Rheumatic diseases of the periarticular soft tissues

Rheumatic diseases of the periarticular soft tissues are tendonitis (tendinitis, tendovaginitis), ligaments (digitisment), places of attachment of these structures to bones (enthesopathy), synovial bags (bursitis), aponeurosis and fasciae (aponeurosis and fasciitis) of an inflammatory or degenerative nature, not caused Direct injury, injury, infection or tumor. Are one of the most common causes of pain in the joints and the difficulties of movement in them.

Below are the most common diseases of this group.

Plechelohepatic periarthritis. A characteristic clinical picture - pain and limitation of movements in the shoulder joint - can be observed with damage to a variety of periarticular structures. More often than not, there is an isolated or combined lesion of the tendons of the supraclavicular and biceps muscles, as well as the subacromial bag. The ability to identify the exact cause of the lesion predetermines the success of the treatment.

The defeat of the tendon of the supraspinatus can proceed as a simple tendonitis, calcifying tendonitis and tearing (tearing) of the tendon. A simple tendonitis of the supraspinatus is the most common form of the humeropathy periarthritis. Diagnosis is based on the detection of soreness with the tension of the supraspinous muscle, which is created when trying to remove the ball from the hand against the resistance of the doctor. Characteristic of the Douborn symptom: active hand diversion to 60 g. Painless, then in a limited area (70 70 90gr.), There is a sharp pain (because of the compression of the tendon between the coronoid process of the scapula and the head of the humerus), and with further retraction of the hand, the pain passes. When acclimatizing tendonitis of the supraspinatus, which is revealed in the radiography of the shoulder joint, the pain is usually stronger, it is noted and at rest, and the limitations of the movements in the shoulder joint are more significant. A detailed study reveals, however, signs of an isolated lesion of the tendon of the supraspinatus. This pathology develops primarily in young and middle-aged people. With the breakdown (or rupture) of the tendon of the supraspinatus, which occurs more often in the elderly after lifting the weight or failing to fall with the support of the hand, in addition to pain and restriction of movements, it is typical to not be able to hold the withdrawn hand (a symptom of the falling arm). In the presence of such a clinical picture, arthrography of the shoulder joint is mandatory, since in the case of a complete rupture, surgical treatment should be performed.

Tendonitis of the biceps arm muscle is characterized by persistent pain in the anterolateral area of ​​the shoulder joint, a significant pain in palpation of the biceps tendons and pain arising from the tension of this muscle (ie, when the supine forearm is bent against resistance).

Bursitis of a subacromia bag is often not an independent disease, but a consequence of the spread of changes from the tendon of the supraspinous and biceps muscles adjacent to it. It is the combined damage of these structures that explains the presence of severe pain, which significantly limits almost all movements (a picture of the so-called blocked or "frozen" shoulder). Radiographically, in a number of cases, calcification is observed in the region of the subacromial sac.

Periarthritis of the elbow joint. The most frequent periarticular diseases in the ulnar region are enthesopathy in the region of the epicondyle of the humerus and inflammation of the bag (bursitis) of the elbow joint.

Enthesopathies of tendons attached to the epicondyle of the humerus constitute the pathological basis of the clinical syndrome known as the elbow of a tennis player. Pain is noted more often in the area of ​​the external epicondyle, where the extensors of the fingers and the forearm of the forearm are attached, is strengthened at any strains of these muscles. Pain in the area of ​​the medial epicondyle of the humerus is usually due to the enthesopathy of the tendons of the muscles, the flexor of the fingers and the hand. The diagnosis of bursitis of the elbow joint usually does not cause difficulties. It is established in the presence of a characteristic ballot on the palpation protrusion above the elbow process.

In the region of the wrist joint, tendovaginitis is most often noted. Tendovaginitis de Kervena is characterized by the defeat of the long deflecting and short extensor muscle of the thumb in the place of their passage through the bone-fibrous canal at the level of the styloid process of the radius bone. It is manifested by pain in the movements of the thumb, a slight swelling in the area of ​​the "anatomical snuffbox".

Periarthritis of the hip joint is one of the frequent causes of pain in the area of ​​this joint. The pain syndrome has in some cases characteristic features - pain in rest is absent (it occurs only when lying on a diseased side or in a sitting position - the leg on the leg), occurs at the first steps, but then gradually decreases and goes away when walking. When palpation is determined by local soreness in the area of ​​a large trochanter. In radiography, you can sometimes find the fringe of the contours of a large trochanter, the linear shadows of the calcifications of the tendons of the muscles attached to it or the synovial bags located here.

The periarthritis of the knee joint is most often affected by the tendon, which is the so-called goose-foot (attachment of a semi-tendon, slender, tailor, and semimembranous muscle in the medial condyle of the tibia). The pain in this area is characteristic both with active and passive movements (flexion, sharp extension or turn of the tibia), tenderness in palpation.

Treatment of rheumatic diseases of the periarticular soft tissue in the first 2 weeks is carried out with non-steroidal anti-inflammatory drugs (naproxen, indimethacin, orthophene, butadione), pseudo-cortisone phonophoresis on painful areas, resting limb. In the absence of a sufficient effect, local administration of corticosteroids at the site of the most painful tenderness of soft tissues is indicated. In cases of poor periarticular diseases, which are difficult to treat, or frequently recur, a local X-ray therapy is indicated.