Patient My hand started to hurt again, red, swollen, hot, painful, dysfunctionalDoctor
The initial diagnosis was tenosynovitis, but it should not be arbitrary,
Let’s learn together
DoctorQWhat is tenosynovitis?
A:
When the hand is fixed in a certain position for repetitive and excessive movement, the frequency of friction between the tendon and the tendon sheath increases, which can lead to edema, fibrosis, and internal The cavity is narrow. When the tendon is narrowed in the tendon sheath, it is prone to pain and movement disorders, namely tenosynovitis (Tenosynovitis), also known as stenosing tenosynovitis (Narrowtenosynovitis).
QWhat is its type?
A:
1. Stenosing tenosynovitis
(Narrowtenosynovitis):< strong>
This type of tenosynovitis mostly occurs in the tendon sheaths of the extensor pollicis brevis and abductor pollicis longus, and is called styloid stenosis Tenosynovitis, which occurs in the flexor tendons of the thumb or finger called “trigger finger.” Although the synovial membrane of the tendon sheath secretes synovial fluid to lubricate the tendon sheath, repeated friction is inevitable in some special movements, such as woodworkers, weightlifters, restaurant waiters, manual operators, etc. Because the above-mentioned tendon sheath acts as a pulley, the friction is the largest and the most vulnerable to damage, which is manifested as the thickening of the tendon sheath, which affects the normal activity of the tendon. Stenosing tenosynovitis may also be the result of certain quiescent or subclinical collagen disorders.
2. Acute fibrous tenosynovitis(Acutefibroustenosynovitis):< /p>
Acute fibrous tenosynovitis is also known as fricative synovitis. The site of the lesion is in the connective tissue surrounding the synovium, where edema, hyperemia, and infiltration of leukocytes and plasma cells can be seen. The disease is characterized by a soft fricative sound caused by fibrils of connective tissue rubbing around edema tendons. The most common part is the upper part of the wrist, which is characterized by the tendon of the carpal extensor brevis and the abductor pollicis longus and the extensor pollicis brevis muscle abdomen. It is also called crepitus tenosynovitis.
3. Acute serous tenosynovitis(Serousacutetenosynovitis): also called rheumatic tenosynovitis , is part of systemic rheumatism, a reaction of acute rheumatic fever. The patient had high fever, joint pain, swelling, and effusion, the most important of which was rheumatoid myocarditis. After the fever, the serous ooze of the tendon sheath is exuded and absorbed, and the tenosynovitis heals itself.
4. Tuberculous tenosynovitis(Tuberculoustenosynovitis): This tenosynovitis is caused by tuberculosis caused by bacterial infection. The synovium of the tendon sheath is first violated, and it spreads from the palm to the forearm along the ulnar side and the bursa through the carpal tunnel. The tendon sheath is hypertrophic due to infiltration of tuberculosis granulation tissue, and the sheath contains yellow exudate and yellow rice grains. Gradually, the tendon is also infiltrated by granulation tissue to form nodular hypertrophy, losing its original smooth motor function. When granulation tissue invades other tendon sheaths and nerves, it can cause flexion and sensory disturbances.
5. Acute suppurative tenosynovitis(Acutesuppurativetenosynovitis): It often occurs in trauma Later, especially puncture wounds. Mostly occurs in the flexor tendons of the wrist and fingers. The early stage of infection is synovitis of the tendon sheath, and then the tendon loses its luster and turns gray or green. At the same time, it was infiltrated and necrotic with pus. The most common is Staphylococcus, followed by Streptococcus.
QWhat causes it?
:
Injuries, strains (especially in the hands and fingers), osteoarthritis, some immune diseases, and even infections can also be caused.
QWhat are the symptoms?
A:
1. Pain
Most of them can’t clearly point out the location of the pain, but only complain that the joint is “uncomfortable”, and the inside of the joint during exercise A feeling of soreness or lack of energy.
Sometimes a band of pain is felt.
2. Local swelling
the affected tendon will There are cord-like bulges of varying degrees.
3. Dysfunction
4. Local swelling, redness
QWhat is the check method?
A:
1. Local tenderness:
obvious tenderness in and around the tendon sheath of the injured part;< /p>
2. Positive resistance test:
Due to the diseased tendon sheath Inflammation or swelling, the pain will be aggravated when the joint is hyperextension or hyperflexion, such as stenotic tendon of the styloid process or hyperflexion, the pain will be aggravated, and there will be a positive Finkelstein sign.
Note:
The diagnosis of this disease mainly depends on its clinical manifestations and physical examination. Use tendon palpation:
Tendon palpation: palpation of carpi flexors is mainly flexor carpi chalateralis, palmaris longus, carpi ulnaris Flexor; Carpi extensors are mainly extensor carpi longus, extensor carpi ulnaris and extensor carpi ulnaris: palpate the extensor digitorum, check the tendon of the total extensor finger, the extensor tendon of the index finger, and the extensor tendon of the little finger in turn. Then palpate the thumb Abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus. Pay attention to whether there is any change in muscle tension, whether there is tenderness, and whether the movement is barrier-free.
The auxiliary examination is less used, but X-ray examination shows calcium deposition in tendon and tendon sheath. It is also helpful for the diagnosis of this disease.
QTreatment ?
A:
1. Wash your hands with warm water< /strong>
Cultivate the habit of washing hands with warm water after work, not cold water, move your hands in time, and massage yourself. If you have this disease, it is more expensive to treat it early, so as not to delay it into chronicity.< /span>
2. Rotate the wrist
When the tingling starts , you can do some gentle hand movements to relieve pain. Rotating the wrist is one of the simple exercises. Rotate the wrist for about 2 minutes.
Some wrist muscles, restore blood circulation, and eliminate the bending posture of the wrist, which often causes symptoms such as wrist pain.
3. Raise the arm
raise the hand , higher than the head, and rotate the wrist while rotating the arm. This will help your shoulders, neck, and upper back adjust.
4. Turn the head and neck
Take breaks between work After a while, put your hands on the table and rotate your head for 2 minutes. Bend your neck forward and backward, nod your shoulders with your head, and
twist your neck, looking at your left shoulder and your right shoulder.
5. Regular exercise
Daily exercise and relaxation All sore muscles are important, even if you don’t feel pain. The local exercises described earlier should be practiced at least 4 times a day.
6. Take pain relievers
Take non-steroidal Anti-inflammatory drugs, for example, to reduce inflammation and pain. But do not use paracetamol, this anti-inflammatory drug is suitable for headaches.
7. Fist practice
Lightly grip Fist, then open, fingers straight. Repeated practice like this can help relieve the tingling.
8. Avoid drooping arms
When sleeping, Keep your arms close to your body and your wrists not bent. If you let your hand hang down by the bed, it will increase the pressure on the hand.
9. Use tools with care
When using tools , do not concentrate pressure on the base of the wrist. Use your elbows and shoulders as much as possible.
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