Tendinitis

　　The etiology of this disease is mostly unknown, and most cases are due to poor blood supply to the tendons and repeated minor trauma, which often leads to significant damage. Repeated or severe trauma (partial rupture), overuse injury, overexertion (due to inappropriate exercise), and other common causes of the disease. Occupations that require long-term repetitive joint strain, such as typists, cargo handlers, or those requiring long-term computer operation, can trigger or worsen the disease. Common affected sites include the wrist, fingers, and shoulder.

　　Certain systemic diseases (commonly seen in rheumatoid arthritis, progressive systemic sclerosis, gout, Reiter's syndrome, and amyloidosis) and elevated blood cholesterol levels (Type II hyperlipidemia) can also affect the tenosynovium. In younger adults, particularly women, disseminated gonococcal infection can cause migratory tenosynovitis, with or without limited synovitis. Middle-aged and elderly women, who often engage in repetitive household chores, are prone to tenosynovitis. Women who often wear high heels may experience excessive pressure on the toes, leading to swelling and lump formation, severe pain, and other symptoms, known as flexor tenosynovitis of the toes.

　　The most common complication of tenosynovitis is the stenosis of the sheath, which is a chronic aseptic inflammation caused by the prolonged mechanical friction of the tendon within the sheath. The pathological changes mainly involve the appearance of inflammatory cells around the tenosynovium, and with the progression of the disease, the collagen fibers of the tendon may degenerate, leading to sheath stenosis. Common complications include pain, local swelling, and limited movement. Other complications include pain, local swelling, and limited movement.

　　The symptoms of tenosynovitis vary depending on the site of onset, and common clinical types include stenosing tenosynovitis of the radial styloid process at the wrist, flexor tenosynovitis of the finger, and flexor tenosynovitis of the toes at the sole of the foot.

　　Stenosing tenosynovitis of the radial styloid process is a condition that occurs at the bony prominence (radial styloid process) on the thumb side of the wrist, characterized by marked pain around the prominence and restriction of thumb movement, with local tenderness. During self-examination, by holding the thumb tightly between the other four fingers and performing a wrist flexion movement towards the wrist's ulnar side, severe pain will be felt at the radial styloid process.

　　De Quervain tenosynovitis commonly occurs on the palm side of the thumb and middle finger, and is particularly prominent upon waking in the morning. The affected finger exhibits flexion and extension dysfunction, with pain sometimes radiating to the wrist. There is tenderness at the joint flexion site, and a thickened tenosynovium, resembling a pea-sized nodule, can be palpated. When bending the affected finger, it suddenly stops at a semi-flexed position, the finger cannot be straightened, nor can it be屈曲, as if it were suddenly “locked”, and it can only be moved again with assistance from the other hand, producing a motion and sound similar to cocking a gun, hence it is also known as “trigger finger” or “clicking finger”.

　　Long-term standing and walking in high heels is a common cause of plantar flexor tenosynovitis in women. The body's center of gravity is shifted forward, and the entire body's weight is concentrated on the front part of the sole. Over time, friction between the synovium and the tendons, inflammation exudation, and other factors can induce stenosis or inflammation of the tenosynovium.

　　A. Pain

　　Most people cannot clearly point out the location of the pain, only say that the joint is 'awkward', there is a feeling of acid and胀in the joint during exercise, or it is not possible to exert force. Sometimes there is a feeling of strip-like pain.

　　B. Local swelling

　　The affected tendons will have cord-like swellings of varying degrees.

　　C. Dysfunction

　　Tenosynovitis occurring in the wrist of the upper limb can affect the power of the players, and sometimes the movement may deform when hitting the ball. Tenosynovitis occurring in the ankle of the foot can cause pain during movement and affect the action. The synovium is a sheath-like structure surrounding the tendons. The outer layer is fibrous tissue, attached to the bone and adjacent tissues, and plays a role in fixing and protecting the tendons. The inner layer is synovium that nourishes the tendons and secretes synovial fluid to facilitate the movement of the tendons. Due to repeated excessive friction, inflammation, edema, and thickening of the fibrous sheath wall form a narrow ring, causing the tendons to become fibrotic and thickened, making it difficult for the tendons to slide within the sheath, which is stenosing tenosynovitis.

　　Prevention of tenosynovitis:

　　1. When doing household chores such as washing clothes, cooking, knitting sweaters, cleaning, etc., pay attention to the correct posture of the fingers and wrists, do not over弯曲 or extend; do not carry heavy objects; do not use excessive force with the fingers and wrists.

　　2. When you feel the joints are tired, you can take a hot bath to relax the tense muscles, or apply heat to the sore areas.

　　3. In winter, it is best to use warm water to wash clothes, and after it snows, wear cotton gloves to prevent the hands from getting cold.

　　4. Rotate the wrist joint 360 degrees; or clench your fist with force and relax it several times; or press the fingers or palm back and forth a few times, which can effectively relieve the pain in the hands.

　　5. For people who work at a desk for a long time, it is recommended to adopt a correct working posture, try to keep the hands balanced, and let the wrists touch the objects, do not hang in the air.

　　The examination of tenosynovitis patients mainly includes the description of their symptoms and the physical examination by professional doctors. However, when it is necessary to differentiate tenosynovitis from other diseases such as ganglion, X-ray examination is required.

　　The diagnosis of this disease mainly relies on its clinical manifestations and physical examination, and tendinous palpation is often used:

　　Tendon palpation: Palpation of the flexor carpi ulnaris is mainly the flexor carpi radialis, palmaris longus, and flexor carpi ulnaris; the extensor carpi radialis longus and brevis, and the extensor carpi ulnaris are mainly the extensors of the wrist; palpation of the extensor digitorum, checking the tendons of the extensor tendons of the fingers in order, such as the extensor tendons of the index finger and the extensor tendons of the little finger. Then palpate the abductor pollicis longus, the extensor pollicis brevis, and the extensor pollicis longus. Pay attention to changes in muscle tension, whether there is tenderness, and whether there are any obstacles in movement.

　　While auxiliary examinations are used less frequently, X-ray examination can show calcification deposits in tendons and their sheaths. It also helps in the diagnosis of the disease.

　　Supplementing vitamins is beneficial for the healing of tendinitis, with 1000 milligrams of vitamin C, 10,000 international units of beta-carotene (vitamin A), 22.5 milligrams of zinc, 400 milligrams of vitamin E, and 50 micrograms of selenium daily. Vitamin B6 also helps to relieve wrist pain.

　　Eat more vegetables: Eat more vegetables, such as rapeseed, green vegetables, celery, etc., and eat more foods rich in protein and calcium, and lean meat, chicken, eggs, soy milk, etc.

　　Eat more fruit: You can eat some oranges, apples, green pears, hawthorns, etc., to supplement vitamins and balance nutrition.

　　Western Medicine Treatment for Tendinitis:

　　Conservative Treatment

　　For cases with short course and mild symptoms, conservative treatment can be implemented, including using splints to appropriately immobilize the thumb, changing the activities and habits that trigger the disease, reducing cold stimulation, local hot compresses, physical therapy, topical drug application, etc.

　　Closed Treatment: Intra-articular injection of corticosteroid drugs, with fast onset, long-lasting effect, and effective rate up to 50-80%. However, since there may be multiple partitions inside the first extensor interval, sometimes the effect of closed injection is not complete. For diabetic patients, the effect of closed therapy is poor. The method of closed injection is to let the patient abduct the thumb, identify the first extensor interval, disinfect it, and then insert the needle to reach the base of the first extensor interval, pull it back a little, and inject the drug, ensuring that the drug is injected into all the sheaths of the first extensor interval. Complications of closed therapy include subcutaneous tissue atrophy, fat necrosis, pigment loss, etc., and repeated corticosteroid injections should be avoided.

　　Surgical Treatment

　　Surgical treatment is suitable for patients with recurrent de Quervain's tenosynovitis, poor effects of closed treatment and conservative treatment, and severe symptoms. The operation can be performed under local anesthesia, with a transverse incision made 1 cm proximal to the styloid process of the radius along the skin皱纹, paying attention to protect the superficial branch of the radial nerve, exposing the first extensor interval, cutting open the first extensor interval, and paying attention to explore whether there is any partition in the interval room during the operation. If there is a partition, it should be completely excised, and the abductor pollicis longus tendon and the extensor pollicis brevis tendon should be completely released. Encourage patients to start moving their thumb early and perform functional exercises 1-2 days after the operation. Complications of the operation include radial nerve superficial branch injury and painful neuroma, discomfort around the incision.