Tenosynovitis of the long head of the biceps tendon: causes, symptoms, diagnosis, treatment and recommendations

Causes

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The active development of the disease is facilitated by infection of adjacent tissues or the penetration of pathogenic microflora into the tendon structure. In 80% of cases this occurs due to a puncture or other violation of the integrity of the tendons. Main routes of damage:

1. Existing infections, especially STIs (in 90% of cases of identified infectious tenosynovitis, the patient suffered from gonorrhea).
2. Physical trauma, after which the acquired acute infection is divided into monomicrobial and polymicrobial. Each of them progresses depending on the nature and extent of the damage.
3. Physiological aging process (common cause of patellar tenosynovitis).
4. Staphylococcus aureus migrating from the epidermis, with which the patient was previously infected.
5. Animal bite and subsequent suppuration of the bite wound.
6. Intravenous use of hard drugs (tenosynovitis of the long head of the biceps tendon is likely to occur).
7. Open damage to the skin, the surface of which was exposed to fresh or salt water with the presence of mycobacteria.

Any of the above methods leads to tenosynovitis. This includes situations where the patient has not completed the full course of treatment for rheumatoid or reactive arthritis.

Rehabilitation

Rehabilitation is required only after surgery for tenosynovitis of the shoulder joint. In most cases, the patient does not need rehabilitation measures.

Prevention and prognosis

Persistent monotonous movements and/or poor posture are often the cause of tenosynovitis. They are also central starting points for disease prevention. People who do a lot of computer work should make sure the keyboard is as flat as possible.

This relieves pressure from the wrist. It is also recommended to place a pillow in front of the keyboard. It is recommended to purchase an ergonomic mouse.

People who work on computers, musicians, massage therapists and others should pay attention to the variety of movements and take breaks more often.

Advice! It is not recommended to self-medicate with folk remedies, exercises or other alternative therapeutic measures.

If you have muscle or joint diseases (right or left shoulder, ankle, patella and others), you should consult a doctor. Sometimes surgery is required. If there is severe pain in the ligaments or joints (right or left), fever, swelling, you need to urgently call an ambulance, as this may indicate an infection.

Clinical example

Hello, my right shoulder hurts when I make sudden movements; when I stretch, the pain reaches my elbow. The pain is either pulsating or stretching. We had an ultrasound of the right shoulder joint. I am attaching the results. We have already seen a neurologist and prescribed a blockade and manual therapy. All this didn't help

Symptoms

An examination is enough for a doctor to make a preliminary diagnosis. And using diagnostic methods, the doctor confirms it, determining the nuances of the pathology.

Tenosynovitis of the tendon of the long head of the biceps brachii muscle is a stenotic disease that manifests itself as a specific pulling pain. In 9 out of 10 cases, the patient complains that an unpleasant sensation covers the shoulder and spreads along the front surface of the arm (along the biceps muscle). Palpation of the affected area gives a painful sensation: its localization is the groove between the tubercles of the humerus and in the direction below, where the tendon is even better accessible to palpation. Due to the pain, the patient has difficulty abducting his arm.

Tenosynovitis of the popliteus tendon is manifested by the following distinctive features:

Symptoms may be supplemented depending on the period of limitation of the lesion.

Diagnostics

Diagnosis of tendon tenosynovitis is difficult only because of the premature prescription of antibacterial therapy, which 60% of doctors carry out even before the final diagnosis is made. Laboratory research regarding the pathology in question is of secondary importance.

Methods for identifying tendon pathology are as follows:

1. Laboratory research. In the blood, an increase in the content of leukocytes and an increase in ESR are established as indicators of an active inflammatory process.
2. X-ray examination. The main goal of the method is to confirm the presence of tenosynovitis and exclude the concomitant development of osteomyelitis, bursitis, and arthritis.
3. Ultrasound research. The method is informative and has advantages over MRI: low price, technical simplicity. Ultrasound does not involve the use of magnetic field energy. The procedure is safer for health and does not affect devices implanted inside the body (heart rate drivers). Ultrasound helps to study in detail the structures of tendons and ligaments, making it possible to differentiate tenosynovitis, including through the use of color Doppler mapping (CDC).
4. MRI. The method provides an image of the entire joint, including the capsule with the glenohumeral ligaments, the articular cartilage on the head of the humerus. The muscles and tendons surrounding the joint and the synovial bursae are also visualized.

MRI and ultrasound of the shoulder or knee joint are not interchangeable diagnostic methods. The implementation of each of them involves specific goals and objectives.

What are the causes of tenosynovitis of the tendon synovium?

What are the main causes and factors for the development of tenosynovitis of the tendon synovium?

• Tendon wounds and injuries. If it occurs without infection entering the injury, then the wound heals faster and the disease passes easily. If an infection gets inside, then it delays the healing process, requiring medication. For a while, a person loses the ability to fully move the affected limb as before. But if you recover, functionality will return.
• Rheumatic diseases.
• Low immunity, which could not overcome the infection that penetrated the synovial membrane.
• Joint degeneration. A condition such as bursitis often affects tendons.
• Genetic predisposition.
• Other infectious diseases, such as tuberculosis, HIV, syphilis, herpes, etc. Here, the infection spreads throughout the body through the blood.
• Old age, which is marked by the fact that the nutrition of the joints becomes worse with age.
• Load and overfatigue of the tendon. Typically, in professional activities, a person must perform the same actions, that is, load a specific muscle group, while the rest are little involved. The lack of variety in movements gives a greater load, which develops tenosynovitis. This applies not only to people who actively lead their lives, but also to those who have a sedentary job.

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Treatment

Delay in going to the hospital does not promise a positive prognosis - the disease progresses to an even more aggravated stage. Then the patient loses the opportunity to even self-care, and there is no need to talk about the implementation of work activity. One of the options for wasting time is the desire to normalize health using unofficial methods. Traditional medicine does not contain a single recipe that can restore the tendon-ligament apparatus. And patients taking decoctions and applying compresses to the body waste time, increasing the risk of developing disability.

Conservative

If the diagnostic results confirm that the existing disorder is tenosynovitis of the long head of the biceps tendon, treatment with conservative methods involves the following:

To implement hormonal treatment, drugs from the glucocorticoid group are used - Dexamethasone and Prednisolone.

Injection of hormonal drugs, especially in chronic processes, does not provide a complete cure, increases the rate of collagen degradation, and negatively affects the production of new collagen (reduces its synthesis by 3 times).

The doctor expands general prescriptions with the active use of immunomodulatory agents and vitamin therapy.

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During conservative therapy, it is important not to load the affected joint; for this purpose, immobilization is performed with an orthosis. Local application of ointments is recommended: Nise, Dolobene, Ketonal.

Physiotherapy

Physiotherapeutic methods help normalize blood circulation, relieve or minimize pain, and improve metabolic processes in the affected area. Procedures that are advisable to prescribe if tenosynovitis of the biceps brachii tendon, popliteal fossa or other part is confirmed include magnetic therapy; laser therapy; applying thermal applications. The use of electrophoresis with novocaine will improve limb abduction and reduce pain.

Recently, radon baths have been actively used.

After the documented recognition of the safety of radon in the treatment of joint pathologies, interest in this gas is growing. The element’s demand is explained by its unique therapeutic capabilities.

Radon is an inert gas that is colorless and odorless. It is 7.5 times heavier than air, has 3 isotopes, the most important of which is 222 Yal with a half-life of 3.82 days.

Before performing radon baths, the doctor makes sure that the patient has no contraindications to the medical technology:

Among them:

1. Fever of unknown origin.
2. Oncological processes (confirmed) – the presence of malignant neoplasms, benign tumors that have a tendency to grow.
3. All blood diseases.
4. Heart rhythm disturbances (atrial fibrillation, extrasystole).
5. Psycho-emotional disorders (epilepsy, neuroses, schizophrenia).
6. Previous large-focal or multiple small-focal cerebral infarction.
7. Professional activities associated with prolonged exposure to radioactive or electromagnetic radiation.
8. The period of pregnancy and breastfeeding.
9. Violation of the functional activity of the thyroid gland, high predisposition to its hyperfunction.
10. Condition on the eve of surgery.
11. Severe gynecological conditions - fibrocystic mastopathy, uterine fibroids, fibroids, adenomyosis, endometriosis.
12. In men - prostate adenoma.
13. Cholelithiasis.
14. The presence of stones in any segment of the urinary system.
15. Confirmed retinal detachment.
16. The presence of defects on the skin, areas of weeping dermatitis, pathologies of fungal origin.
17. Confirmed osteoporosis.

To determine the radon concentration for the procedure, the doctor is guided by the dominant pain manifestations. Dry air baths and traditional water baths are performed. The effect of the procedure is improved blood supply to the tissues adjacent to the joint; high probability of long-term pain relief (in 90% of cases).

Anton Epifanov about physiotherapy:

Surgery

Surgical intervention is performed in extreme cases when it is not possible to restore the limb using conservative methods. Surgical treatment is aggravated by the patient's age over 45 years, the presence of insulin-dependent diabetes mellitus, and if the etiology of tenosynovitis is the progression of a polymicrobial infection.

Tendon plastic surgery is a multi-stage, delicate operation. It involves subsequent long-term recovery and has a high price.

The introduction of antibiotics a day before surgery and active intraoperative antibiotic therapy help eliminate the risk of complications in the postoperative period.

Features of anesthesia during surgery for tendon tenosynovitis:

• in the choice of anesthesia, the short duration of the intervention, the absence of the need for deep relaxation, and the presence of adequate hemostatic measures are important;
• modern medications provide adequate pain relief without threatening the patient’s life;
• A common complication after surgery is short-term post-anesthesia depression. It provides the possibility of early transfer of the patient from the ICU (intensive care ward) with patient activation;
• The depth of immersion in anesthesia is ensured by narcotic analgesics. In clinics with high financial support, they practice the most successful combination for anesthesia during short operations - Diprivan + narcotic analgesics (in 68% of cases). But the high cost of Diprivan limits its use in clinical practice. Hospitals with less funding use Ketamine for anesthesia. Its difference from Diprivan is specific: as patients recover from anesthesia, they need sedative therapy (carried out in standard dosages). It is important for the specialist to monitor the main vital signs - they must be stable throughout the entire surgical intervention.
• In 23.3% of cases, barbiturates were used for anesthesia, mainly sodium thiopental in standard dosages. If the depth of anesthesia was sufficient, “controllability” of anesthesia causes certain difficulties. Long-term post-anesthesia depression is possible, requiring constant monitoring of the patient.

The prognosis for recovery is favorable (subject to early seeking of medical help). However, the patient should prepare: full recovery will take 3-4 months.