When tendonitis is the inflammation of a tendon that often after degeneration (tendinopathy) developed. The tenosynovitis is tendinitis with inflammation of the tendon sheath. The symptoms are usually motion and tenderness. The chronic irritation or inflammation of a tendon or tendon sheath may cause scarring and limit the movement. The diagnosis is made clinically, occasionally supported by imaging. The treatment includes conservation, NSAIDs, sometimes corticosteroid injections.
A tendinopathy usually leads to repeated small tears or degenerative changes (sometimes with calcium deposits) that occur over years in the tendon.
When tendonitis is the inflammation of a tendon that often after degeneration (tendinopathy) developed. The tenosynovitis is tendinitis with inflammation of the tendon sheath. The symptoms are usually motion and tenderness. The chronic irritation or inflammation of a tendon or tendon sheath may cause scarring and limit the movement. The diagnosis is made clinically, occasionally supported by imaging. The treatment includes conservation, NSAIDs, sometimes corticosteroid injections. A tendinopathy usually leads to repeated small tears or degenerative changes (sometimes with calcium deposits) that occur over years in the tendon. Tendinitis and tenosynovitis are most frequently associated with the shoulder tendon (rotator cuff), the tendon of the long head of the biceps, Mm. flexor carpi radialis and ulnaris, flexor digitorum (in infectious Beugertenosynovitis, infectious Beugertenosynovitis), the tendon of the popliteus muscle, the achilles tendon (tendinitis of the Achilles tendon) and the tendons of the abductor pollicis longus and extensor pollicis brevis, which share a common tendon sheath (the disease arising from this is the de Quervain’s syndrome, De Quervain’s syndrome). Etiology The cause of tendonitis is often unknown. An occurrence in middle or older age is the rule, as the vascularization of the tendons decreases at this age; repetitive microtrauma can contribute. Repeated or massive trauma (near to rupture), overload and excessive use in the untrained state thought to play a similar role. Some quinolone antibiotics increase the risk of tendinopathy and tendon rupture. The risk of tendinitis may also under certain system diseases (most common in RA, systemic sclerosis, gout, reactive arthritis and amyloidosis or significantly elevated cholesterol levels in the blood diabetes mellitus or very rarely) increases to be. In young adults, v. a. in women, disseminated gonococcal infection can cause acute disseminated tenosynovitis. Symptoms and complaints Affected tendons usually have a significant movement pain. Occasionally, the tendon sheaths are swollen and it comes to effusion. Usually this happens when the patients have an infection, RA or gout. The swelling may be visible or palpable only. Along the chord palpation triggers localized pressure pain of varying severity. In systemic sclerosis, the tendon sheath can remain dry, but the movement of the tendon in the vagina causes a rubbing sound that can be felt or heard with a stethoscope. Diagnosis Clinical evaluation Sometimes imaging Usually, the diagnosis can be made based on symptoms and physical examination including palpation or special maneuvers to assess the pain. MRI or ultrasound be performed to confirm the diagnosis or rule out other conditions. MRI can detect tendon and inflammation (as well as in sonography). Rotator cuff tendinitis: This disease is the most common cause of shoulder pain. Active abduction in an arc of 40-120 ° and internal rotation lead to pain (rotator cuff injury / subacromial bursitis). The passive abduction causes less pain, but the abduction against resistance may increase the pain. Sometimes calcium deposits in the tendon can be detected below the acromion on the radiograph. Ultrasound or MRI may be helpful in further assessment and treatment decisions. Tendinitis of the biceps tendon: pain in the biceps tendon are amplified by flexion or supination against resistance. The examiner can cause pressure pain proximal to the bicipital groove of the humerus by letting the biceps tendon roll under his thumb (fast). Tenosynovitis of the extensor volar (digital tendinitis): This common musculoskeletal disorder is often overlooked (Fingerbeugertendinitis and tenosynovitis). The pain occurs on the palms of the thumb or other finger, radiating distally. Palpation of the tendon and tendon sheath triggers tenderness, swelling and occasionally a node are present. In later stages it comes to the phenomenon of “trigger finger” with blockade at diffraction and sudden release of the stretching with a snapping noise (trigger finger). Tendinitis of the gluteus medius: Patients with trochanteric bursitis almost always have a tendinitis of the gluteus medius. In patients with trochanteric bursitis palpation over the lateral projection of the greater trochanter femoris to tenderness leads. With a history of the patients report often chronic pressure on the joint, trauma, a gear change (eg. As due to osteoarthritis, stroke or leg length difference) or inflammation at this point (z. B. in RA). Therapy rest or immobilization, heat or cold, followed by exercises High-dose NSAIDs Occasionally Kortikosteroidinjektion The symptoms are (by rest or immobilization (splint or sling) of the tendon, application of heat (usually in chronic inflammation) or cold acute usually at inflammation) and high-dose NSAIDs (see table: improved treatment of rheumatoid arthritis with NSAIDs) for 7-10 days. In causal gout indomethacin or colchicine are helpful (gout). Once the inflammation is under control, the mobility should be improved by specific exercises several times a day, v. a. on the shoulder, as can develop contractures rapidly here. The injection of a Depotkortikosteroids (z. B. betamethasone 6 mg / ml, triamcinolone 40 mg / ml, methylprednisolone 20-40 mg / ml) in the tendon sheath may be helpful. One injection is usually displayed when the pain or if the problem is very chronic. The injection volume can range from 0.3 to 1 ml, depending on the location. The simultaneous injection of the same or double the amount of a local anesthetic (eg., 1-2% lidocaine) supports the diagnosis when it comes to an immediate pain relief. The clinician must be careful to not inject into the tendon itself (which is evidenced by a significant resistance at the injection), because this could lead to a weakening of the tendon with the risk of rupture. Patients are advised to save the injected joint to reduce the small risk of rupture. Sometimes it can lead to a deterioration hour to 24 after injection. Repeated injections and symptomatic treatment may be required. Rarely is in refractory cases, v. a. in tendinitis of the rotator cuff, surgical exploration with removal of calcium deposits or tendon repair, followed by a stepped physical therapy, is required. Occasionally patients require a surgical procedure to remove functionally limiting scarring or tenosynovectomy to relieve chronic inflammation. Tips and risks Corticosteroids should not be injected directly into the tendon, because this could lead to a weakening of the tendon with the risk of rupture. Summary tendinitis and tenosynovitis include inflammation as opposed to tendinopathy (degeneration of the tendon). Pain, tenderness and swelling are maximum along the tendon history. In most cases the diagnosis by examining incl. Crave specific maneuver is detected, and occasionally there is a confirmation of the diagnosis by MRI or ultrasound. The treatment includes conservation, heat or cold, high-dose NSAIDs, sometimes corticosteroid injections.