Treatment of tendon rupture of the long head of the biceps. Tendonitis - causes, symptoms, diagnosis, treatment

The biceps brachii muscle, or biceps, is located on the front surface of the shoulder. It flexes the arm at the elbow joint and, to some extent, provides outward rotation of the forearm (supination). In addition, the biceps brachii muscle plays an important role in stabilization shoulder joint, i.e. prevents dislocations. The muscle consists of two heads, which at the top are attached to the scapula by two separate tendons, and at the bottom the muscle is attached to the radius with a single tendon (distal tendon).

Among biceps tendon ruptures in the area of the shoulder joint (i.e. proximal tendon ruptures), the most common tendon rupture is the long head of the biceps brachii tendon. As a rule, rupture of this tendon occurs in the place that is located inside the shoulder joint (separation from the place of attachment to the supraglenoid tubercle), or in the place where the tendon is located in the intertubercular groove. Less common are ruptures of the tendon of the long head of the biceps brachii muscle in the area of the musculotendinous junction (i.e., the place where the tendon gradually passes into the muscle belly) and ruptures of the muscle belly itself. Tendon ruptures are even less common short head biceps brachii muscle. Distal biceps tendon ruptures are described in a separate article.

Causes of biceps tendon rupture

Most often, rupture of the tendon of the long head of the biceps brachii muscle occurs in men over 35 years of age when they carry or lift something heavy with their hands in front of them (for example, when carrying a heavy box in front of them). Lifting a weight, especially with a jerk and without taking into account its weight, is a clear example of such a situation.
Ruptures in women are extremely rare. Scientists have found that for a tendon to rupture, the object must weigh more than 68 kg, however, if the tendon tissue is subject to significant changes, it is possible that a rupture could occur when lifting even less weight.
Unfortunately, with age, some people's tendons lose their strength, and in cases where the mass of an object being carried or lifted turns out to be more than critical, a rupture may occur. You can prevent rupture by warming up before significant physical effort, but, unfortunately, this simple requirement is often neglected. However, a man doing a warm-up before bringing a box of groceries home from the car would look very unusual, you must admit.

It is worth noting that regular classes physical education, and not from time to time, will be able to strengthen the tendon tissue. No other effective ways There is no such thing as tendon strengthening (except perhaps for Prolotherapy, which is in clinical research). It is worth noting that even if prolotherapy turns out to be effective, its implementation in relation to the proximal tendons of the biceps brachii muscle will be very difficult. Various biological additives also do not have real effectiveness, and recommendations for abundant consumption of jellied meat, meat broths, and chicken cartilage are nothing more than widespread myths.

In addition, a rupture of the tendon of the long head of the biceps brachii muscle can occur when falling on the arm.
Multiple loads sporting nature(swimming or tennis) can lead to overuse injury, which causes the tendon to become weaker and eventually rupture.
In addition to repeated repetitive stress, the tendon of the long head of the biceps brachii can be compromised by rotator cuff tears and shoulder impingement syndrome.

Additional risk factors for biceps tendon ruptures are:

Smoking: Nicotine can interfere with the nutrition of tendon tissue.
Administration of corticosteroids. Taking and local injections of corticosteroids (drugs such as diprospan, hydrocortisone) can cause necrosis and tendon rupture.
In addition, there are suggestions that certain systemic diseases and the use of fluoroquinolone antibiotics may contribute to tendon rupture.

Subcutaneous tears of the biceps brachii muscle occur mainly as a result of indirect trauma. A sharp sudden contraction of a muscle in a state of tension leads to rupture of the long head tendon during impact, wrestling, lifting of weights and the distal tendon, mainly during sudden lifting of weights. A complete rupture leads to the formation of diastasis between the ends of the tendon due to both muscle traction and degenerative changes in the ends of the damaged tendon. Depending on the size of the diastase tendon ruptures divide on the:

small (up to 1 cm),
medium (from 1 to 3 cm),
large (from 3 to 5 cm),
and extensive (over 5 cm).

During the first week after injury, tendon and muscle damage is considered fresh, up to 3 weeks. - stale and at a later date - outdated.

What happens when there is a break?

When the tendon of one of the heads of the biceps brachii muscle is ruptured (or separated from the place of attachment to the scapula), the strength of the muscle becomes decompensated and the muscle belly shifts downward as a result of muscle contraction, which leads to the appearance of a characteristic spherical deformity (the so-called Popeye symptom).

Classification of biceps tendon rupture

Ruptures of the biceps tendon can be full and partial.

Partial breaks. As the name suggests, these tears are incomplete, and because part of the tendon remains intact, the muscle does not move downward.
Complete breaks. This type of tear is much more common than a partial tear. A complete tear means that the muscle is completely detached from the bone and is pulled down by its contraction towards the elbow joint.

As we have already noted, rupture of the long head tendon occurs more often. Its tendency to rupture is determined by anatomical features: the tendon runs inside the shoulder joint and is attached to the supraglenoid tubercle of the scapula.
Fortunately, the biceps in the area of the shoulder joint is attached to the bones by two heads, and ruptures of both tendons are monstrously rare. Thanks to this dual attachment, in many patients the biceps continues to perform its function even after complete rupture of the long head tendon.
Long head biceps tears can also damage other structures in the shoulder joint, such as the rotator cuff.

Rate rotator cuff if a rupture of the biceps tendon is suspected, it is very important, since if it is damaged, the injury can have a very atypical picture.
For example, with a rupture of the subscapularis tendon, the tendon of the long head of the biceps brachii muscle can dislocate forward from the intertubercular groove, while remaining intact.

Symptoms

Sometimes there is an audible click or crunch at the moment of rupture.
Unexpected, acute pain in the shoulder area, which gradually decreases and almost completely disappears 2-3 weeks after the injury.
Pain when trying to tense the biceps brachii muscle (biceps)
Bruising along the front surface of the shoulder from the shoulder to the elbow joint. A few days after the rupture, the area of the bruise becomes larger, it gradually goes down and can even reach the hand.
Pain or tenderness on palpation.
Weakness of movement in the shoulder and elbow joints.
Difficulty turning the forearm.
Due to the fact that the torn tendon can no longer hold the muscle in a taut state, the muscle gathers into a lump above the elbow, and soft tissue retraction appears in the area of the shoulder joint.

When subcutaneous rupture of the biceps brachii muscle patients note a cracking or crunching sound, sudden pain and weakness in the arm. In victims, the contours of the biceps brachii muscle change, local pain occurs on palpation, and decreases muscle strength hands, subcutaneous hemorrhages appear. Shoulder pain increases with raising the arm, flexing and supination of the forearm.
When damage to the short head Patients experience a clicking sensation in the shoulder joint. Upon examination, a bulge is noticeable in the middle part of the shoulder and a depression in the lower part of the shoulder. On palpation in the area of the coracoid process of the scapula, pain and retraction of soft tissues, bifurcation of the biceps muscle are noted.
Damage to the distal biceps tendon manifested by the absence of tension in the tendon in the area of the elbow bend (“empty elbow joint"). The strength of flexion and supination of the forearm is sharply reduced. The belly of the biceps muscle moves proximally and takes on a spherical shape

Examination and diagnosis

After the doctor listens to your complaints, he will examine your shoulder. Often the diagnosis of a complete tear is obvious due to the characteristic deformity of the shoulder muscles.
A biceps tear becomes even more obvious when it contracts (Popeye muscle).
Partial tears are less obvious. To diagnose it, the doctor may ask you to bend your arm and tense your biceps. Pain when trying to use your biceps may indicate a partial biceps tear.
It is also very important that the doctor excludes other injuries to the shoulder joint. The biceps can also tear at the elbow joint, although such tears are less common. Tears in the elbow area are determined by the depression along the front surface of the shoulder closer to the elbow joint. The doctor will examine your arm to rule out damage in this area.
In addition, it is necessary to exclude damage to the rotator cuff, impingement syndrome and tendinitis. To detect these problems, your doctor performs special tests by asking you to move your arm.

In order to clarify the diagnosis, additional research methods may be required:

Radiography. Although radiographs do not show very well soft fabrics, they are performed in order to rule out other problems that may be causing pain in the shoulder joint.
Magnetic resonance imaging (MRI). This examination method is optimal for imaging soft tissues. It can display both full and partial breaks.

Treatment

Due to the fact that the second, uninjured head compensates for the function of the biceps brachii muscle, some surgeons, such as Watson-Jones, believed that there was no need for surgery for such ruptures at all. However, if the torn long head of the biceps tendon is not reattached to the bone, some cosmetic and functional problems are inevitable.

Scientists Soto-Hall and Stroot studied elbow flexion strength and abduction strength of the externally rotated arm in patients with ruptures of the long head of the biceps brachii tendon. It turned out that at short periods after injury, the flexion force decreased by 20% compared to the opposite arm, and the abduction force decreased by 17%. Subsequently, as self-adaptation muscular system the strength deficit was even smaller. Accordingly, functional problems with a rupture of the tendon of the long head of the biceps brachii muscle can be regarded as minor, and, from a functional point of view, surgery to restore the attachment of the tendon to the bone can be considered advisable only in young people with high functional demands.

Conservative treatment.

The essence of conservative treatment comes down to local application of cold on the first day after injury, the use of painkillers and short-term immobilization on a scarf (less than 2 weeks). Immobilization is needed simply to provide rest to the arm and relieve pain. As soon as the pain subsides, it is necessary to begin movements in the elbow and shoulder joints. .
Shoulder deformation, i.e. a cosmetic defect that cannot be corrected with conservative treatment.

Ice. Applying an ice pack for 20 minutes every day several times can help reduce swelling and pain. Do not apply ice directly to the skin.
Non-steroidal anti-inflammatory drugs. Medicines such as ibuprofen, aspirin, or naproxen reduce pain and swelling.
Peace. Avoid heavy lifting and excessive activity to reduce pain and limit swelling. Your doctor may recommend using a headscarf for a short time.

It is worth noting that a torn tendon of the long head of the biceps brachii muscle can serve as a mechanical obstacle to movements in the shoulder joint - the so-called impact syndrome or impingement syndrome.

Surgical treatment

The main goals of surgical treatment, during which the attachment of the torn tendon to the bone is restored, are:

Elimination of a cosmetic defect
Preventing impingement syndrome
Maximum Recovery strength of the biceps brachii muscle in patients with high physical demands.
In addition, surgery may be advisable if conservative treatment does not lead to success.

Method of intervention. There are two fundamentally different surgical treatment options. In one of them (if there is a separation from the place of attachment to the supraglenoid tubercle), the tendon is attached exactly to the place from which it was torn off. This operation is quite complex, it is advisable to perform it arthroscopically, i.e. through small incisions with the introduction of a video camera into the joint cavity. To fix the tendon in this case, special expensive implants are required.
In the second version of the operation (which also gives good functional results), the tendon is attached not to the place from which it came off, but to humerus.
A significant advantage of the first method is that the tendon of the long head of the biceps brachii muscle will perform a stabilizing function and prevent possible shoulder dislocations. However, it is worth noting that this advantage cannot be put in first place, since the complexity of the operation and less reliable fixation may offset the advantages.

Complications

Complications of surgical treatment are rare. Recurrent ruptures of the repaired tendon are rare.

Rehabilitation

After the operation, your shoulder will be temporarily immobilized using a special scarf or bandage.

Strictly adhere to the rehabilitation program recommended to you by your doctor. Although recovery is a long process, your active participation and interest in the result is main factor Your return to your original level of physical activity. It takes 2-3 months for the tendon to completely heal. It is important at this time to limit your physical activity. Results of surgical treatment. Almost all patients eventually return to full range of motion. There is every reason to hope for a return to hard physical work and sports after some time.

Attention! the information on the site does not constitute a medical diagnosis or a guide to action and is intended for informational purposes only.

If painful sensations appear constantly, then it would be wiser to refuse work or movements that cause them.

Causes of tendinitis

Tendonitis of the long head of the biceps tendon is accompanied by pain in the upper anterior regions shoulder girdle. As a rule, such pain occurs due to overstrain of the biceps muscle after lifting weights. In this case, shoulder abduction and rotation are not impaired. During the diagnostic process, a test of resistance to active supination of the hand is performed. Patients with chronic tendinitis are usually examined using nuclear magnetic resonance. This study reveals areas with abnormal impulses, indicating degenerative changes in the tendons.

D.Nobel
The most frequent illness shoulder joint, not associated with injury, is tendinitis of the tendons of the muscles that form the muscle capsule. The tendons of these four muscles attach to the greater and lesser tuberosities of the humerus. The tendon of the long head of the biceps muscle passes through the intertubercular groove, starting from the supraglenoid tubercle of the scapula.
Exercise #5.
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This is inevitable if, after the disappearance of the first symptoms of acute tendinitis, a strong load on the tendon immediately resumes, since it is very sensitive to sprains and other damage for another 1.5-2 months.

The cause is damage to the muscle capsule by the coracoacromial ligament, the anterior edge of the acromion or the acromioclavicular joint, which leads to degeneration, inflammation and thinning of the tendon.

Stage II requires supplementing treatment with injections into the joint cavity (lidocaine, bupivacaine in combination with triamcinolone). Short-acting anesthetics are used in the diagnosis of pathology; long-acting drugs are used for therapeutic effect. Muscle relaxants are used only for severe pain and in rare cases (lots of side effects).
Inflammation of the tendons of the shoulder joint develops in waves with a gradual deterioration of the condition.
curvature of the spine;
Shoulder tendonitis is a common inflammatory and degenerative pathology of the shoulder joint, not directly related to acute shoulder injury. Long-term high loads on the shoulder cause microtrauma to the muscle tendons that form the capsule of the shoulder joint, their inflammation and subsequent degeneration.
At rest there is usually no pain
"Tendinitis of the shoulder joint" and other articles from the section Diseases of the joints
When the muscle capsule ruptures, the supraspinatus tendon is primarily damaged. Almost always, tendinitis of the supraspinatus tendon develops first, then the inflammation gradually spreads to the entire muscle capsule, subacromial bursa, joint capsule and other structures, ultimately leading to ankylosis of the joint.
Lean forward in front of the back of a chair or wall. Use your healthy hand to rest on the surface. Allow the affected limb to hang freely. Next, you begin to swing it from side to side. If you stand by a chair, you can also rock back and forth. Gradually increase the amplitude of the pendulum.
What to do if a nerve is pinched in the back? Find out from this material.

The mechanism of tendonitis

It causes a lot of discomfort, as it is impossible to perform simple physical exercises.

Supraspinatus tendinitis can lead to ankylosis of the joint if it spreads to the entire capsule and other structures.

Shoulder tendonitis: symptoms

Pain syndrome

Important!

Low-intensity aching pain occurs only periodically with sudden movements. No changes in the joint are recorded on the x-ray. thyroid gland pathology, diabetes mellitus.

Limited movement

Social groups most susceptible to shoulder tendinitis:

Treatment of shoulder tendonitis, first of all, involves ensuring complete rest of the affected area.
The tendon of the long head of the biceps brachii muscle passes inside the shoulder joint, adjacent to the tendons of the rotator cuff muscles, and, rising under the acromion, is attached to the upper edge of the glenoid cavity of the scapula. Thus, the same compression in the subacromial space that causes rotator cuff syndrome can cause tendonitis of the long head of the biceps brachii muscle. Another cause of tendonitis is dislocation of the tendon of the long head of the biceps brachii muscle from the intertubercular groove, which happens when the transverse ligament of the humerus holding the tendon is torn.
The cause of supraspinatus tendonitis is damage to the muscle capsule by the anterior edge of the acromion, the coracoacromial ligament and, sometimes, the acromioclavicular joint; this leads to inflammation, degeneration and thinning of the tendon. As a result, the thinned tendon ruptures; the tendons of the infraspinatus muscle and the long head of the biceps muscle may also rupture.
Exercise #6.

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Inflammatory reaction

Tendinitis develops in three main stages:

Degeneration of joint tissue

With this disease, palpation of the anterior edge of the acromion and intertubercular groove is painful.

Features of the development of shoulder tendinitis

Injections with corticosteroids can reduce collagen production, thereby reducing the elasticity of the tendons. Therefore, hormonal treatment is carried out only in the acute period with an interval of 2-3 weeks. Not recommended for biceps tendinitis.

I degree

Painful sensations are more pronounced, limited active movements appear. X-ray reveals signs of osteosclerosis and periostitis, the formation of osteophytes located on the tubercles of the humerus is recorded.

II degree

The capsule of the shoulder joint is formed by 5 muscles: supraspinatus, teres minor, infraspinatus, subscapularis (forms the rotator cuff) and biceps major (biceps). Since the socket of the shoulder joint only partially covers the head of the humerus, the load when holding it in correct position and when moving, rests on the muscle tendons.

III degree

people 40-60 years old (this is due to an age-related decrease in the elasticity of tendons);

Diagnostics

For this purpose, special splints, splints or dressings are used. Primary treatment for shoulder ligament injuries includes:

Regardless of the immediate cause of biceps tendinitis, its clinical picture is the same. The pain is limited to the anterior surface of the shoulder joint and the upper part of the shoulder and intensifies with external rotation of the arm bent at the elbow against the doctor’s force. It can occur when assessing the strength of the forearm flexors (when the patient bends the arm in the forearm, overcoming the doctor’s resistance), as well as during direct palpation of the inflamed tendon. Pain during external rotation of a flexed forearm held by a physician (Ergason's sign) indicates displacement of the tendon of the long head of the biceps brachii muscle from the intertubercular groove.
Over time, tendinitis usually improves, so conservative treatment is sufficient.
Raise your hands straight in front of you. Brush right hand place it on your left elbow, and your left hand on your right. So you begin to swing your arms from side to side.
The main task in treating shoulder tendonitis is to restore proper motor activity, relieve inflammation from the tendon and reduce pain.
At the initial stage, the patient practically does not feel any specific symptoms of the disease. With sudden movements in the joint, short-term, mild aching pain may occur.

Treatment of tendinitis

This type of disease is also called “tendonitis of the long head of the biceps” - the tendon that holds it together becomes inflamed. top part biceps and shoulder muscles.

Physiotherapy procedures accelerate recovery: electro- and phonophoresis, magnetic currents, cryotherapy, laser treatment, ultrasound and paraffin baths.

Painful attacks last up to 8 hours. Pain occurs even at rest. X-ray: the gap between the head of the humerus and the acromion is narrowed, the upper subluxation and erosion on the anterior edge of the acromion are recorded. Tendon tissue is capable of regeneration. The tension that arises from heavy workload disappears during the period of rest. The lack of respite after hard work leads to microtrauma (the appearance of microcracks) in the ligamentous apparatus of the shoulder and the development of inflammation. Most often, ligaments are damaged at the point of attachment to the bone, then inflammation affects the entire muscle capsule and other periarticular structures. With continued exposure to the irritating factor, adhesions with ossification elements occur in the tendons. Possible rupture of the muscle capsule due to significant degenerative thinning of the tendons.

athletes (weightlifters, tennis players, swimmers, baseball players);

Protecting the shoulder joint from stress.

If biceps tendonitis is caused by impingement of the biceps tendon in the subacromial space, its treatment is similar to that of rotator cuff syndrome. Treatment of tendonitis caused by tendon dislocation begins with restricting the movement of the arm in the shoulder joint and prescribing NSAIDs, after which gradual development of the shoulder joint begins. It is useful to strengthen the synergistic muscles of the biceps brachii muscle. Pain relief is possible after the introduction of glucocorticoids into the tendon sheath of the long head of the biceps brachii muscle, but the danger of such a procedure is that if glucocorticoids accidentally enter the tendon, they contribute to its degeneration. If conservative therapy does not produce results, fixation of the tendon of the long head of the biceps brachii muscle directly to the humerus is indicated. Some experts believe that improvement occurs in all cases, regardless of treatment, while others insist on the need for glucocorticoid injections into the affected structures - as in arthritis of the shoulder joint, as well as with damage to tendons, tendon sheaths and synovial bursae.

A number of folk remedies are also used in the treatment of tendinitis:

Depending on the stage of the disease, different types of recovery are used.

Prevention

In the second stage, the patient begins to feel pain after physical activity. The sensations are more pronounced.

Pain appears in the upper anterior part of the shoulder. Due to overstrain of the biceps muscle, it is impossible to lift heavy objects.

TreatmentSpiny.ru

At stage III, with the above treatment, resection of the anterior part of the acromion process is performed. Surgical removal of scar tissue and partial excision of tendon aponeuroses is indicated when conservative measures fail and narrowing of blood vessels develops.

The diagnosis of “tendinitis” is established on the basis of characteristic clinical signs and motor tests(limitation of certain movements). To confirm the diagnosis, the treating specialist may prescribe:

The onset of tendonitis is associated with the sudden onset of acute or dull aching pain. The pain intensifies when you try to lift your arm up (take a cup from a high shelf, put on a sweater, etc.). Often, increased pain at night leads to insomnia. Palpation of the damaged tendon is accompanied by pain.

people whose work involves an excessive load on the shoulder (painters, builders, loaders, etc.);

Immobilization.Recovery from fixation of the long head of the biceps tendon to the humerus takes a long time, and complete recovery usually does not occur.
Periarthritis is a collective term that describes inflammation of the tissues around the shoulder joint and combines a number of similar syndromes, which result in contracture. Most experts agree that active treatment tactics are necessary to prevent contracture. Sarsaparilla root and ginger.

Supraspinatus

More than 90% of people suffering from tendinitis need a fairly simple treatment - physical exercise.

At the third stage, prolonged attacks of pain appear; they can last for 6-8 hours. Unpleasant sensations occur even at rest.

Swimmers and tennis players often suffer.

Biceps muscle

In order to prevent the development of tendonitis, you should avoid prolonged heavy loads on the shoulder and combine hard work with short rest. You should not test your body’s strength; hard work should be preceded by a warm-up, and it is advisable to increase the load gradually (by 10% during physical exercise).

Ultrasound (detection of hypoechoic areas of irregular shape);

Important!

Rotator cuff

lovers of working on the land, gardeners;

The main methods of secondary therapy include:

Shoulder tendonitis is a pathology that affects people, regardless of their age, gender and professional activity. However, most often this disease affects patients over forty years of age, as well as people actively involved in sports or physical labor, loading the same area.

Shoulder

Tendinitis of the supraspinatus tendon and tendovaginitis of the long head of the biceps brachii muscle can lead to inflammation of other tendons, bursae, joint capsule, cartilage, bones and surrounding muscles.

The combination of these two ingredients is used to treat inflammation of the tendons and joints. To prepare, you need to take 1 teaspoon of a mixture of ginger and sarsaparilla, first chop it, pour boiling water and drink it instead of tea. Apply twice a day.

It is important not to load the damaged joint, but to develop it, that is, to increase the range of motion.

Post-traumatic

The basis for diagnosis is a physical examination, patient complaints, and medical history.

Also occurs due to severe bruises, overexertion, infection.

If the slightest pain occurs, a short rest is necessary. The effectiveness of tendonitis treatment depends on the patient’s compliance with all medical recommendations and correct execution special therapeutic exercises.

Chronic

radiography, Raman arthrography (x-ray with the injection of a contrast agent into the joint);

Unlike arthritis, in which the pain is constant and diffuse, with tendonitis the pain is localized, occurs only when performing certain movements and disappears at rest.

women during menopause (hormonal changes weaken the tendons).

Stages of disease development

Physiotherapy.

The most common tendinitis in clinical practice is the supraspinatus tendon.
Tendinitis of the supraspinatus tendon (even when other parts of the muscle capsule are involved) and tendovaginitis of the long head of the biceps brachii muscle do not affect the range of passive movements in the shoulder joint. Restricted mobility can be caused by inflammation of the joint capsule (adhesive arthritis), synovial bursae and muscles.
Curcumin

You can perform the following set of exercises:

During the examination, the doctor:

Metabolism in the tendons of the rotator cuff is disrupted, which leads to pathological changes (tendinitis). The tendon increases in volume and becomes very thick (about 2 mm on the affected side).
Tissue inflammation begins around calcium deposits.

MRI of the shoulder joint (tendon ruptures and degenerative areas are determined);

Passive movements are usually not limited. Depending on the location of inflammation, characteristic signs are present:
Factors that provoke shoulder tendonitis:
LFC.
Long-term physical activity on the shoulder joint.
Sudden sharp or dull pain in the shoulder, a symptom of a pain arc. Pain on palpation of the anterior edge of the acromion and intertubercular groove. The diagnosis is confirmed if the pain resolves when a short-acting local anesthetic is injected under the acromion.

- one more thing effective remedy from tendonitis. It eliminates the main symptom of the disease – pain. It also works great against inflammation. Curcumin should be used as a seasoning for food. You should consume approximately 0.5 grams per day.

Exercise #1.

checks the possibility of active and passive (when the doctor himself lifts the patient’s limb) movements of the patient;

An ultrasound examination clearly reveals hypoechoic areas of irregular shape.

Perhaps the development of the disease is facilitated by tendon wear, tears and low oxygen supply to tissues.

Physical therapy and exercise

arthroscopy;

Shoulder cuff tendinitis - pain spreads along the upper outer surface of the shoulder with possible irradiation to the elbow;

excessive long-term loads on the shoulder;

Analgesia and anti-inflammatory therapy.Infectious diseases.
Stage I: normalCherry fruits.
You need to take a fairly long towel and throw it over the bar (for example, for a shower curtain). Next, grab the ends of the towel with your hands. Use your healthy limb to pull the fabric down. At the same time raising the sore arm up. After you feel a slight pain, fix the position for three seconds, then very slowly lower your hand. checks the sensitivity of the muscles in problem areas. To determine the range of motion, it is necessary to move the limb in all directions. Patients with tendinitis can only perform limited passive and active movements.
Shoulder tendinitis includes a whole group of diseases: inflammation of the infraspinatus and teres minor muscles, the supraspinatus tendon, and the subscapularis muscle. Calcific tendonitis is characterized by pain when lifting the limb upward, the discomfort increases sharply at night.
blockade in the area of the rotator cuff (the introduction of anesthetics in combination with corticosteroids for tendinitis reduces pain). Teres minor tendinitis - a positive resistance reaction to active external rotation of the shoulder;
shoulder injuries;Clinicians note positive dynamics in the treatment of tendinitis with corticosteroid injections directly into the lesion. These drugs quickly eliminate pain and help to attenuate the inflammatory process.

Video: a set of exercises for the shoulder joint

Folk remedies

Pathologies of a rheumatic nature (arthritis or gout).

Stage II: osteosclerosis, periostitis, cysts; osteophytes of the tubercles of the humerusIndispensable in the treatment of tendonitis. Their juice contains tannins. These substances, combined with anthocyanins, have an anti-inflammatory and strengthening effect. Pour 3 tablespoons of fresh berries into a glass of boiling water. Use 2-3 times a day.
Exercise #2.In order to exclude an error in diagnosis, the doctor may prescribe:
Shoulder tendinitis is characterized by severe pain in the joint area, and the area may become slightly swollen. There are two types of calcific tendinitis:
Therapeutic measures for shoulder tendinitis depend on the stage of the pathology.inflammation of the subscapularis muscle - a positive resistance reaction to active internal rotation of the shoulder;

rheumatoid joint diseases (gout, arthritis);

Note: However, corticosteroid injections do not provide a complete cure, and they can also increase the rate of collagen degradation and reduce its synthesis, which reduces the tensile strength of the tendon and leads to its rupture. Therefore, such treatment of shoulder tendinitis is justified only in the acute period (once every 2-3 weeks).

Anatomical features of the body structure.

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Shoulder tendonitis

Stage III: narrowing of the space between the acromion and the head of the humerus, superior subluxation of the shoulder, erosion of the anterior edge of the acromion.

Carrying out local procedures.

A gymnastics stick is required. Place it at arm's length, and, holding it in an upright position, use the affected limb to describe a large circle with the stick.

MRI - as part of this examination, pictures of the internal structure of the body are taken;

Severe pain occurs when lifting heavy objects.

Degenerative calcification.

At the first stage of tendinitis development, it is enough to temporarily eliminate the load on the shoulder and limit its mobility (immobilization). Pain-causing movements should be avoided for 2-3 weeks. Therapeutic exercises Strengthening the shoulder muscles and increasing mobility is carried out with a gradual increase in load.

biceps tendonitis - pain spreads along the upper anterior surface of the shoulder, rotation and abduction are not impaired.

Clinical picture

inadequate rehabilitation treatment after operations and injuries, cervical osteochondrosis(adhesions form in the tendons of the shoulder);

Radiography

Non-steroidal anti-inflammatory drugs (for internal use) have proven themselves to be quite effective. However, their long-term use is recommended only for chronic conditions of overexertion. Also, to relieve pain in the shoulder area, patients are prescribed simple analgesics and muscle relaxants. With the development of muscular-tonic syndrome, it is recommended to use muscle relaxants that reduce pathological muscle tension and reduce the severity of pain. Enough effective method treatment is local therapy using gels and ointments, which include NSAIDs. If necessary, these drugs can replace systemic non-steroidal anti-inflammatory drugs. As a complement to the main course of treatment, the patient is prescribed physiotherapeutic procedures. Ultrasound treatment has proven itself well, as well as laser and magnetic therapy. In the case of the development of a severe inflammatory process and if standard treatment is ineffective, patients are indicated for treatment with antibiotics. Surgery is recommended only when all conservative methods and a program of physical therapy procedures have failed, and also if the patient shows signs of stenosing tendonitis (which is characterized by narrowing of blood vessels) or Osgood-Schlatter disease. During surgery, tendon aponeuroses and scar tissue are dissected or partially excised. This operation requires two or three months of rehabilitation, which includes gradual use physical therapy exercises for stretching and strength development.
Improper development or weakening of tendons.
X-ray contrast examination reveals a rupture of the muscle capsule and communication between the subacromial bursa and the joint cavity.

It is necessary to apply cold to the affected limb on the first day, and heat on the following days. Applying a fixing bandage to the joint.

Treatment

Exercise #3.

Anesthetic injection into the bursa (in the area of the rotator cuff). If the pain decreases, this confirms the diagnosis of tendinitis;

This disease occurs due to insufficient blood supply to the tendon due to increased load.

The main cause of degenerative calcification is the wear and tear process of aging, as the blood supply to the tendons decreases and they weaken. Microtears of fibers occur. and reactive calcification.

Important!

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Biceps tendonitis - SportWiki encyclopedia

Clinical picture

The patient is able to raise his arm only 90º, holding even a small load becomes problematic, throwing his arm behind his back is impossible.

congenital anomalies of the shoulder joint;

Treatment of biceps tendonitis

Note: treatment of shoulder tendinitis will be effective only if the patient follows all the specialist’s recommendations without exception regarding keeping the inflamed limb at rest. If you continue to do your usual work, the disease will only progress in the future.

Forecast

Failure to maintain correct posture.

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Tendonitis of the shoulder joint - clinical picture of the disease

Stage I: rest with gradual increase loads; immobilization is contraindicated due to the risk of adhesive arthritis; Exercise therapy to strengthen muscles and increase joint mobility; aspirin and other NSAIDs.

Physiotherapy

Causes

Place the hand of the affected limb on the healthy shoulder. Lift it up. With your healthy hand, carefully begin to lift your bent elbow up. Next, lower your elbow. Maximize your allowable amplitude every day.
X-ray;
The most common disease among professional athletes. Characterized by acute pain.
Reactive calcification.
Prolonged immobilization increases the risk of developing adhesive arthritis.
Inflammation of the shoulder tendons leads to thickening of the joint capsule. On the affected side, thickening can reach 2 mm. A local inflammatory reaction is characteristic: slight swelling, redness and local hyperthermia. Sometimes an effusion forms in the vagina of the damaged tendon, followed by suppuration.

Characteristic symptoms

bacterial infections (gonorrhea);

Rotator cuff tendonitis

In order to prevent the development of the pathological process, you should, if possible, avoid work that requires holding your arms in a raised position for a long time, and you should also avoid monotonous movements in the joint for a long time. Before performing any physical activity, it is recommended to do a short warm-up. The pace of the load should increase gradually.

Inflammation of the long head of the biceps

In the case when a patient is diagnosed with shoulder tendinitis, the most characteristic symptoms of this pathology are limited mobility and the occurrence of long-lasting pain at the site of inflammation and in nearby areas. In some cases, pain may increase gradually as the inflammatory process develops. Patients often complain of a creaking sound (crepitus) that occurs when moving a limb. It can be heard even from a distance. The inflamed area is hyperemic, local body temperature is increased. In some cases, tendonitis is complicated by the deposition of calcium salts in the shoulder joint, which leads to weakening of the tendon and joint capsule. In a passive state, there is often no pain, but painful sensations begin to increase towards night. Due to the forced position of the body and the severity of the pain syndrome, patients experience sleep disturbances. There are also difficulties when rotating the hand. As a rule, pain begins in the upper part of the shoulder and ends in the large brachialis muscle on the back. Most often, the inflammatory process is localized in the rotator cuff, wrist extensor muscles and biceps tendons.

Stage II: the same as stage I, plus injections of local anesthetics and glucocorticoids, for example 3 ml of 1% lidocaine, 3 ml of 0.5% bupivacaine or 20 mg of triamcinolone (as a long-acting drug); A short-acting local anesthetic is used for diagnosis, a long-acting anesthetic and a glucocorticoid provide a therapeutic effect.

Treatment

Physiotherapy procedures are very effective in treatment.Exercise #4.

Arthroscopy;
In case of post-traumatic tendonitis, it is important to pay special attention to treatment and prevention and in no case should you load the limb until it occurs. full recovery tendons.

The mechanism of occurrence has not been precisely established. It develops in three stages. At the initial stage, changes occurring in the tendons contribute to the formation of calcifications; calcium crystals are deposited in the tendons; during this period, the calcifications are reabsorbed by the body. It is at this moment that pain is most likely to occur. In the next period, the tendon is restored, then the mechanism of absorption of calcifications (which is not yet fully understood) is launched, and the tissue regenerates. The pain subsequently disappears completely.

NSAIDs are also indicated orally for up to 5 days and topically. Local therapy with NSAIDs is carried out for 2 weeks. during the acute period. If the course is prolonged, ointments that improve blood flow (with capsaicin, etc.) are effective.
Tendinitis is often accompanied by calcification of the tendons. At the site of micro-tears, rough adhesions are formed, which reduce the range of both active and passive movements of the shoulder. Calcific tendonitis (tendinosis) is characterized by the prevalence of symptoms of tendon degeneration and ossification. When listening to the joint with a phonendoscope, and often at a distance, crepitus (creaking, crunching) is heard. The development of degeneration leads to thinning of the tendons, limb weakness, and possible rupture of the joint capsule.
allergy to drug therapy;

With lesions of the cuff muscles, patients complain of pain arising in the upper outer part of the shoulder, radiating to the elbow. Pain syndrome appears after unusual physical activity (working with arms raised high). In case of damage to the teres minor muscle, a positive test of resistance to active external rotation of the shoulder is noted during a diagnostic examination. If the subscapularis muscle is affected, an active internal rotation resistance test is positive. Such tests are performed when supraspinatus tendonitis is suspected.

Stage III: the same as in stages I and II, plus resection of the anterior part of the acromion.

There are a sufficient number of methods.

Prevention

Rest your arms in front of you and interlace your fingers. Raise the folded limbs upward. The maximum load is on the healthy hand - it drags the sick one.

CT arthrography (x-ray examination with the introduction of a contrast agent into the joint).

This type of disease appears due to repeated damage to tendons and muscles.

A biceps tendon rupture can be attributed to either a shoulder injury or an elbow injury. The biceps is a muscle located in the front of the shoulder - between the shoulder and elbow joints. This is a strong muscle in the upper arm that helps us lift objects and bend the elbow. Tendons attach the biceps to the bones on both the shoulder and elbow sides. If these tendons are torn as a result of a fall, sports injury or wear, strength in the upper arm is lost and movement becomes painful.

A biceps tendon injury can be divided into two parts:

– partial damage, in which there is no complete separation of the tendon
– a complete injury in which the tendon is completely torn off

Injuries can occur in the shoulder (proximal injuries) or in the elbow (distal injuries). Most injuries are the result of continuous, prolonged strain and wear and tear on the biceps muscles and tendons. This usually occurs during strength sports involving heavy lifting and begins with the separation of tendon fibers. If the impact on the tendon continues, it will definitely undergo rupture.

A biceps tendon rupture can occur in two directions:

At the shoulder joint: A proximal biceps tendon avulsion is a shoulder injury because the tendon attaches to the shoulder joint. The tendon is particularly susceptible to injury at this location as it makes a sharp turn to attach to the shoulder joint and stretches in and out of the shoulder up to 5 cm as the shoulder moves. This is where the biceps tendon usually ruptures, and is especially common in people over 60 years of age. This injury is often associated with a rotator cuff injury. In some cases, symptoms are minimal and go away on their own; in other cases, severe deformation (of the Popeye muscle) and muscle contraction occurs. In some cases, surgery can help treat symptoms of muscle shortening, weakness, and deformity.

In the elbow joint: Injury to the distal tendon associated with the elbow joint is common in middle-aged men and can be caused by heavy lifting or sports. When such an injury occurs, a loud cracking sound is usually heard. Surgery is usually required to restore full function and relieve symptoms.

Symptoms of biceps tendon injury

Symptoms characteristic of the injury include sharp, sharp pain in the forearm area - sometimes with a characteristic cracking or clicking sound.
Spasm, bruising, pain in the shoulder, biceps and elbow are also typical. In addition, it will likely be difficult to turn your palm up or down.

How is a biceps tendon rupture treated?

It should be noted that the biceps have two attachment points in the shoulder: the long head and the short head. The long head is the tendon in the shoulder that is most commonly injured. Injuries to the short head of the biceps are quite rare, unlike injuries to the long head. Thanks to the dual attachment to the shoulder, many people can continue to move the arm and use the biceps even when the long head is severely damaged or completely torn. For many people, medication treatment is sufficient to relieve symptoms.

A biceps tendon rupture most often occurs where the long head attaches to the shoulder.

Conservative

Non-drug treatment for a biceps tendon tear involves resting the injured arm and avoiding any heavy lifting activities that may aggravate the symptoms of the injury. Applying ice helps relieve swelling and general pain. You can also take anti-inflammatory drugs and non-steroidal medications to relieve pain. Physical therapy done at home may also help.

Surgical

Thanks to this, patients can choose between several treatment options, in which the incisions will be minimal in both number and size. The goal of the surgery is to reattach the tendon back to the bone. At the shoulder, the long head of the biceps is usually reattached using a small approach, the long head of the biceps is fixed to the top of the humerus using a small anchor and suture. After such an operation, the arm regains all the lost functions and strength, the scar becomes invisible, and the muscles return to their normal state.
When the muscle tendon is damaged in the elbow area, repair is done by making a small incision (3-4 cm) and reattaching the tendon back to the forearm using surgical sutures and a small fixation device. Full recovery usually occurs within 3-4 months.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Tendinitis– inflammation of the tendon. Most often, the disease begins with inflammation of the tendon sheath (tenosynovitis, tenosynovitis) or tendon bursa (tenobursitis). If the inflammatory process spreads to the muscles adjacent to the tendon, then such diseases are called myotendinitis. Most often tendon inflammation affects the knee, heel tendon, hip, shoulder, elbow and base thumb hands.

When conducting laboratory research no changes are observed, except in cases where the disease is associated with infection or a rheumatoid process.

As a result of constant stress, including frequent impact on the surface of the lower extremities (when running), tendinitis can develop in the upper thigh. It affects the rectus femoris tendon (basis and quadriceps tendonitis), the iliopsoas tendon (hip flexor tendonitis), and the adductor longus tendon (groin tendonitis). The main manifestations of tendinitis hip joint are:

changes in gait and lameness;
slow increase in symptoms;
pain decreases after initial activity and returns with greater force during subsequent activities;
cracking in the upper thigh.

Treatment includes both conservative methods (rest, anti-inflammatory drugs, cortisone injections, etc.) and surgical methods (removal of inflamed tissue from the tendon through surgery).

Gluteal tendonitis

Tendinitis gluteal muscles– dystrophic phenomena in the tendons of the gluteal muscles. The disease manifests itself in the form of muscle weakness, their atrophy, increasing motor impairment, difficulties in moving from horizontal position. The progression of the disease can lead to a rupture at the junction of the muscle and the tendon, with a sharp click and pain, and limited mobility. Treatment in most cases is conservative.

Tibialis posterior tendinitis

Posterior tendinitis tibialis muscle(post-tibial tendinitis) is an inflammation of the tibialis posterior tendon located along the inside shins and ankles. This type of foot tendonitis develops as a result of prolonged overstrain of the lower leg muscles, chronic microtrauma or tendon strain. It is most often observed in female athletes after 30 years of age. Besides common methods, treatment of tendonitis of the posterior tibial muscle is based on wearing special orthopedic shoes with foot support and a reinforced heel, and the use of arch supports with high shock-absorbing characteristics. In some cases, surgical treatment aimed at suturing ruptures or reconstructing the tendon is indicated.

Shockwave therapy for calcific tendinitis of the shoulder - video

Before use, you should consult a specialist.

5–7% of the population suffers from pain in the shoulder area, and the prevalence of such complaints triples after reaching 60 years of age. The reason for this is various diseases osteoarticular and muscular-ligamentous systems, but tendonitis is of greatest importance.

Muscle tendons, despite their strength, are a rather vulnerable structure of the shoulder. With prolonged exposure to unfavorable factors, pathological processes develop in connective tissue, which disrupts the function of the entire joint. Therefore, shoulder tendonitis requires a quick and adequate response not only from the patient, but also from the doctor.

Causes and mechanism of development

The shoulder joint performs a vital function in Everyday life person. It provides a wide range of movements, without which it is difficult to imagine professional, sports and everyday activities. Because of this, a significant part of the load falls on the shoulder.

Long-term exposure to a mechanical factor causes microtraumatization of the tendons running in fairly narrow channels and the development of an inflammatory process, which is the basis of tendinitis.

Athletes are primarily susceptible to this influence: javelin (discus, shot) throwers, tennis players, weightlifters. A similar condition is often observed among representatives of blue-collar professions (builders, painters).

But the disease may also have a completely different development mechanism, in which inflammation is of secondary importance. Degenerative-dystrophic processes that begin to develop after the age of 40 often come to the fore. This is facilitated by metabolic-endocrine, vascular disorders, as well as age-related changes in organism. Therefore, in addition to injuries, the following conditions should be considered as possible factors for the development of tendonitis:

Gout.
Diabetes.
Reactive arthritis.
Osteoarthritis.
Infectious diseases.

In most cases, there is a combination of several factors. But no matter which of them causes tendon damage, the further development of the disease is subject to the same mechanisms.

Tendinitis should be considered as a multifactorial disease, the development of which is associated with increased loads on the shoulder.

Symptoms

To make a correct diagnosis, the doctor conducts a clinical examination of the patient. First, he finds out the complaints, the circumstances of the pathology, and then examines the place of possible damage. This will help identify the characteristic features of the disease.

The function of the shoulder joint is provided by various muscles, the tendons of which can become inflamed. Certain symptoms will depend on their involvement in the pathological process. But you should still note the general signs of tendonitis:

Pain in the shoulder area.
Clicking or crunching in the joint.
Limitation of some movements.

Pain first occurs during exercise, and then bothers you even at rest and at night. They can be sharp or dull, monotonous. Upon examination, you can see some signs of inflammation: swelling, redness. However, this will not always be the case. Sometimes it is possible to determine pain at the site of the damaged tendon. Special tests are of great importance, during which the doctor prevents the patient from performing active movements. The appearance of pain at this moment will indicate damage to one or another muscle.

Chronic tendonitis can lead to tendon ruptures. They appear not only under significant load, but even when performing simple movements.

Rotator cuff injury

The first area to consider is rotator cuff tendonitis. It is formed by the supraspinatus, teres minor, infraspinatus and subscapularis muscles, playing an important role in stabilizing the joint during various upward movements of the arm. In this case, pain in the outer upper part of the shoulder joint is characteristic, which can spread to the elbow. They often occur due to unusual loads, especially when working for long periods with raised arms.

Isolated damage to specific structures of the rotator cuff may occur. The most common injury to the supraspinatus muscle is due to its special vulnerability. The disease is initiated by compression of the tendon between the head of the humerus and the acromial arch. As a result, pain appears in the middle of the upper part of the joint. The shoulder abduction resistance test is positive, confirming damage to the supraspinatus muscle.

If the pathology affects the infraspinatus and small teres muscle, then you should perform a test with resistance to external rotation of the shoulder. A patient with tendonitis may find it difficult to comb their hair or make similar movements. When the subscapularis tendon becomes inflamed, the test with resistance to internal rotation of the shoulder becomes positive.

Biceps injury

The biceps tendon is also damaged. Tendinitis of the long head of the biceps is characterized by the appearance of pain along the anterior superior surface of the shoulder joint. As a rule, they occur after lifting weights. A test with resistance to outward rotation of the hand (supination) helps to identify the disease. In addition, there is palpation pain at the site of the tendon - the intertubercular groove, located along the anterior surface of the humerus at its upper edge.

Tendinitis of the biceps and rotator cuff requires differential diagnosis with other pathologies that cause pain in the shoulder joint: arthritis, arthrosis, injuries.

Diagnostics

To confirm damage to the muscle tendons in the shoulder area, it is necessary to use additional funds. As a rule, they include instrumental visualization methods that allow you to see a clear picture of the changes taking place. These include the following:

Magnetic resonance imaging.
Ultrasound of the joint.
Radiography.

To identify disturbances in the body's metabolic processes, a biochemical blood test should be performed. In addition, consultation with a traumatologist is required.

Treatment

A comprehensive approach to the pathology helps to effectively treat shoulder tendinitis. In this process, not only medical manipulations are important, but also a deep understanding by the patient of the essence of the disease. As a rule, a variety of treatment methods are used:

Drug therapy.
Physiotherapy.
Therapeutic gymnastics.
Massage.
Operation.

The choice of one method or another is based on the characteristics of the disease and the properties of the body. Therefore, the therapeutic program is developed individually for each patient. Wherein Special attention is given to unloading the affected shoulder and creating peace. Factors that provoke pain should be eliminated as much as possible, including wearing a scarf. However, long-term immobilization of the joint is not recommended.

Treatment of tendinitis is based not only on the effects of certain drugs, but also requires the active participation of the patient.

Drug therapy

Without the use of medications, it is difficult to imagine the treatment of any pathology, including tendinitis. The drugs are used to reduce inflammation, relieve pain and swelling, eliminate muscle tension and improve the function of the shoulder joint. Considering the great importance of degenerative processes in the development of the disease, one should also include those medications that will improve metabolic processes in the tendon itself, promoting its healing. Thus, it is recommended to use the following medications:

Anti-inflammatory (Artrosan, Dicloberl).
Muscle relaxants (Mydocalm).
Chondroprotectors (Arthra, Dona).
Vascular (Solcoseryl).
Vitamins and microelements.
Hormones (Diprospan, Kenalog).
Local anesthetics (Novocaine).

The last two groups of drugs are used exclusively for topical use. They are injected into the area of the affected tendon to eliminate pain. Various anti-inflammatory ointments (Dolobene, Diklak) are used as local therapy.

Medicines must be used as prescribed by the doctor. Self-administration of medications is strictly prohibited due to the possibility of developing unexpected reactions.

Physiotherapy

For shoulder tendinitis, physical methods of influence are actively used. They provide additional positive effect in combination with medicines. To make the acute symptoms of the disease go away more quickly, you can use the following procedures:

Electro- and phonophoresis of novocaine, lidase.
UHF therapy.
Ultraviolet irradiation.
Laser treatment.
Wave therapy.
Mud and paraffin therapy.
Magnetotherapy.

The course of treatment may consist of several procedures, but it must be completed in full. This will make it possible to obtain a lasting therapeutic effect.

Physiotherapy

In case of damage to the tendons of the shoulder, it is mandatory physiotherapy. Without it, it is difficult to ensure restoration of joint function to the same extent, since it is movements that should contribute to the functioning of the muscular-ligamentous system. The following exercises may be prescribed:

Throwing a towel over the bar, grab its ends and pull down with your healthy hand, while lifting the patient.
Holding it in front of you gymnastic stick, describe a circle with it.
Place the palm of the affected hand on the opposite shoulder and lift your elbow up, helping with your healthy hand.
Squeezing your hands into a lock, raise your arms in front of you.
Swing the sore arm back and forth and to the sides like a pendulum.

It must be remembered that gymnastics can be performed only during the period of remission, when there are no acute signs of the disease. In addition, you should not overload the joint with intense exercise - you need to develop your shoulder gradually so as not to cause pain and worsening of the condition.

Efficiency therapeutic exercises largely depends on the patient’s persistence and his desire to get a good result.

Massage

Don't forget about shoulder massage. It is also performed after the pain has been eliminated. Thanks to massage techniques, muscles relax, the delivery of nutrients to the affected area improves, which helps to activate recovery processes. As a rule, it is recommended to undergo 10–15 sessions.

Operation

If conservative therapy does not show the desired effect or a tendon rupture occurs, then tendinitis must be treated surgical methods. They mainly perform arthroscopic operations, which are considered minimally invasive and minimally traumatic. With their help, excision of altered tissues, plastic surgery and fixation of the tendon are carried out. After this, rehabilitation treatment is required, which consists of the above-mentioned conservative techniques.

If tendonitis in the shoulder area is suspected, it is necessary to first determine which muscle is affected. Based on the results of the diagnostic examination, the doctor determines further treatment, in which the patient himself must take an active part.

Tenosynovitis of the joint (ankle, knee): symptoms and treatment

Tenosynovitis is an inflammation of the joint synovium surrounding the tendon. The disease can occur in both acute and chronic forms.

Tenosynovitis develops under the influence of such factors:

Injuries. If a joint has been damaged and a person has some kind of infection in the body, the risk that he will develop tenosynovitis is very high. Treatment will be more difficult and lengthy if the bursa vaginalis of the joint has been torn, completely or partially.
Malfunction of the immune system.
Arthritis of rheumatoid nature.
Dystrophic-degenerative changes in the joint. In an advanced form, changes also spread to nearby tendons.
Infection with certain bacteria and viruses.
Age-related changes when joint tissues wear out and receive insufficient nutrition.
Constant loads. Tenosynovitis of the knee or ankle joint can develop even in those people who are inactive, but at the same time, due to professional activity or habit, constantly load the same joint.

Symptoms of tenosynovitis occur in people of any age, but older people are more likely to suffer from this disease.

Classification of tenosynovitis

The following types of this pathology are distinguished:

Stenosing tenosynovitis. This form of the disease is often called tenodovaginitis of the elbow, ankle, knee or hip joint. The most common inflammation of those tendons that are responsible for abducting the big toe to the side is observed. In parallel, the extensor digitorum brevis may be affected. As a result, the mobility of the thumb is severely limited. If acute treatment is not carried out, the disease becomes chronic. Scars form on the tendons and ligaments, and over time the joint becomes completely blocked. This type of tenosynovitis mainly affects women;
Tuberculous tenosynovitis. This form of pathology develops if the tuberculosis bacillus is introduced into the patient’s body. The vaginal cavities of the tendons of the hands are affected. The limb swells greatly, but there is no pain;
Chronic tenosynovitis of an inflammatory nature. The clinical picture of this form of the disease is very similar to the course of tuberculous tenosynovitis. Rheumatoid arthritis often develops against the background of this disease. An accurate diagnosis can only be made based on the results of studies of effusion from the joint cavity - they will show which bacteria caused the inflammation.

In addition, the disease is classified by location. There are tenosynovitis of the ankle, knee, elbow, hip, wrist joint and head of the biceps.

Symptoms of the disease

The pathology develops slowly, at the initial stage the symptoms are very mild. Therefore, with the first complaints, the patient consults a doctor already in case of serious damage to the tendon, when long-term, complex treatment is required.

During a detailed interview, the patient recalls exactly when he first felt discomfort in the area of the elbow, ankle or knee joint - if treatment had been started during this period, it would have been shorter and the prognosis would have been favorable. In an advanced stage, the joint becomes blocked and it is impossible to restore its full functionality.

The disease can be recognized by the following signs:

Enlargement and swelling of the joints when palpated.
Limitation of mobility.
Severe redness of the skin in the area of the affected tendon.
Pain that occurs when stress is placed on the muscles located next to the inflamed tendon.

Symptoms may vary depending on the location of the inflammation.

Ankle joint damage

In terms of external signs, in case of ankle joint disease, the tendon is no different from a healthy one. But the tissues around it are filled with fluid.

Lesions in this area lower limb develop against the background of rheumatoid arthritis or after mechanical damage to the limb. Very rarely, the cause of ankle tenosynovitis is flat feet.

Pain in this case can occur in any part of the foot, or can cover its entirety. The discomfort intensifies after standing for a long time or long walks.

Sometimes pain occurs when stretching the leg or lifting it up with muscle tension - this indicates that the inflammatory process also affects the spine.

Knee joint damage

The main symptom of knee tenosynovitis is an increase in kneecap. Swelling and edema of the knee joint are explained by the accumulation of fluid in the synovial bursa, the amount of which increases sharply with loads and movements of the knee joint.

This fluid is the cause of inflammation. The patient usually does not complain of sharp pain - severe pain is a concern only during exacerbation of knee tenosynovitis.

Damage to the long head of the biceps

Swimmers and tennis players suffer from this form of the disease, that is, athletes involved in those sports in which repeated movements of the arm are made above the head.

The cause of inflammation is constant tension of the biceps muscle, its focus is in the antebrachial upper limb. If treatment is not carried out in a timely manner, the inflammation spreads to the elbow joint.

De Quervain's disease

The causes of inflammation in this case are heavy loads on the tendon of the thumb and wrist. De Quervain's syndrome usually develops in people who perform monotonous movements for many years - typesetters, musicians, cutters, seamstresses. It is often diagnosed in hardworking housewives and summer residents.

If the cause is an injury while doing housework, the disease develops very quickly and the patient does not postpone visiting the doctor. The problem is that the wrong treatment is often prescribed, aimed at eliminating the symptoms of the bruise, while the tendon is affected and tenosynovitis develops.

In the chronic course of de Quervain's disease, examination and diagnosis are carried out, as a rule, in the later stages, when the joint is almost completely blocked. Therefore, treatment is also not always successful.

The pain is localized in the thumb, wrist and along the edge of the wrist joint. Sometimes the pain syndrome covers the elbow joint or the entire limb.

Diagnosis and proper treatment are also complicated by the fact that the pain can be of different types: for some it is aching, for others it is sharp, arising during movements and stress.

How is the treatment carried out?

Treatment for inflammation of the tendon of the knee, ankle or hip joint is selected depending on its shape and location. For example, puncture (the most radical method of treatment for this disease) is most often required for lesions of the knee joint.

When medications and physical therapy fail, fluid from the joint cavity is pumped out, then medication is injected into the cavity. Sometimes this is an antiseptic solution; in severe cases, hormonal drugs are administered. Such methods make it possible to stop the inflammatory process and begin measures to restore joint function.

But if the patient drew attention in time to suspicious pain and swelling in the area of the wrist, shoulder or knee joints, treatment may be limited to a course of certain medications and physiotherapeutic procedures.

Medicines should act in three directions: relieve swelling, eliminate pain and inflammation. Usually, drugs of local and systemic action are selected.
Physiotherapeutic procedures are aimed at activating metabolic processes in the affected joint, while the effect of medications is enhanced. Electrophoresis, magnetic and laser therapy, ultraviolet irradiation, and ultrasound are used. In some cases, a course of therapeutic massage is prescribed.

It is important to choose the right different techniques and, if necessary, adjust the therapy program in order to achieve success. Ignoring the doctor’s recommendations and self-medication can lead to the saddest complication of tenosynovitis - complete blockade of the affected joint.