Tenosynovitis of the tendon of the long head of the biceps, popliteal muscle and biceps of the

The active development of the disease is facilitated by the infection of adjacent tissues or the penetration of pathogenic microflora into the tendon structure. In 80% of cases, this occurs due to a puncture or other violation of the integrity of the tendons. The main ways of defeat:

  1. Available infections, especially STIs (in 90% of cases of detected infectious tenosynovitis, the patient suffered from gonorrhea).
  2. Physical trauma, after which the introduced acute infection is separated by monomicrobial and polymicrobial. Each of them progresses depending on the nature, extent of damage.
  3. The physiological process of aging (a common cause of tenosynovitis of the knee muscle).
  4. Staphylococcus aureus migrating from the ep >

Any of these methods leads to tenosynovitis. Including situations where the patient has not completed a full course of treatment regarding rheumatoid or reactive arthritis.

Symptoms

A doctor has enough examination to make a preliminary diagnosis. And the doctor confirms it by diagnostic methods, determining the nuances of the pathology.

Tenosynovitis of the tendon of the long head of the biceps of the shoulder is a stenotic disease, which is manifested by a specific pain sensation of a pulling nature. In 9 out of 10 cases, the patient complains that an unpleasant sensation covers the shoulder, spreads along the front surface of the arm (along the biceps). Palpation of the affected area gives a painful sensation: its localization is a groove between the tubercles of the humerus and in the direction below, where the tendon is even more accessible to palpation. Against the background of pain in the patient, it is difficult to divert the arm.

Tenosynovitis of the hamstring muscle is manifested by such distinguishing features:

  • an increase in pain in the knee after slight physical exertion;
  • extensive swelling around the knee joint;
  • distinct hyperemia of the skin is visible.

Symptoms may be supplemented depending on the limitation period of the lesion.

Diagnostics

Diagnosis of tendon tendonitis is difficult only because of the premature administration of antibiotic therapy, which 60% of doctors carry out even before the final diagnosis. Laboratory research on the pathology in question is secondary.

Methods for identifying tendon pathology are as follows:

  1. Laboratory research. In the blood, an increase in the content of white blood cells, an increase in ESR, as indicators of an active inflammatory process, are established.
  2. X-ray examination. The main goal of the method is to confirm the presence of tenosynovitis and to exclude the concomitant development of osteomyelitis, bursitis, arthritis.
  3. The study using ultrasound. The method is informative, has advantages over MRI: low price, technical simplicity. Ultrasound does not involve the use of magnetic field energy. The procedure is safer for health, does not affect devices implanted inside the body (heart rate drivers). Ultrasound helps to study in detail the structure of tendons and ligaments, allowing you to differentiate tenosynovitis, including through the use of color Doppler mapping (CDC).
  4. MRI The method provides an image of the entire joint, including a capsule with shoulder-ligamentous ligaments, articular cartilage on the head of the humerus. The muscles and tendons surrounding the joint, synovial bags are also visualized.

MRI and ultrasound of the shoulder or knee joint are not interchangeable diagnostic methods. The implementation of each of them implies specific goals, objectives.

Treatment

Procrastination with going to the hospital does not promise a positive prognosis – the disease goes to an even more aggravated stage. Then the patient loses the possibility of even self-care, and there is no need to talk about the implementation of labor activity. One of the options for losing time is the desire to normalize health with unofficial methods. Traditional medicine does not contain a single recipe that can restore the tendon-ligamentous apparatus. And patients taking decoctions and applying compresses to the body lose time, increasing the risk of developing disability.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Conservative

If, according to the diagnostic results, it is confirmed that the existing violation is tenosynovitis of the tendon of the long biceps head, treatment with conservative methods involves the following purposes:

Type of treatment, prescribed group of drugsPurpose and FeaturesPossible side effects
Nonsteroidal anti-inflammatory drugs: Diclofenac, Nimesulide (Nise), IbuprofenReduce the spectrum of the inflammatory process, minimize pain. The listed medications are administered 1 time per day for 10 daysGastropathy
Painkillers: Ketanov, Ketarol, Dexalgin, AnalginAnalgesics are administered with insufficient effectiveness of NSAIDs, when pain in the limb persists. Drugs eliminate pain attacks for 4-5 hours, which helps to normalize well-being, helps postpone recoveryGastropathy, sleep disturbance, arrhythmia
Diuretics: Furosemide, LasixTherapy, the purpose of which is to reduce edema. Dosage depends on the weight of the patient, the severity of edemaKidney lower back pain
Antibiotic therapy: Ceftriaxone, CeftazidimeBroad-spectrum antibiotics are prescribed with a proven relationship of tenosynovitis and an existing infection. The goal is the elimination of pathogenic microfloraIntestinal upset

To implement hormonal treatment, glucocorticoids are used – Dexamethasone and Prednisolone.

Injection of hormonal drugs, especially in chronic processes, does not provide a complete cure, increases the rate of collagen degradation, negatively affects the production of new collagen (reduces its synthesis by 3 times).

The doctor expands the general purpose of the active use of immunomodulating agents, vitamin therapy.

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During conservative therapy, it is important not to burden the affected joint – for this, an orthosis is immobilized. Local application of ointments is recommended: Nise, Dolobene, Ketonal.

Physiotherapy

Physiotherapeutic methods help to normalize blood circulation, stop or minimize pain, improve metabolic processes in the affected area. The procedures that should be prescribed if tenosynovitis of the tendon of the biceps of the shoulder, popliteal fossa, or other department is confirmed include magnetotherapy; laser therapy; drawing thermal applications. The use of electrophoresis with novocaine will improve limb abduction and reduce pain.

Recently, radon baths are actively used.

After documenting the safety of radon in terms of treating articular pathologies, interest in this gas is growing. The demand for the element is due to its unique therapeutic capabilities.

Radon is an inert gas that is colorless and odorless. It is 7,5 times heavier than air, has 3 isotopes, the most important of which is 222 Yal with a half-life of 3,82 days.

Before conducting radon baths, the doctor makes sure that the patient has no contraindications to medical technology:

  1. Fever of unknown origin.
  2. Oncological processes (confirmed) – the presence of malignant neoplasms, benign tumors, with a tendency to growth.
  3. All blood diseases.
  4. Heart rhythm disturbances (atrial fibrillation, extrasystole).
  5. Psychoemotional disorders (epilepsy, neurosis, schizophrenia).
  6. Long-term large focal or multiple small focal cerebral infarction.
  7. Professional activities associated with prolonged exposure to radioactive or electromagnetic radiation.
  8. The period of pregnancy and breastfeeding.
  9. Violation of the functional activity of the thyroid gland, a high predisposition to its hyperfunction.
  10. Condition on the eve of surgery.
  11. Severe gynecological conditions – fibrocystic mastopathy, uterine fibroids, fibromyoma, adenomyosis, endometriosis.
  12. In men, prostate adenoma.
  13. Cholelithiasis.
  14. The presence of calculi in any of the segments of the urinary system.
  15. Confirmed retinal detachment.
  16. The presence of defects on the skin, areas of weeping dermatitis, pathology of fungal origin.
  17. Confirmed osteoporosis.

To determine the concentration of radon for the procedure, the doctor is guided by the dominant pain manifestations. Perform dry-air baths and traditional – water. The effect of the procedure is improved blood supply to tissues adjacent to the joint; high probability of long-term pain relief (in 90% of cases).

Anton Epifanov about physiotherapy:

Surgery

Surgery is carried out in extreme cases when conservative methods cannot restore the limb. Surgical treatment is aggravated by the patient’s age over 45 years, the presence of insulin-dependent diabetes mellitus and if the etiology of tenosynovitis consists in the progression of polymicrobial infection.

Tendon plastic surgery is a multi-stage, thin operation. It involves a subsequent long-term recovery and is of high price.

The elimination of the risk of complications of the postoperative period helps the introduction of antibiotics the day before the intervention, active intraoperative antibiotic therapy.

Features of anesthesia during surgery regarding tendon tendonitis:

  • in the choice of anesthesiological aid, the short duration of the intervention, the lack of need for deep relaxation, the presence of adequate hemostatic measures are important;
  • modern medicines provide adequate pain relief without jeopardizing the patient’s life;
  • a common complication after the intervention is a short post-anesthetic depression. It provides the possibility of early transfer of the patient from the ICU (intensive care unit) with the activation of the patient;
  • the depth of immersion in anesthesia is provided by narcotic analgesics. In clinics with high financial support, they practice the most successful combination for anesthesia for short operations – Diprivan + narcotic analgesics (in 68% of cases). But the high cost of Diprivan limits its use in clinical practice. Hospitals with less funding use Ketamine for anesthesia. Its difference from Diprivan is specific: as patients recover from anesthesia, patients need sedative therapy (they are administered in standard dosages). It is important for a specialist to control the main vital indicators – during the entire surgical intervention they must be stable.
  • In 23,3% of cases, barbiturates are used for anesthesia, mainly thiopental sodium in standard dosages. If the depth of anesthesia was sufficient, the “controllability” of anesthesia causes certain difficulties. Long-term post-anesthetic depression is possible, requiring constant monitoring of the patient.

The prognosis for recovery is favorable (subject to early seeking medical help). However, the patient should prepare: a full recovery will take 3-4 months.

Conclusion

Tendon synovitis of the tendon can be cured only in a hospital setting, which means – using the methods of official medicine. Counting on alternatives is unsafe. The most common cause of pathology is chronic damage. Orthopedists, traumatologists are involved in the elimination of the disease. If tenosynovitis is of an infectious origin, a venereologist is involved in drawing up a treatment plan.

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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