Tendonitis is a strain on the tendons of the finger joints that causes edema, pain, and difficulty moving with popping, which is often referred to as “trigger finger” or “popping finger,” or stenosing tenosynovitis. Tendonitis is usually caused by overstrain of the joint, mostly in the metacarpophalangeal joint of the finger, the root of the thumb and the radial dorsal side of the wrist joint, and if not taken seriously can change from acute to chronic.
Etiology – Introduction to the structure of the hand]
The left and right hands have 27 bones, 24 long tendons from the forearm, 19 small muscles in the hand, and 3 major nerves, which are linked together as a whole by ligaments, joints and skin to perform the important functions of the hand.
A layer of fibrous tissue, called the tendon sheath, is wrapped around the outside of certain tendons in the hand. The tendon sheath plays the role of a pulley, which has the function of maintaining normal finger flexion and extension and tendon gliding. Although the tendon sheath synovial membrane secretes synovial fluid to lubricate the tendon sheath, the repeated friction of special movements makes the tendon sheath most susceptible to damage, which manifests as thickening of the tendon sheath and affects the normal activity of the tendon. However, stenosing tenosynovitis may also be the result of certain resting or subclinical collagen diseases.
When the hand is fixed in a certain position for repetitive, excessive activity, repeated friction occurs between the tendon and the tendon sheath, resulting in edema and fibrous degeneration, causing narrowing of the internal cavity. The narrowing of the pathway through which the tendon moves within the tendon sheath results in pain and movement disorders, which is called tenosynovitis, also known as stenosing tenosynovitis.
Tenosynovitis is a common condition, most commonly seen in the general tendon sheath of the thumb longus adductor and thumb short extensor tendons at the lower radius of the wrist, and in the tendon sheath of the thumb longus flexor at the head of the first metacarpal. It is less common in the index, middle and ring fingers and less common in the little finger.
The main manifestations are pain, pressure and limitation of joint movement, and the symptoms are obvious in the morning and at rest.
There are two common types of tendinitis as follows.
(1) Radial stenosis tenosynovitis This disease starts slowly, gradually worsens, and sometimes symptoms may appear suddenly, and is more common between the ages of 30 and 50, with more women than men in a ratio of 10:1, with higher than usual incidence in women during lactation or menopause. Pain at and around the thumb on the thumb side of the wrist (radial styloid process), obstruction of thumb movement, pressure and friction at the radial styloid process, and sometimes a slight elevated pea-sized nodule at the radial styloid process. Self-examination: If the thumb is held tightly within the other four fingers and the wrist is flexed to the medial (ulnar) side of the wrist, severe pain occurs at the radial styloid process. In the acute stage, there may be local swelling. When the enlarged tendon passes through the narrow tendon sheath as a “tunnel”, the thumb will ring during flexion and extension activities, which is also known as “bouncing thumb”.
(2) Stenosing tenosynovitis of the flexor tendon occurs mostly in the thumb, middle finger, and ring finger. It is more common in women than in men, and is more common in middle-aged and elderly people. The dysfunction of flexion and extension of the affected finger is especially obvious when waking up in the early morning, and can be reduced or disappeared after activity. The pain sometimes radiates to the wrist. There may be pressure pain in the metacarpophalangeal joint flexion, and sometimes thickened tendon sheaths and pea-sized nodules can be palpated. When bending the affected finger, it suddenly stays in the semi-bending position, the finger can neither be straightened nor flexed, like being suddenly “stuck”, with unbearable soreness. “or “popping finger” is called. In severe cases, the finger can not actively flex and extend, into a straight position or strangulation in the flexion position can not be straightened.
There are also several uncommon.
(1) Acute plasmacytic tenosynovitis: also called rheumatic tenosynovitis, is part of systemic rheumatism and is a reaction to acute rheumatic fever. Patients have high fever, joint pain, swelling, fluid accumulation, where the most important lesion is rheumatic myocarditis. After the fever subsides, the plasma exudate of the tendon sheath is absorbed and the tendonitis heals spontaneously.
(2) Acute septic tenosynovitis: often occurs after trauma, especially puncture injuries, mostly in the flexor tendons of the wrist and fingers. The early stage of infection is synovitis of the tendon sheath, followed by loss of luster of the tendon, which turns gray or green, while being infiltrated with pus and necrosis. The most common is staphylococcus, followed by streptococcus.
(3) Tuberculous tenosynovitis: caused by infection with Mycobacterium tuberculosis. It first invades the synovial membrane of the tendon sheath and spreads from the palm along the ulnar and radial bursae upward to the forearm via the carpal tunnel. The tendon sheath is hypertrophied by infiltration of tuberculous granulation tissue, and the sheath contains yellow exudate and yellow rice granules. Gradually, the tendon is also infiltrated by granulation tissue and forms nodular hypertrophy, losing its original smoothness and motility. When the granulation tissue invades other tendon sheaths and nerves, it can cause flexion and sensory disorders.
Treatment methods
The treatment methods of tendovaginitis are.
1, early or light symptoms, local braking to reduce finger activities, so that local rest; secondly, you can also do massage, hot compresses or physical therapy.
2, the symptoms are obvious, the pain is heavier intra-sheath injection of corticosteroids (commonly known as closed) such as: hydrocortisone acetate, tretinoin acetate or prednisolone acetate for local sealing, with good results.
3, the disease is long, recurrent, the above treatment is not effective, feasible surgical release: magnification of the narrow part of the tendon sheath, parallel partial excision, so that the tendon sheath no longer squeeze the tendon, the efficacy is certain.
4, infants and children tendinitis many congenital, common thumb onset, through physical therapy can often be within 6 months of self-healing. However, if strangulation has occurred, seriously affecting the thumb activities, it is unfavorable to the development of the thumb, and should be surgically released as soon as possible.
Family treatment, preventive measures.
1.Wash hands with warm water
Make it a habit to wash your hands with warm water after working, not cold water, move your hands at the right time, and massage yourself. If you have this disease, it is important to treat it early so that it does not become chronic.
2.Rotate your wrist
When the stabbing pain starts, you can do some gentle hand exercises to relieve the pain. Rotating the wrist is one of the simple exercises. Rotate your wrist for about 2 minutes. It can exercise all the wrist muscles, restore blood circulation, and eliminate the bending posture of the wrist, which often causes wrist pain and other symptoms.
3.Raise your arm
When you rest, avoid making the hand below the shoulder. Support your elbow with the table, or lean your elbow on the handle of the chair. Keep your hands facing up. This is a beneficial resting position. Raise your hands above your head and rotate your wrists as you rotate your arms. This helps your shoulders, neck and upper arms to adjust their position.
4.Rotate your head and neck
Between work should take a break, put your hands on the table and rotate your head for 2 minutes. Bend your neck forward and backward, use your head to point both shoulders, twist your neck, look at your left shoulder and look at your right shoulder.
5.Regular exercise
It is important to exercise and loosen all sore muscles every day, even if you do not feel pain. The local exercises introduced earlier should be practiced at least 4 times a day.
6.Ice packs
Ice can reduce swelling in the acute stage. Do not use hot packs on the wrist to avoid expanding the swollen area.
7.Fist clenching exercise
Gently clench your fist, then open it up and straighten your fingers. Repeat this exercise to help relieve the tingling pain.
8.Avoid sagging arms
When sleeping, keep your arms close to your body and do not bend your wrists. If you let your hands hang on the side of the bed, it will increase the pressure on your hands.
9.Use tools carefully
When using tools, do not concentrate the pressure on the base of the wrist. Try to use the elbow and shoulder.
10.Eat more vegetables
Eat more vegetables, such as greens, bok choy, celery, etc. Eat more protein and calcium-rich food and lean meat, chicken, eggs, soy milk, etc.
11.Eat more fruits
You can eat some oranges, apples, raw pears, hawthorn, etc., to supplement vitamins and balanced nutrition.
12.Danger signals
Wrist and hand pain is not exactly the result of tendonitis, but may also be a sign of a more serious disease. When you move your wrist, if there is a splintering sound, be careful, this is not a sign of tendonitis, but may be a symptom of arthritis. It should be checked by a doctor.