thickens, and a subcutaneous hard nodule appears at the styloid process of the radius, making it difficult for the tendon to slide in the sheath, causing pain and other symptoms.

Lactating and menopausal women are prone to this disease due to endocrine changes, synovial involvement, which is the main reason why this disease is more common in women. In addition to the above reasons, according to our surgical observation and foreign literature reports, there are many anatomical variations that are easy to cause the occurrence of this disease. If the abdomen of the metacarpus pollicis longus or extensor pollicis brevis is too low, part of the abdomen also enters the sheath; Due to the presence of more vagus tendons in the sheath, the number of tendons increases significantly, and some have as many as more than 10 tendons; There is also a hard and thick fibrous septum in the first sheath of the dorsum of the wrist, which makes the original sheath more narrow, and the tendon is very easy to be incarcerated.

These anatomical variations make the patient at a young age of onset and difficult to respond to conservative**.

2.Myosynovitis: the proximal carpal elongation of the dorsal carpal ligament, the radial wrist elongation, the brevis muscle is located on the deep side, and the extensor pollicis brevis and abductor pollicis longus muscle form a certain angle in the superficial side.

When muscles are overmobilized, the muscles, tendons, and the surrounding fascia and peritendon tissues are congested and edematous. Synovial fibrinous exudation increases, and symptoms such as local redness, swelling, and pain appear.

In the case of tenosynovitis, this cause can also be caused by injuries, overstrain (especially in the hands and fingers), osteoarthritis, some immune diseases, and even infections, the symptoms are joint pain, morning stiffness, and usually the feeling of morning stiffness is most obvious after waking up, and the symptoms do not significantly relieve with frequent activity.

Advice: The affected joints are swollen or even snapped, and the joints are immobile. Weaken the movement of the fingers in the early stage, so that the part can be rested; External use of Chinese herbal medicine ingredient - Gu Cheng Cui Ning - has a good curative effect.

Generally speaking, this problem is mainly caused by local chronic strain, trauma, cold, cold and other reasons, ** is the bone and the spleen, combined with local hot compress and microwave**, pay attention to rest, you can relieve the symptoms.