Tendinitis
Synonyms
Tendinitis, Tendovaginitis, Tendo = tendon, Vaginitis = Vaginal inflammation, Tendosynovitis, tendosynovitis
English: tendovaginitis
introduction
Tendonitis is an inflammation of the tendon tissue (Tendon sheath) resulting in a
- mechanical overload
- a bacterial infection or
- arises as part of a rheumatic disease. (Also read: Tendinitis in rheumatism)
Tendonitis can occur in any muscle, but the tendons in the arms, feet, or leg muscles are most commonly affected. The pain of tendinitis is reported as "uncomfortable pulling". With appropriate movements it can sometimes lead to shooting pain in the affected tendon.
Both acute and chronic courses of tendonitis exist.
The tendon is a continuation of a muscle and anchors it to the bone so that movement is possible. Tendons from vagina (Vagina tendinis, "Sheath of the tendon"), which are filled with a fluid, the synovia. These are intended to protect the tendons from mechanical forces (e.g. friction) Offer. In the event of overload or bacterial infections, problems can arise here, which manifest themselves as pain.
Epidemiology
Occupational groups in which tendonitis often occurs include:
- Secretaries,
- Jobs with a lot of computer work,
- Musician or
- Physiotherapists.
In all of these activities, movements are repeated and often combined with poor posture, which increases the risk of developing tendinitis. In principle, people of all ages can develop tendinitis. Tendovaginitis stenosans de Quervain as a special form of tendinitis occurs primarily in women after the menopause.
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causes
Tendonitis can have various causes. Usually the tendon sheath becomes inflamed due to mechanical stress.
The tendon usually slides back and forth in the tendon sheath. If a particular tendon is used a lot, the tendon can rub against the inside of the tendon sheath, causing permanent tendinitis due to wear and tear.
Sports that are characterized by the constant repetition of certain movement sequences are therefore among the typical triggers of tendonitis, e.g. Tennis. Another risk factor in the field of sports is the rapid increase in training:
Tendonitis can occur more often due to the resulting increased stress.
Read our article on tennis elbow
Another cause is unfamiliar work for the body that also requires a monotonous sequence of movements (e.g. renovation work or gardening). A large group of patients with tendinitis is caused by occupational stress. Mostly people are affected who have to work long hours at the computer every day. If the keyboard or mouse on the computer is not ergonomically adjusted, this permanent strain can lead to tendinitis. The same applies to keyboards on cell phones or tablets. If you write a lot here, you can also put strain on your tendon sheath.
In addition to office workers, musicians, craftsmen, masseurs or physiotherapists can also be affected. In these occupational tendinitis, the wrist or fingers are almost always affected. In addition to the mechanical cause of tendinitis, it can also be caused by a Infection with bacteria to be triggered.
Infections mainly occur if the tendon sheath was previously damaged by an accident or injury (Knife stab, knife cut) opened. Germs penetrate through the opening and colonize the inside of the tendon sheath. The most common pathogens that cause bacterial tendinitis are staphylococci and streptococci. Chlamydia, mycoplasma, and gonococcal infections are less common before, but these are also possible.
Tendonitis caused by an infection is treated by giving an antibiotic that is tailored to the pathogen. In addition, the affected extremity must be spared, and surgical relief may be necessary.
The bacterial infection can also trigger post-infectious arthritis. This is an attack by the immune system on the bacteria that are in the tendon sheath and affect it. This triggers tendonitis.
As an independent disease, the Tendovaginitis stenosans ('Snap finger"). Due to the inflammation of the tendon sheath narrowing of the tendon canal and a thickening of the tendon, the movement of the tendon is difficult and difficult, a typical clicking sound can be heard. Tendons belonging to the muscles of the thumb are affected here (Extensor pollicis brevis muscle and Abductor pollicis longus muscle).
Read more on the topic: Causes of tendinitis
Symptoms
The symptoms of tendonitis depend on the clinical course of the inflammation. In principle, tendonitis can occur anywhere on the body that has tendon sheaths. They are mostly found on the wrists or on the ankles.
Acute tendinitis occurs suddenly and manifests itself as swelling of the affected area. There is also pain (pulling, stabbing) both at rest and when moving, as well as pain on pressure in the inflamed tendon sheath. In addition, redness and overheating can be signs of inflammation. If tendinitis occurs acutely, for example after heavy exertion, pressure pain along the course of the tendons and muscles is typical. This pain is limited to the affected tendon sheath and is therefore also a diagnostic aid, since it is limited to the anatomical limits. Often times the affected area is red, overheated, and swollen. If the affected area is further stressed, pulling and stabbing pains occur during movement. In very pronounced cases there is also pain at rest. Often this does not improve within one night, but takes a few days to subside.
Please also read our article on this Tendinitis in the arm
Chronic tendinitis persists for a longer period of time and is usually characterized by a milder course than the acute form.
Mostly, nodular thickenings develop in the affected region, sometimes in connection with so-called crepitations when palpating the tendon. Crepitations are crunching noises that can be heard when palpating the inflamed tendon sheath and that are caused by protein deposits. These are signs of persistent inflammation. Sometimes a painful, palpable “crunching” and rubbing over the affected tendon is noticeable. In some cases, this “tendon grinding” can even be heard and is a clear sign of tendinitis.
This rubbing can lead to the phenomenon of the "flickering finger" (Tendovaginitis stenosans) cause. Here, the thickened tendon is initially stuck in the tendon sheath, but slides out of the narrowing when the muscle pulls stronger, causing the affected finger to suddenly jump forward. This phenomenon usually occurs when the body is stretched too much. These thickenings are most often found in the area of the affected metacarpal joint on the palm of the hand.
In addition, there is pain when the affected tendon is passively overstretched and during active tension against resistance. Both phenomena are found in acute and chronic cases of tendinitis and are also diagnostic aids.
Diagnosis of tendinitis
The diagnosis of tendinitis is usually based on the clinical picture based on the typical symptoms. For example, with certain movements, pain in the area of certain muscles, to which the inflamed tendon belongs. In addition, the medical history with an occupational medical history provides important information about the presence of tendinitis. In some cases, you can see the muscles and tendons sagging or deposits on the X-ray. However, since it is very difficult and difficult to see, this method is rarely used because radiation exposure should be avoided. These tendons can also thicken. An ultrasound scan of the affected tendon can show a tear or tear. This would have to be treated differently than the tendinitis alone.
therapy
Tendonitis is treated by immobilizing the affected area. Come into use
- Bandages
- rails
- or in severe cases a cast
Cooling pads can also be helpful and relieve pain when moving. In addition, local pain relief and anti-inflammatory measures can be taken, including ointments or injections of corticosteroids ("cortisone"). Alternatively, pain relievers and anti-inflammatory drugs - so-called non-steroidal anti-inflammatory drugs (e.g. diclofenac, ibuprofen) - can be used systemically in tablet form.
Also read our main article too Therapy of tendinitis
Chronic tendinitis usually has to be operated on, as the conservative treatments described usually do not achieve any improvement. In this case the tendon sheath is split.
In the case of an underlying bacterial infection, the treatment of tendinitis is supplemented with an antibiotic and, if necessary, with surgical relief.
Inflammatory rheumatic diseases as the cause of tendinitis are primarily treated with non-steroidal anti-inflammatory drugs. In addition, immunosuppressive therapy to modify the body's own defense reactions must usually be initiated.
Treating a Tendovaginitis stenosans consists of surgical splitting of the tendon sheath, since conservative measures are unsuccessful in this case. It looks different with one De Quervain's stenoscopic tendovaginitis From: Here, therapy is first carried out by immobilizing or injecting painkillers. Surgical splitting of the tendon sheath is only attempted if these therapeutic measures fail to improve.
Therapy with a bandage
Bandages for the treatment of tendinitis are mainly used on the wrist in order to stabilize and immobilize it. Above all, the bandages can avoid overstressing the joint, which usually led to the tendinitis. They have the advantage that the functions of the affected joint are not restricted and that everyday work can continue to be carried out.
Read more on this topic at: Forearm bandage
In addition, depending on the strength, these bandages can protect against injuries. These are mainly used in sports. In addition to immobilization and protection against permanent overloading of the affected tendon, the bandages can also be used preventively after previous tendinitis. For example, if activities are to be carried out which led to an inflammation of the tendon sheath the previous time.
The bandage reduces the stress on the wrist, which means that inflammation tends to be absent or, if the tendinitis is present, it subsides.
There are many different bandage manufacturers that offer all possible materials and strengths. The different models are designed to guarantee the patient an optimal fit and adapt to their individual needs. The bandages can, for example, be very stable and thereby prevent injuries or effectively stabilize the wrist.These are particularly recommended for unstable wrists, for example after a fracture, or to prevent repeated injuries.
Elastic bandages, on the other hand, enable the wrist to be more mobile, so they do not stabilize it as effectively. They are more used to immobilize inflammation or overloads.
In addition, the bandages differ according to the materials used. Bandages made of neoprene are very hard-wearing, tear-resistant and malleable, but also airtight, so that these bandages are usually not worn permanently. Some people are allergic to neoprene and should not use these bandages.
If the supportive effect of the bandage may be less, we recommend knitted wrist bandages. These warm the wrist, but are also breathable at the same time and can therefore be worn over the long term.
Which bandage is the right one should always be decided by a medical professional in order to select the correct fit and the right materials. In addition, the function of the bandage should be adapted to the current needs of the complaints in order to achieve an optimal therapy result.
Therapy with a tape
Taping the parts of the body affected by tendinitis is an alternative or complementary treatment method, which is usually carried out by orthopedic surgeons, but sometimes also by trained physiotherapists. In this case, the area to be treated - in contrast to plaster of paris or a splint - is not completely immobilized, but rather restricted in its range of motion or its undesired movements.
So-called kinesio taping has established itself in the area of tendinitis. Here elastic, water and air permeable adhesive plasters of different colors are used, which are stuck on using a certain technique. Since the painful inflammation of the tendon sheaths usually arises from overloading certain muscles or muscle groups, this is exactly where the effect of taping comes into play: The muscles are relieved by reducing the muscle tension in the resting state, swelling and pain are reduced by lifting the skin and joint functions are stimulated the depth sensitivity improved.
Therapy with plaster of paris
If the application of a plaster of paris or a plaster splint is selected as a therapeutic method for tendinitis, this should achieve absolute immobilization and movement out - usually over 14 days - in the affected part of the body.
Regular checks of the plaster of paris with regard to the fit and firmness are necessary in order to prevent complications such as circulatory disorders or nerve or skin damage caused by pressure points.
Depending on which part of the body (e.g. wrist, arm, foot, etc.) is affected by the tendinitis and in which area of the respective body part the inflamed tendon sheaths are located, different types of plaster cast are preferred. In the case of inflammation in the wrist area, a forearm cast is usually applied, which surrounds the wrist, but leaves the fingers free and allows them to move freely.
It is different, however, with de Quervain's tendovaginitis, in which the affected thumb is the only finger that is enclosed in the cast (Roe deer leg cast).
If the tendons on the elbow are affected, an upper arm cast is used (forearm cast with additional inclusion of the elbow and upper arm), if tendinitis in the foot area is a lower leg cast (inclusion of the foot and lower leg, knees and toes are free).
Homeopathy for tendinitis
In addition to the general medical measures, which can usually be used to successfully treat tendinitis, there are also some homeopathic approaches that can be used to treat this type of inflammation. Homeopathic medicines with the names Rhus tox and Arnica in various dilutions (potentiations) are mainly used here. As a rule of thumb, you should stick to a dosage of "5 globules three times a day". The tendinitis should improve after just a few days.
Home remedies for tendinitis
Often the symptoms of tendinitis can be significantly reduced and the inflammation process can be contained with simple home remedies.
So consciously keeping the affected part of the body calm in everyday life and wearing simple support cuffs or bandages from the pharmacy can be a first start.
In acute inflammations, cooling with ice packs or quark compresses (spread cold quark on a cloth and wrap around the affected area) and anointing with horse, moor and marigold balm usually help. In addition, compresses with diluted arnica tincture or a mixture of alcohol and healing earth, but also cabbage or savory poultice compresses can help against the inflammation.
Applying and rubbing in non-prescription, pharmacy-only Voltaren® gel (active ingredient: diclofenac) can also reduce symptoms through local pain relief and a decongestant and cooling effect.
In addition, care can be taken to ensure that food and drink consumption is as low in meat and alcohol as possible during the inflammatory phase, but that sufficient vitamin E (soy products, nuts, vegetable oil, whole grains, etc.) is consumed. The Schüssler salts No. 1, 2, 3, 4, 7, 8 and 11 administered by a homeopath can also be used as a therapeutic attempt.
How long does tendinitis last?
If there is an acute tendinitis, regardless of the area, it usually takes 1-2 weeks for it to subside. The exact duration of the healing phase depends to a large extent on the extent of the immobilization or the protection of the affected part of the body.
However, if the acute tendonitis is not adequately treated and if the tendons continue to be overloaded in this area, it may turn into a chronic inflammatory disease that can last for weeks or months.
Even if the symptoms are usually only remedied by surgery, the chances of recovery are good overall. In order to prevent an immediate relapse after the tendinitis has subsided, the triggering movements should be avoided and a regular visit to a physiotherapist should be considered. Physiotherapy specifically helps the muscles z. B. to strengthen the affected arm / leg, to stretch it and to loosen it with massages and to minimize bad posture or incorrect stress in everyday life by correcting posture or support measures.
prophylaxis
If there is a mechanical problem in the performance of certain work, the working conditions should be adjusted to prevent renewed tendinitis. For example, people doing computer work can put a pillow under their wrists to correct the incorrect posture leading to tendonitis.
Tendonitis on the wrist
Tendons run from the muscles on the forearm to the hand and fingers. They are surrounded by tendon sheaths that protect the tendons and guide them to their destination like splints. These tendon sheaths can become inflamed in the area of the wrist. Tendonitis is noticeable on the wrist in a similar way to that on the rest of the hand.
The focus is on pulling or stabbing pain when moving forearm and hand. In pronounced cases, pain can also occur at rest. There is also often redness and swelling along the affected tendons. It is also possible that movement leads to a palpable crunching and rubbing of the tendon on the wrist. Chronic tendinitis on the wrist can also lead to nodular thickening of the affected tendon.
The cause is usually high, monotonous stress in the wrist area, often at work or during sports. A non-ergonomic workspace or incorrect technique in sports can also contribute to tendinitis in the wrist. In addition, bacterial infections in the context of accidents or injuries are of course a possible cause of tendinitis on the wrist. A rheumatic disease can also trigger such an inflammation.
During the treatment, the wrist should be protected and immobilized, e.g. take place via a rail. Also, using pain relievers like ibuprofen or diclofenac can reduce pain and stop inflammation. Painkillers can be used either in tablet form or as an ointment. In the case of severe pain or inflammation, the introduction of cortisone directly into the tendon sheath can also be used for treatment.
In the case of chronic inflammation, however, these measures are usually of little help; an operation must often be considered here. Of course, every measure only brings long-term improvement if the cause of the tendinitis in the wrist is eliminated.
Read more on the topic: Tendonitis on the wrist
De Quervain's tendovaginitis
Tendovaginitis stenosans de Quervain is a special form of tendinitis that is restricted to the tendons of the thumb. Thus, the inflammatory process affects the tendon sheaths of the thumb attachment points of two muscles (Abductor pollicis longus muscle and Extensor pollicis brevis muscle)so that their tendons can slide back and forth less easily in the tendon sheaths due to scarring and constrictions by other tissues.
The result is load-dependent pain when spreading and stretching movements in the thumb joint and certain wrist movements, whereby the pain can even radiate into the forearm.
Also read about pain in the right forearm.
The cause of this disease has not yet been conclusively clarified. However, it is suspected that it is an overuse syndrome or a concomitant disease, for example in rheumatoid arthritis.
Clinically, there is often swelling and tenderness on the lower part of the thumb and wrist. In addition, the so-called Finkelstein test is positive. When the thumb side of the hand is brought up to the forearm (Ulnar abduction) with a bent thumb and pain in the area of the thumb when the fist is closed.
The therapy of choice is the 14-day immobilization of the forearm including the thumb with a cast or splint and the administration of painkillers. If this does not lead to improvement, the tendon sheath must be surgically split lengthways (Tenotomy).
For more information, see: De Quervain's tendovaginitis
Summary
Tendonitis is an inflammation of the tendon sheaths that surround the tendons and are found in the hands and feet. The most common cause of tendinitis is movement-related overload in connection with poor posture, less often a bacterial infection or an inflammatory rheumatic disease. The clinical picture is accompanied by painful movement, redness, swelling and warming. In some cases, tendinitis is also expressed as a grinding noise when palpating (Crepitation). The Tendovaginitis stenosans, which emerges as a "quick finger" and the De Quervain's stenoscopic tendovaginitis , also known as flicking thumb.
The treatment of tendinitis consists of immobilization and pain relief. In severe cases as well as with Tendovaginitis stenosans and De Quervain's stenoscopic tendovaginitis an operation is carried out that splits the tendon sheath to relieve the symptoms.
Overall, the prognosis for acute tendinitis is good. Chronic courses usually require surgery.
