I. What is stenosing tenosynovitis? Stenosing tenosynovitis is a chronic aseptic inflammatory change in the tendon sheath caused by mechanical friction. Second, the cause of stenosing tenosynovitis? The unique physiological structure of the tendon sheath, which is divided into two layers, the inner layer is synovial membrane with a small amount of synovial fluid in between, which has the function of lubrication and maintaining the mobility of the tendon. However, due to frequent activities in daily life and work, excessive friction is caused, which increases the mechanical friction between the tendon and the tendon sheath. This irritation leads to inflammatory reactions such as tendon sheath bleeding, edema, and exudation. In the long term, this leads to narrowing of the tendon sheath, adhesions between the tendon sheath and the tendon, and degeneration of the tendon. The tendon sheath and the bone form a very elastic “bone-fiber tunnel” through which tendons of the extremities can undergo tenosynovitis. Third, the pathology and etiology? Stenosing tenosynovitis is not a simple inflammatory injury to the tendon sheath, there is edema, hyperplasia, adhesion and degeneration of both tendon and tendon sheath. It is often caused by rapid finger movements or prolonged forceful finger movements, such as knitting, laundry, orchestral exercises. If the patient has congenital tendon abnormalities, rheumatoid arthritis, postpartum, etc., the disease is more likely to occur. IV. Clinical manifestations? Clinical manifestations are local pain, pressure pain and limitation of joint movement. The main clinical manifestations are popping finger and popping thumb and radial stenosis tenosynovitis. The initial stiffness and pain of the affected finger disappears after slow activity, but with the prolongation of the disease there is gradually a popping sound with obvious pain, and in severe cases the affected finger is flexed
In severe cases, the affected finger is flexed and does not dare to move. The middle finger and ring finger are the most frequent, while the index finger and thumb are the second most frequent. On physical examination, a painful nodule the size of a soybean can be palpated at the distal transverse metacarpal stripe, and the nodule moves up and down with the flexor tendon when the affected finger is flexed or extended, and the popping is felt to occur here. Radial stenosis tenosynovitis is a painful condition on the radial side of the wrist joint that gradually worsens, with no ability to lift objects. On examination, there is no inflammation of the skin, but there is limited pressure pain on the surface of the radial styloid process or its distal side, and sometimes painful nodules can be palpated. The pain at the radial styloid process is called a positive Finkelstein test when the wrist joint is shaken with a fist ulnar deviation. V. Treatment: 1. rest and braking, avoid weight bearing; 2. local closure (1ml of ponisolone acetate injection + 1ml of lidocaine hydrochloride injection); 3. warmth, hot compress, wrist protector application brake; 4. futalin ointment or white pulse ointment application (anti-inflammatory, analgesic); 5. non-surgical treatment is ineffective, consider performing stenosis tendon sheath incision decompression; 6. pediatric congenital stenosis tendonitis Non-surgical treatment is usually ineffective, and surgical treatment should be performed.