Diagnosis and therapy of ankle tenosynovitis

Severe pathology of inflammatory origin, with damage to the tendons and their vaginas, is called “ankle tendovaginitis.” The disease is characterized by severe pain and changes in the functionality of the affected tissues.

The danger of the disease lies in the possible necrosis of the tendons and the spread of the infectious agent in the circulatory system – septic lesions of internal organs. Primary manifestations require immediate contact with a medical institution – for a full diagnostic study and the appointment of appropriate treatment.

Root causes

The main primary sources of the development of pathological deviations are presented:

  1. Constantly performing monotonous movements (in individuals of certain professions) provokes overstrain of tendons and their synovial vaginas. Stable loads on the same site cause inflammatory processes in pre-traumatized parts.
  2. Infectious lesions in which the spread of pathogenic microorganisms occurs in the circulatory system – brucellosis, gonorrhea, tuberculosis. An additional reason for the spread of the inflammatory process to the sheaths of the vaginal tendons is the direct path – with existing purulent arthritis or osteomyelitis.
  3. A non-specific type of pathology that forms under the influence of pathogens (internal migration) coming from arthritis or bursitis. Spilled phlegmon in the area of ​​soft tissues can contribute to the flow of purulent secretion into the tendon sheaths and the subsequent development of the pathological process.
  4. Rheumatic lesions of the connective tissues of a non-microbial (aseptic nature) – psoriasis, ankylosing spondylitis, rheumatoid arthritis, lupus, systemic scleroderma.
  5. Injuries and injuries – a negative process begins with the penetration of pathogenic microflora into the area of ​​open wound surfaces.
  6. Violations in the circulatory system of the joint and adjacent tissues – contributes to the formation of a degenerative form of the disease, with the process of deformation of the synovial membranes. Changes in the free passage of blood flow are provoked by bruises or varicose vessels.

Classification

The disease has several currents and is divided into individual symptomatic signs. By nature of origin, ankle tenosynovitis is further divided:

  • Aseptic form – with a division into reactive, post-traumatic and professional;
  • Infectious – specific or non-specific etiology.

According to the characteristics of the ongoing process of inflammation:

  1. On serous;
  2. Serous fibrinous;
  3. Purulent form.

Symptomatic manifestations

Depend on the defeat option:

  • Acute pathology – occurs under the influence of systematic overloads of a certain area of ​​the lower limb. A small swelling is formed at the site of damage, without changing the color of the skin. Painful sensations are formed during the active movements of the sick foot.
  • Additional symptoms are swollen lymph nodes, decreased appetite, and fever. In the absence of therapy, the patient’s condition will begin to deteriorate, signs of the inflammatory process will begin to capture more extensive areas. Suppuration can provoke a septic lesion and the shock of the same name.
  • Chronic – progresses with an aseptic form of the disease. At the lesion site, moderate soreness is noted, with palpation examination, you can hear crackling and crunching. The disease is characterized by practically absent symptomatic manifestations. In some cases, the main symptomatology corresponds to the location of the process and differs in the clinical picture.

With damage to the foot area – the disease is diagnosed by specific manifestations:

  1. Painful sensations with loads on the sore spot – sharp and throbbing bursts of pain occur when accumulation of purulent exudate;
  2. Swelling in the ankle and foot;
  3. Partial limitation of movements;
  4. Changed tendon functionality
  5. Local increase in body temperature;
  6. A palpation examination of the pathological site allows you to determine the presence of abnormal nodes and infiltration;
  7. The formation of intoxication syndrome – a viv >

Signs of the disease indicate the need to visit a specialist consultation to conduct a diagnosis and prescribe appropriate therapy.

Diagnostic research

In the first dose, the specialist makes the patient’s anamnestic data:

  • Pain during palpation examination;
  • Puffiness of local origin;
  • Violations of free movement;
  • Complaints about the condition and well-being;
  • The timing of the anomaly;
  • Working conditions.

After a preliminary diagnosis is made, the patient is sent for instrumental and laboratory diagnostics:

  1. X-ray images – are necessary to differentiate the desired disease from joint inflammation with arthritis (with tendovaginitis, the process does not affect bone tissue);
  2. Ligamentography – a separate subspecies of fluoroscopy, using contrast agents – is recommended for the exclusion of infectious processes;
  3. Clinical blood test – is prescribed to determine inflammatory processes.

In case of problems with an accurate diagnosis, an additional CT procedure is performed.

Therapies

Infectious form of tenosynovitis requires treatment with antibacterial agents:

Specialists warn that uncontrolled use of antibiotics can lead to the development of serious abnormalities. The appearance of dysbiosis, fungal forms of diseases is provoked by an improperly selected drug. In the period of antibiotic therapy, the use of alcoholic and low alcohol drinks is prohibited.

To take indicators of elevated body temperature, Ibuprofen and Paracetamol are more often prescribed.

To stabilize and improve the functionality of the autoimmune system, it is recommended:

If the disease is one of the complications of tuberculosis, then the patient is recommended therapy:

Non-steroidal anti-inflammatory drugs are used for non-specific forms of the disease, therapy is performed:

Purulent tendovaginitis is treated by puncture in the synovial vagina and the subsequent administration of antibacterial agents (taking into account the sensitivity of pathogenic microflora). Additionally, anti-inflammatory non-steroid drugs, Novocain and Hydrocortisone can be used.

In the absence of the desired effectiveness, the use of a course of x-ray therapy or the introduction of steroids into the affected area of ​​the tendon is recommended.

As a result of the manipulation, the patient’s motor activity of the joint is restored, the negative symptoms disappear.

Preventive measures

To prevent the secondary occurrence of the inflammatory process, it is necessary to adhere to a number of recommendations:

  • Termination of intentional or accidental overstrain of the joints – the process leads to a violation of the integrity of the tendons;
  • Continuous exercise of exercise therapy and specialized gymnastics;
  • Visiting massage sessions – to stabilize the blood circulation process, lymphatic metabolism;
  • Timely treatment of any infectious processes;
  • Refusal from uncontrolled use of antibacterial agents;
  • Periodic vitamin therapy – in order to increase the functionality of the autoimmune system;
  • Wearing specialized orthopedic shoes.

The implementation of simple rules will prevent recurrence of the disease, improve the general condition and well-being of the patient.

Forecast and Possible Consequences

Seeking professional help with the initial development of the disease allows you to suppress negative symptomatic manifestations in the first week from the start of therapy. In this case, no complications of the pathology are recorded.

The main negative processes of the disease (in the absence of the necessary treatment) include:

  1. Reformation in a chronic form;
  2. The spread of the inflammatory process to adjacent tissues and tendons;
  3. Damage to bone and cartilage tissue – with existing infectious forms of the disease;
  4. The formation of septic lesion – as a result of the relocation of pathogenic microflora into the systemic circulation.
Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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