Tenosynovitis
Tendons are bound to the periosteum by a tough tendon sheath at the point where they cross the joint to prevent the tendon from springing up like a bowstring or sliding in two directions. Repeated excessive friction causes inflammation, edema, and thickening of the fibrous sheath wall of the tendon and tendon sheath to form a stenosis ring, resulting in difficulty in sliding the tendon within the sheath, leading to stenosing tenosynovitis. The most common type of stenosing tenosynovitis is in the wrist, also known as “keyboard hand”.
High Risk Groups
The most common age group is 40-60 years old, with more women than men (8-10:1); acute trauma, long-term repetitive finger movements, such as computer operation, practicing musical instruments, playing cell phones, writing scripts, knitting sweaters, etc.; and people with rheumatoid arthritis, diabetes, etc. Specifically, middle-aged and elderly women, office workers, orchestral musicians, light industrial workers, etc. are at high risk for tendovaginitis.
Clinical manifestations: pain, local swelling, and functional impairment are common manifestations
Tenosynovitis of the hand
It is usually found in the middle finger and ring finger, but the frequent use of the thumb by cell phone users has increased the number of affected groups; it is obvious in the morning, the affected finger shows flexion and extension dysfunction, pain sometimes radiates to the wrist, there is pressure pain at the finger joint flexion, and thickened tendon sheaths and nodules like pea size can be palpated. When bending the affected finger, it suddenly stays in the semi-bending position, the finger can neither straighten nor bend, as if it is suddenly “stuck”, but after using the other hand to assist in triggering, the finger can move again, producing a bolt-like action and popping sound, so it is also called “trigger finger “or “popping finger”.
Tenosynovitis of the wrist
Pain on the lateral side of the wrist joint, which gradually worsens, and the inability to lift things; when making a fist during self-examination and bending the wrist joint medially, severe pain can occur on the lateral side of the wrist joint.
Plantar tenosynovitis manifests as heel pain syndrome; (see heel pain syndrome chapter for details)
Examination method.
Based on typical clinical manifestations and physical examination, including: local swelling, local pressure pain and a positive resistance test: the pain is aggravated by hyperextension or hyperflexion of the joint.
Treatment.
General treatment: adequate rest for at least 3 weeks, with local splinting if necessary; this can be supplemented by massage, heat therapy, etc.
Sealing treatment: local steroid injection into the tendon sheath can be used, which is very effective.
Surgical treatment: if non-surgical treatment is ineffective, resection of the narrowed tendon sheath can be considered.
Prevention.
Precautions.
Wash hands with warm water, use tools carefully, try not to concentrate force on the wrist, use wrist guards if work is unavoidable, and pay attention to proper rest after long hours of work; elevate the hand at rest and avoid letting the arm hang over the edge of the bed when sleeping.
Exercise strengthening.
Finger-to-finger exercise, as shown with the palm of the hand flat on the table or on the leg, thumb and little finger together, insist on 6 seconds and rest; repeat 10 times a day.
wrist extension, as illustrated by bending the affected hand with the assistance of a healthy hand, hold for 15-30 seconds, rest; repeat 3 times a day.
wrist flexion, holding a can or other heavy object in one hand with the palm facing upward in a lifting motion, then slowly return to normal position, do 15 strokes, switch hands, repeat 2 cycles, add weight as you get used to it.
longitudinal wrist strengthening, straighten the arm laterally with the thumb facing up, hold the can in your hand and bend your wrist from side to side, keep the thumb facing up and try not to lift the forearm, do 15 reps, change hands, repeat 2 cycles, add weight after getting used to it.
Wrist extension, hold the can palm side down, bend the wrist up and down, do 15 strokes, repeat 2 cycles.
grasp object exercise, grasp an elastic sphere with force, hold for 5 seconds, then relax, do 15 strokes, repeat 2 cycles.
As shown, gloves a rubber band, use your fingers to hold it open, do 15, repeat 2 cycles
(Pictures from the Internet)
Author: Tian Hongtao, Wuhan Union Orthopaedic Hospital
Title: Associate Professor, Associate Chief Physician
Specialties: artificial joint replacement Joint diseases: femoral head necrosis, knee osteoarthritis, rheumatoid rheumatoid arthritis, ankylosing spondylitis, joint infections, bone and joint deformities.
Clinic hours: all day every week on 1, 3 and 6.
Contact: Tel: 13908622515
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