Tendonitis, tendonitis and tendon sheath cysts are chronic diseases of the locomotor system, commonly seen in manual workers, athletes and housewives. Tendons and tendon sheaths are two important structures in the human locomotor system, and the joint between them is like a “sword” and a “sheath”. Under normal physiological conditions, the tendon sheath not only ensures the effective sliding of the tendon, but also secretes a small amount of synovial fluid to nourish the tendon. However, recent studies have shown that tenosynovitis and tendonitis are two different pathological changes. Tendonitis is a chronic aseptic inflammation of the tendon caused by prolonged mechanical friction within the tendon sheath, and the pathological changes are mainly inflammatory cells in the peritendinous tissue. Tendonitis, on the other hand, is a degenerative disease of the tendon itself, and the pathological changes are mainly degeneration of the collagen fibers that make up the tendon, often associated with old age, microscopic injury and blood damage. As for tendon sheath cyst, it is a benign mass in the hand and foot, and its pathogenesis is considered by most scholars to be the formation of mucus-like degeneration of the excess connective tissue in the joint capsule or tendon sheath. 1. Tenosynovitis of the flexor tendon. The disease is most common in the thumb, middle finger and ring finger, and the site of onset is at the beginning of the tendon sheath of the flexor tendon corresponding to the head of the palm. When the hand grasps the object, the tendon sheath by the object and the palm bone extrusion and injury, tendon sheath long-term friction and gradually formed narrow, the corresponding tendon can also become shuttle-shaped or gourd open expansion, tendon sliding difficulties, finger flexion and extension when the board machine-like action or popping sound, so the disease is also known as the board machine finger or popping finger. Early treatment of this disease can be conservative treatment including local fixation, physical therapy, hot compresses, Chinese medicine fumigation, etc.. Steroids can also be injected into the tendon sheath, but attention should be paid to the aseptic operation when injecting. Generally, once a week, 3-5 times for a course of treatment. If still ineffective, surgery can be considered for longitudinal incision of the narrow tendon sheath, and if necessary, a small strip of the tendon sheath can be removed longitudinally. Practice finger flexion and extension activities after 24 hours after surgery. 2, radial stenosis tendinitis. The radial styloid process of the wrist and the dorsal carpal ligament above together form a bony fibrous canal, the short extensor thumb tendon and the long thumb tendon pass through this canal and fold into a certain angle, when the thumb and wrist activities, the tendon and the canal rub together and tendon sheath inflammation can easily occur. The main manifestation of this disease is limited pain at the radial tuberosity, sometimes radiating to the hand, elbow, shoulder, wrist and thumb. The early conservative treatment of this disease is the same as before. If conservative treatment is not effective, surgery is recommended. The two tendon sheaths of the short thumb extensor and long thumb extensor tendons should be explored during surgery. If there is a vagus tendon, it must be removed. Care should be taken not to damage the nerves and blood vessels during surgery and to encourage early activity after surgery. 3, biceps long head tenosynovitis. The long head of the biceps is located in the inter-nodal groove formed between the greater and lesser tuberosities of the humerus. When the shoulder joint moves, this muscle slides and rubs in the groove, and excessive activity can cause tenosynovitis. This disease can also be caused by rotator cuff injury, calcium salt deposits, and intra-articular lesions of the shoulder that involve the tendon sheath. This disease is mostly seen in middle-aged people and is a common cause of shoulder pain. Most scholars believe that it is a single disease and should be separated from frozen shoulder. The main clinical symptoms are pain in the intertrochanteric sulcus and limitation of shoulder joint movement, and the pain increases with resistance elbow flexion and forearm rotation back. Early treatment should include avoidance of heavy lifting and trauma, in addition to the conservative treatment described above. Surgical treatment is only indicated in isolated cases. The long head of the biceps is cut off and the distal end is sutured to the short head of the biceps or fixed to the upper end of the humerus, which is very effective, but it takes 6 months for the shoulder to fully recover its function. 4.Tendonitis tendonitis. It is a degenerative change within the tendon tissue, and simple tendonitis is the main cause of spontaneous rupture of Achilles tendon and biceps tendon, etc. The typical pathological changes include reduction of organelles in tendon cells, reduction of mucopolysaccharide and water, thickening of collagen fiber diameter and increase of light and dark bands. These pathological changes are generally considered to be related to the reduced blood supply in the tendon, which results in a decrease in the mechanical properties of the collagen fibers and eventually leads to spontaneous rupture of the tendon. Clinically common ruptures of the Achilles and biceps tendons occur in athletes and patients over middle age. For acute complete tendon ruptures, surgical repair is indicated. And for chronic partial injury can be conservative treatment. 5, tendon sheath cysts tendon sheath cysts. It is more common clinically, and it is usually found in the foot, mostly in young adults. Cysts generally develop slowly, in addition to local lumps, rarely have symptoms, occasionally local pain. Individual cysts occur in the carpal tunnel or ankle canal and can compress nerves causing corresponding symptoms. A small number of cysts can disappear on their own and do not recur. Most cysts can continue to grow or exist and should be treated. In the early stage, conservative treatment can be given by local extrusion of the rupture or injection of steroids after the cyst fluid is extracted with a needle. If conservative treatment is ineffective, surgical excision may be performed. Since tenosynovitis, tendonitis and tendon sheath cysts are common and frequent diseases in the clinical sports system, and these diseases are related to certain occupations and operating techniques, in addition to effective treatment of these diseases, attention should be paid to the combination of prevention and treatment to increase the efficacy and prevent recurrence. In the prevention and treatment of such diseases should pay attention to the following points: (1) local braking, the combination of static and dynamic. Limit the movement of the injury and encourage other aspects of movement. (2) Local injection of steroids, the dose and frequency should be properly controlled, and special attention should be paid not to inject the drug into the tendon. (3) For patients with local bacterial inflammation and diseases such as diabetes mellitus and peptic ulcer, steroid drugs should be prohibited locally. Tendon sheath cyst is a cystic mass near the joint, and the etiology is not well understood. Chronic injury increases synovial fluid in the synovial cavity and forms a cystic herniation; or mucosal degeneration of connective tissue may be an important cause of the pathogenesis. Currently, synovial fluid cystic herniation at the small joints of the hand and foot (at the dorsal navicular lunate joint of the wrist, dorsal mid-tarsal joint of the foot, etc.) and tendon sheath cysts occurring in tendons are collectively referred to as tendon sheath cysts. The cystic herniation of large joints is named separately, for example, the cystic herniation of the posterior knee joint is called N-fossa cyst or Baker cyst, so there is confusion and it is still debatable. Clinical manifestations: 1. The disease is more common in females and adolescents. It has the highest incidence in the dorsal wrist, the radial flexor wrist tendon on the palmar side of the wrist and the dorsum of the foot, and is also commonly seen at the metacarpophalangeal and proximal interphalangeal joints of the fingers. Occasionally, these mucinous degenerative cysts can occur on the anterior tibialis tendon membrane below the anterior knee joint, but they are more difficult to diagnose because of the deeper site. 2. A slow-growing mass appears in the lesion, which is asymptomatic when it is small and grows to a certain level of soreness and swelling when the joint is moved. Examination reveals a round or oval mass of 0.5-2.5 cm, with smooth surface and no adhesion to the skin. Because of the fluid filling in the capsule, the tension is greater, and it feels like a hard rubber-like substance when you look at it. If the neck of the capsule is small, it can be pushed slightly; if the neck of the capsule is large, it is not easy to push, and it can be easily mistaken for a bony mass. There is soreness and swelling pain with heavy pressure on the mass. Clear jelly-like material can be extracted by puncture with a 9-gauge needle. Treatment and prevention: Tendon sheath cysts can sometimes be ruptured by extrusion and heal spontaneously. There are more clinical treatment methods, but the recurrence rate is high. 1. The principle of non-surgical treatment is to make the cyst contents expel, then inject drugs or leave a sterile foreign body that can be removed (such as sutures with thick silk threads) inside the cyst, and apply pressure to bandage it so that the cyst cavity will disappear by adhesion. Usually, 0.5 ml of prednisolone acetate is injected into the bursa and then pressure bandaged. This method is simple, less painful, and has a lower recurrence rate. 2.Surgical treatment of tendon sheath cysts of the fingers – generally small and difficult to puncture; tendon sheath cysts that have recurred many times in other parts can be surgically removed. The cyst should be completely removed during surgery, and if it is a tendon sheath, part of the connected tendon sheath should be removed at the same time; if it is a synovial herniation of the joint capsule, it should be ligated and removed at the root to reduce the chance of recurrence. Tendon sheath cysts of the wrist are a common injury, mostly occurring at the tendon slide of the joint. It is commonly found on the back of the navicular and lunar joints, between the long thumb extensor tendon and the common extensor tendon; secondly, on the radial side of the palmar surface of the wrist, between the radial carpal flexor tendon and the long thumb extensor tendon, which is known as “wrist tendon tumor”. This disease is mostly seen in young and middle-aged women. (Etiology) It is generally believed that it is due to local Qi and blood cohesion, and is related to trauma and chronic strain. It is also thought to be caused by local gelatinous degeneration. The outer layer of the cyst wall is composed of dense fibrous connective tissue, and the inner layer is covered by white smooth synovial membrane, and the cyst cavity is filled with egg-white thick or thin jelly-like mucus. Sometimes the cyst cavity can be connected with the tendon sheath or joint cavity (it is believed that the formation of cyst is related to the increase of pressure in the joint or tendon sheath), and in some cases the cyst cavity is closed and the root of the cyst is closely adhered to the tendon sheath or joint capsule. Clinical manifestations and diagnosis 1. The main manifestation of this condition is a slowly developing localized hemispherical mass bulge. 2, The patient feels mild localized soreness and pain of the cyst and weakness of the wrist and hand. In those cases where the distal part of the affected area appears to be weak, it suggests that the cyst is connected to the tendon sheath as a result. However, in some cases, there is no discomfort and the cyst is only felt to be an encumbrance and unattractive. However, excessive wrist activity (due to increased internal pressure) may result in soreness and weakness. 3.Checking the cyst, the surface is smooth to touch and no adhesion to the skin, and the early stage is soft with mild fluctuation; later, it appears small and hard due to fibrotic changes, and when pressed hard, there is soreness and swelling, or dispersive pain around the cyst. If the cyst grows in the proximal end of the small fissure or in the carpal tunnel, it can compress the ulnar or median nerve, then muscle paralysis or abnormal sensation in the corresponding area will appear. X-ray examination, no abnormal findings. Treatment 1.Manipulation therapy 2.Surgery After several times of manipulation therapy is ineffective, or often recurrence, surgical removal can be considered.