Tendinitis
| Classification according to ICD-10 | |
|---|---|
| M65.4 | De Quervain's tendovaginitis |
| M65.9 | Tendonitis (synovitis and tenosynovitis, unspecified) |
| ICD-10 online (WHO version 2019) | |
The tendon sheath inflammation ( tendovaginitis , also peritendinitis or paratendinitis ) is an inflammation of the tendon sheaths . It manifests itself in severe stabbing or pulling pains . Tendonitis occurs mainly in the area of the wrist , but z. B. also in the ankle area. In principle, they are possible wherever tendon sheaths exist.
causes
Non-infectious causes
Tendonitis occurs in sports mainly due to rapid increases in stress or duration of stress. In cross-country skiers, for example, this affects the tendon sheaths of the foot extensors and the ankle flexors.
Tendonitis can also be caused by prolonged overuse of the wrists. Examples of such causes are poor posture or unergonomic equipment at computer workstations - which can lead to repetitive strain injury syndrome , sometimes colloquially known as "mouse arm" - and similarly monotonously stressful activities as well as continued overuse of the wrist.
In the past, tendinitis was very common in secretaries because typing with mechanical typewriters required more effort than with modern keyboards.
The tendinitis was formerly known as "fibrositis" of the tendons (sheaths). New studies on the diseased tendon material show that the fibroblasts increasingly produce the more unstable type 3 collagen instead of the more stable type 1 collagen. This indicates degenerative processes.
A classification of the sick according to occupational groups is difficult today. The risk factors include frequent work with hand-held vibrating tools, work with hand strength of over 4 kg or a cycle time of less than ten seconds. However, there are contradicting studies for working with computer keyboards.
In September 2006, a landmark ruling by the Göttingen Administrative Court was published, which recognized the tendinitis of a railway ticket officer as an occupational disease (Az .: 3 A 38/05). The German Occupational Disease Ordinance , which also applies to all employees with statutory social insurance in the private sector, was fundamental to the judgment . In Germany, the social courts are generally responsible for disputes relating to statutory accident insurance , with the exception of civil servants.
In chronic complaints from RSI (repetitive strain injury) spoken.
Infectious causes
Infections mainly occur with stab wounds that lead to an opening of the tendon sheath and colonization with bacteria . The involvement of the synovial epithelium of the tendon sheaths is also known for pathogens that can trigger post-infectious arthritis. The most common pathogens in open wounds are staphylococci and streptococci. The treatment is based on that of all soft tissue infections . The principles are immobilization, surgical relief and the administration of an antibiotic .
In addition, the synovial epithelium, which lines both tendon sheaths and joint cavities, can also be affected by chlamydia , mycoplasma , gonococci and the like. a. be attacked directly or these can trigger immunological cross-reactions. Antibiotic therapy depends on the pathogen and is effective when there is serological evidence of an active infection process. It is also assumed that chlamydia, mycoplasma, diarrhea pathogens (e.g. Yersinia), Borrelia and others are involved in chronic and rheumatological courses. They can trigger post-infectious arthritis . The primary infections can sometimes show an almost asymptomatic course, which is why the symptoms are often not associated with an infection and instead are often attributed to an overload situation.
In the following, only the much more common non-infectious tendinitis is described, but not the rheumatological and acute purulent forms.
Symptoms
In acute inflammation, tenderness and muscle tenderness is typical. Often there is also overheating and redness as signs of inflammation. In pronounced cases, there is also pain at rest, but little improvement is seen after the overnight immobilization.
The chronic forms are sometimes only noticeable through nodular thickening of the affected tendon, sometimes with painful, palpable “crunching” and rubbing of the tendon. This can lead to the phenomenon of the so-called jerking fingers (tendovaginitis stenosans = constricting tendon sheath inflammation): The thickened tendon is initially stuck in the tendon sheath, and when the muscle pulls it suddenly slides out of the narrowing (especially with extension movements ). In Switzerland this is also called “spick finger”.
The clinical examination reveals a typical zone of pressure pain that adheres to the anatomical boundaries of the affected tendon and muscle. There is also pain when the tendon is passively overstretched (see below: Finkelstein test ) and when the muscle is actively tensed against resistance.
Must be delimited u. a. Pain in the joint ( arthralgia , osteoarthritis ), pain at the tendon insertion in the bone (insertion tendinopathy or tendoperiostitis, e.g. tennis elbow ) and bottleneck syndromes of peripheral nerves (e.g. supinator box syndrome ). In the case of tendons that do not have a tendon sheath, however, paratendinitis may be present, e.g. B. on the Achilles tendon .
therapy
If the pain is severe, immobilization of the affected muscle (splint, plaster cast ) can be useful. A supportive bandage is often put on and an anti-inflammatory ointment is applied. Nonsteroidal anti-inflammatory drugs also relieve pain and reduce inflammation .
In the medium term, a Velcro splint can be useful as it relieves discomfort through compression. Occupational therapy and an adaptation of the workload are also useful, for example by using different equipment or longer breaks during work, etc. For musicians, casual warming up or warming up of the hands and wrists before the actual game helps to prevent tendinitis.
For chronic pain, local anesthetic (to local anesthetics ) are injected occasionally be cortisone -Präparate used. Surgical splitting of the tendon sheath is possible, especially in the stenotic form. With chronic inflammation, in contrast to acute inflammation, warmth is usually perceived as more pleasant than cold.
Some medical studies on extracorporeal shock wave therapy (ESWT) show that 70–80% of those treated reported a clear relief of symptoms after three months. However, after this time, a high rate of improvement can generally be expected even without therapy. Other studies show no effect, the method is not generally accepted. In Germany it is a self-payer service, the treatment of which is not covered by health insurances due to a lack of good quality studies.
Special shape
Tendovaginitis stenosans de Quervain (Quervain's disease) , which affects the first tendon compartment of the hand, is a special form of tendinitis . The tendons of the thumb muscles, abductor pollicis longus and extensor pollicis brevis, run through it . The cause is usually an overload of these tendons due to frequent abduction (moving the thumb away from the palm) and predisposition. An increased occurrence is observed in people who frequently hold a baby with forceful splaying of the thumb and frequent typing of cell phone messages.
The Finkelstein test (according to Harry Finkelstein , 1865–1939), which corresponds to passive overstretching of the tendons, is usually clinically positive.
The therapy does not differ from that of other tendinitis and consists of the use of an anti-inflammatory drug , local or systemic, immobilization and avoidance of overload, the use of ice and, if necessary, the infiltration of a cortisone preparation. If this does not lead to healing, the fibrous tendon sheath can be surgically split. Potential specific complications (in addition to the general risks of any surgery) are but means a violation of the superficial cutaneous branches of the spokes nerve , a volar subluxation of the tendons and a local induration of tissue.
See also
literature
- Anna Sander, Ingo Marzi, Johannes Frank: The treatment of tendovaginosis on the hand. In: Hand Surgery Scan. Volume 05, No. 01, March 14, 2016, p. 69, doi: 10.1055 / s-0041-107103 , online at thieme-connect.com .
Web links
Individual evidence
- ↑ Ludwig Heilmeyer , Wolfgang Müller: The rheumatic diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 309–351, here: pp. 342–346: The soft tissue rheumatism (fibrositis, muscular rheumatism, myalgia, panniculitis).
- ↑ Klaus Giersiepen, Michael Spallek: Carpal Tunnel Syndrome as an Occupational Disease - Carpal Tunnel Syndrome as an Occupational Disease . In: Deutsches Ärzteblatt . tape 108 , no. 14 . Deutscher Ärzteverlag, April 1, 2011, p. 238–242 , doi : 10.3238 / arztebl.2011.0238 , PMID 21547163 , PMC 3087121 (free full text) - (meta-study of the German medical journal).
- ↑ The court recognizes tendonitis as an occupational disease. In: aerzteblatt.de . September 4, 2006, accessed February 2, 2015 .
