- Tendinitis: Description
- Tendonitis: Schnappfinger
- Tendonitis: Tendovaginitis de Quervain
- Tendonitis: symptoms
- Tendouritis: causes and risk factors
- Tendinitis: examinations and diagnosis
- Tendinitis: treatment
- Tendonitis: Disease course and prognosis
Under one Tendonitis (Tendovaginitis, peritendinitis, tendosynovitis) is understood to be an inflammation of the tendon sheaths. Mostly the forearm, the hand and the wrist are affected. There are two special forms of tendonitis: Tendovaginitis stenosans and Tendovaginitis stenosans de Quervain. All important information about causes, symptoms, diagnosis and treatment of tendonitis can be found here.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. M65
Tendonitis: Tendovaginitis de Quervain
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
A tendon sheath (vagina synovialis, vagina tendinis) is a sheath-like structure around a tendon that protects it and reduces friction with adjacent tissue such as ligaments and bones. It is filled with synovial fluid (synovial fluid).
Distinguish from a tendonitis is tendinitis (tendinitis) itself.
The tendonitis can in principle occur on any true tendon sheath. In some parts of the body, however, a tendon sheath is especially often inflamed: hand, forearm and foot. Known forms of tendonitis on the hand are Schnappfinger and Tendovaginitis de Quervain.
If the complaints on the diffuser on the fingers, it may be a snap finger. Read more in the article Schnappfinger.
Tendonitis: Tendovaginitis de Quervain
If the thumb is painfully restricted in movement, de Quervain tendosaginitis should be considered. Read more in the article Tendovaginitis de Quervain.
The tendonitis often begins insidiously. The main symptom is pain over the affected tendon sheath. These increase especially in the active or passive movement of the joint, more precisely, the affected tendon. Swelling and redness are usually visible above the joint. Also a morning stiffness and a feeling of tension are described. In the so-called Tendovaginitis crepitans If you move the joint, you may feel rubbing.
Tendouritis: causes and risk factors
Very rarely, tendonitis is caused by bacteria (septic tendovaginitis). Instead, tendovaginitis is usually a non-bacterial infection caused by overuse and poor posture. The inflammatory response causes the tendon and tendon sheath to swell, to the extent that the fine fluid film in the tendon sheath is no longer sufficient for smooth tendon movement. In part, the tendon even gets stuck in her tendon sheath.
The inflammation continues to increase, and there is additional pain. The surfaces of the tendon and the tendon sheath may change due to the inflammatory reaction, resulting in a sensible and audible rubbing during movement. Doctors call this disease symptom Tendovaginitis crepitans.
At the flexor tendons of the fingers small nodules can form in the tendon, so that it can no longer slide smoothly. Then one speaks of one Tendovaginitis stenosans (also Schnappfinger or quick finger). This affects mostly the thumb. But it can also ignite the flexor tendons of other fingers. In addition, this form of tendonitis may also develop in connection with inflammatory diseases of the rheumatic type.
One variant of Tendovaginitis stenosans is the Tendovaginitis stenosans de Quervain. Here the tendonitis is located in the first extensor tendon compartment of the hand. In total there are six such compartments in which the extensor tendons are routed to the wrist and fingers. The tendon fans are formed by a strong ligament, the so-called retinaculum extensorum.
Sometimes, at the transition between hand and arm, a tendon sheath is inflamed (wrist). Cause is usually an acute or chronic overload or misloading of the tendons running here. For example, if the tendonitis is based on too much work with the computer mouse, the doctor speaks of the "mouse arm". Also, local bruises on the tendons can cause a tendon sheath to inflame (and sometimes the tendon itself). The flexed eyes of the hand are particularly stressed during sports such as climbing, gymnastics, rowing or table tennis games.
Not only on the wrist itself, you can feel it when a tendon sheath inflames here. Arm ailments can also occur, more specifically a pulling in the forearm. Intensive practice with musical instruments such as guitar, violin or piano can also be the reason, if in the area of the wrist and forearm a tendon sheath inflames.
Elbow pain often speaks for the so-called tennis elbow, caused by a permanent overload and microtrauma, which lead to tears on the tendons. However, a tennis elbow is an inflammation of the tendons of the muscles of the forearm and thus no tendonitis. Arm pain caused by tendonitis is localized to the forearm in most cases.
Very often, but not always, it is the upper extremities where a tendon sheath inflames. Foot pain can also be indicative of tendovaginitis. It often develops in athletically active people, either through direct trauma or chronic instability in the ankle joint. Especially the following sports favor a Tendovaginitis: foot and basketball, hockey and ballet. Also with skiers it can come to a tendon inflammation at the foot. The posterior tibial muscle (tibialis posterior muscle) or the fibular fibular muscle (fibularis brevis muscle) may be affected.
Read more about the investigations
Tendinitis: examinations and diagnosis
If you suspect tendonitis, it is best to visit a GP or orthopedic specialist. On the basis of the medical history and the physical examination, a tendovaginitis can usually be easily diagnosed. To record the medical history, your doctor will talk at length to you about your condition. He may ask the following questions:
- Have you recently done unusually heavy manual work such as gardening or moving?
- What is your profession? Do you work a lot on a computer keyboard?
- Which movements cause the pain?
- Since when is the pain?
- Do you help with anti-inflammatory drugs?
The symptoms described can occur not only in tendonitis, but also in other diseases - such as osteoarthritis of the thumb saddle joint (rhizarthrosis). The doctor must rule out such diseases before he can diagnose "tendonitis".
Imaging procedures are usually not necessary and are used only in exceptional cases. To exclude bony changes, X-ray images can be taken in two planes. In addition, the tendon can be visualized using ultrasound. Tendons can also be visualized by magnetic resonance imaging (MRI).
Read more about the therapies
Tendovaginitis therapy is usually conservative. It is important to avoid the cause of tendonitis (such as overload, miscarriage) as far as possible. For example, if the tendonitis is based on frequent work on the computer keyboard, for example, a special palm rest in front of the keyboard can make sense: you place your wrists as you tap on them, so that they are not bent upwards - this relieves the tendons.
Tendinitis: Conservative therapy
To avoid movements that increase tendonitis and aggravate the pain, the hand or foot can be immobilized with a splint. However, the immobilization should only be temporary, otherwise the tendon may stick to the tendon sheath.
Local cooling, electrotherapy and cross-friction massages can also be used for tendonitis. Physiotherapy exercises for strengthening and stretching can have a positive effect on the muscles and tendons. By means of physical or manual therapy, it is also possible to correct chronic incorrect loading.
Sometimes anti-inflammatory analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) are used. These include, for example, ibuprofen and diclofenac. They can be taken as a tablet. In addition, anti-inflammatory ointments may be helpful.
If necessary (such as repeated painful tendonitis), the doctor can administer targeted cortisone injections. They have an anti-inflammatory effect and usually help well, but should not be given any number of times. Repeated cortisone injections can damage the tendon tissue.
Tendon sheath inflamed: home remedies
Various home remedies can help with inflammation and pain in tendonitis. Examples:
- Moist cold compresses soaked in vinegar water (1 tablespoon vinegar per 1 glass of water) can cool the painful areas.
- Good conditions also help with horseradish, healing earth or cottage cheese.
- An ointment with propolis (bee resin) has an anti-inflammatory effect.
If pain and recurrent tendovaginitis occur despite intensive conservative treatment, surgery may be considered. It can be done on an outpatient basis and is usually performed under local anesthesia (if necessary under general anesthesia). Depending on the form of anesthesia you can leave the clinic immediately after the procedure (local anesthesia) or after a few hours (general anesthesia).
In tendon sheath surgery, the ligament covering the tendons is severed. The roof of the tendon canal is also split and, if necessary, inflamed and thickened chordal tissue is removed. The surgeon must be careful not to injure adjacent nerves and vessels. Finally, the wound is sutured and connected.
After the operation, you should start with light movement exercises immediately to avoid adhesions. The threads are removed about ten days after the procedure. The scar will be tender in the first few weeks. Over time, however, the pain subsides and the surgical scar becomes less sensitive. Depending on the activity, you may resume your work after one to three weeks.
As with any surgery, complications may also occur with tendon sheath surgery, such as accidentally injuring nerves. Rarely, it also happens that a nerve grows in the scar tissue. If pain and discomfort occur again after a symptom-free interval, a new operation may be necessary.
As a further complication, the surgical wound can ignite. Then you should be treated with an antibiotic.
Tendonitis: Disease course and prognosis
The tendonitis often has a protracted course. Importantly, the joint is spared right at the onset of symptoms to prevent the acute inflammation from becoming chronic. The prognosis of a Tendonitis is good, however, as long as the triggering movements are avoided as far as possible and there are no other conditions such as rheumatism or joint inflammation.