Tendonitis of the long head of the biceps brachii muscle treatment. Tendinitis of the long head of the biceps

Tendinitis of the long head of the biceps

Tendinitis is an inflammation of the tendon that initially occurs in the tendon sheath or tendon bursa. In this case, it is an inflammatory process in the part of the tendon that connects the upper part of the biceps muscle to the shoulder. Most often, the disease appears after too much stress, when performing a certain type of work or while playing sports.

Clinical features of the disease

There are also cases when tendinitis develops not due to excessive stress, but as a result of muscle wear and injury. With tendinitis in the localization of the long head of the biceps, pain syndrome is observed in the upper anterior part of the shoulder girdle.

It takes a lot of time for the tissue layer of the biceps tendon to regenerate. For example, if a person’s professional duties involve performing intense and the same exercises with his hands raised above head level, or if he is an athlete (tennis player, basketball player), the tendon part is subjected to regular excessive load, and normal regeneration simply does not occur in a timely manner .

When the tendon wears out, its tissue degenerative changes begin, the collagen fibers become tangled and very often rupture. It becomes obvious that during this process the tendon loses its strength and becomes inflamed, which can lead to rupture.

Quite often, tendonitis of the long head of the biceps develops after a direct injury. For example, if a person falls on his shoulder, this will lead to the onset of illness, and the transverse ligament of the shoulder may rupture.

Features of tendinitis

Thanks to this ligament, the formation of connective tissue is located in the bicipital notch, which is located next to the apex of the humerus. When it ruptures, the biceps is not held in place and quietly slips out, subsequently it becomes irritated and inflamed.

The condition can occur if the rotator cuff tears, impingement or shoulder instability occurs. If the cuff ruptures, this will allow the humerus to move unrestrictedly and act on the connecting formation, which, naturally, will lead to its weakened state.

The appearance of the disease is also facilitated by instability of the shoulder, which occurs when the head of the humerus is excessively mobile inside the socket.

The most important symptom of tendonitis of the long head of the biceps is pain, which is dull in nature. Often the pain syndrome is localized in the front of the shoulder, but sometimes it goes down to the area where the biceps muscle is located.

Painful sensations are one of the main principles of the disease

The pain intensifies when you move the limb, especially if you lift it up. When the limb is at rest, the pain subsides. There is also weakness in forearm rotation and elbow flexion.

First, the doctor interviews and examines the patient. The patient must give accurate answers about the nature of his work, about possible injuries suffered, and if he is an athlete, then about the intensity of training.

During the examination, the doctor pays special attention to how the patient performs certain movements; perhaps they are difficult as a result of muscle weakness and pain. A series of special tests are then performed to determine whether there is a rotator cuff injury or shoulder instability.

If an X-ray examination is not enough to determine the most appropriate treatment, then the doctor may refer the patient for an MRI.

Shoulder MRI result

This study can provide much more information about the damaged biceps tendon, making it possible to see whether there is an inflammatory process, whether the labrum is damaged, or whether there are tears in the rotator cuff.

To determine if there are other problems with the shoulder joint, your doctor will order a diagnostic arthroscopy.

Treatment of this disease can be of two types: conservative and surgical.

The conservative method consists in completely unloading the biceps tendons, that is, the patient should exclude the slightest load on this area and provide rest to the tendon. NSAIDs are used to reduce pain and inflammation. Steroid injections are prescribed very carefully because they often weaken the tendon further.

The patient must undergo a course of physiotherapeutic procedures and exercise therapy. Physiotherapeutic treatment helps to quickly reduce the inflammatory process, and exercise therapy helps restore muscle mass.

Physiotherapy

If the patient works in an occupation where there is a risk of shoulder instability and rotator cuff tears, he will be advised to change jobs. This will reduce pain and inflammation, and give the person the opportunity to live a full life.

If conservative treatment has not brought any results and the person still suffers from pain, then surgical treatment is recommended. It is also used if other problems are detected in the shoulder area. Most often, surgical treatment consists of acromioplasty. During the operation, which surgeons perform using arthroscopy, the anterior lobe of the acromion is removed.

This makes it possible to expand the distance between the acromion and the adjacent head of the humerus, thus reducing the pressure on the tendon itself and nearby tissue.

If the patient has severe degenerative changes in the tendon, then biceps tenodesis is performed. This method involves reattaching the superior biceps tendon to a new location. This surgical intervention gives a good result, but, unfortunately, it is not durable.

After the operation, rehabilitation lasts about six to eight weeks. A positive outcome will largely depend on the patient himself, that is, on his mood for a good final result. Doctors do not recommend lying in bed; soon after the operation you need to start physical therapy exercises.

Exercise therapy for tendinitis

A physical therapy doctor will select a set of exercises and monitor the process of strengthening the muscles of the shoulder and forearm. Typically, positive dynamics are observed after two to four weeks.

If the patient conscientiously follows all the recommendations of the attending physician, then complete recovery of the shoulder and forearm will take three to four months.

In order to avoid tendonitis of the long head of the biceps, you must adhere to the following recommendations. Firstly, before training, do warm-up and warm-up exercises, try not to do monotonous movements for a long time. Secondly, do not allow physical overload and avoid injury. Change the load regularly, the intensity of the load should increase gradually, and, do not forget, take timely rest.

Muscles and tendons are the most important part of the musculoskeletal system; together they provide joint movement. Tendon dysfunction results in loss of normal motor function in the affected area, the patient is unable to move the shoulder and experiences severe pain.

Biceps tendonitis is an inflammatory condition of the tendon in the area where it attaches to the biceps. The pathology occurs most often in people who perform hard work and in athletes, and requires mandatory treatment under the supervision of a competent specialist.

Biceps tendonitis is accompanied by the following symptoms:

pain occurs in the shoulder, which increases over time; the pain also intensifies with physical activity; crunching of the tendon may occur during movement; sometimes swelling and redness occur in the area of ​​inflammation; motor activity of the affected shoulder is impaired due to pain; with purulent tendinitis, the general body temperature, weakness, nausea and other symptoms of intoxication occur.

The severity of tendinitis symptoms depends on the stage of the disease. Since the pathology develops gradually, there are 3 degrees of pathology:

At the very beginning of the disease, the pain is weak, unpleasant sensations arise only with a sudden movement of the hand and quickly pass. At the second stage, the pain is more pronounced, it occurs during physical activity and does not go away for a long time. At the last stage, the symptoms are pronounced, attacks of pain bother you even at rest .

It is best to start treatment at an early stage of tendinitis, so even with mild shoulder pain that appears regularly, you should definitely visit a specialist.

Tendinitis is an inflammatory disease that affects the main or long head of the biceps muscle. The disease begins with inflammation of the tendon sheath and tendon bursa, and gradually spreads to the muscle.

According to the World Joint Diseases Organization, 80% of people in the world have joint problems. The worst thing is that joint diseases lead to paralysis and disability. Today there is one effective remedy that differs from all previously existing means.

Interestingly, biceps tendonitis is a disease that affects not only humans. The pathology is often observed in horses and cattle, and biceps tendinitis in dogs is also common.

Tendinitis of the head of the biceps is associated with increased physical stress on the shoulder, sudden monotonous movements, which cause microtrauma to the tendon. Most often, the pathology occurs in professional athletes, for example tennis players, swimmers, since during training they perform active movements of the shoulder.

If the athlete follows the training rules and gives the shoulder a rest, then the tendon will have time to recover normally and inflammation will not occur. Otherwise, degenerative disorders and inflammation will occur in the tendon; this condition can lead to its rupture if a person neglects treatment and continues to put stress on the shoulder.

Biceps brachii tendinitis can occur not only with heavy physical activity, but also with shoulder injury. In this case, the transverse ligament that secures the tendon ruptures. As a result, it is displaced and injured, which leads to the formation of an inflammatory process.

To prescribe an effective treatment for tendinitis, you must first make a correct diagnosis, for this you must consult a doctor. The specialist will take an anamnesis, conduct an external examination and send you for an ultrasound. Based on the results of the examination, the correct diagnosis will be established and the doctor will prescribe effective therapy.

Treatment for long head of biceps tendonitis begins with immobilizing the shoulder. The patient is prohibited from loading the affected joint, so as not to injure the tendon even more. Depending on the stage of the pathology, wearing a fixation bandage, an orthosis or even a plaster cast may be indicated.

To relieve pain and inflammation, the patient is prescribed to take non-steroidal anti-inflammatory drugs and use external agents. A course of physical procedures, for example, magnetic therapy, electrophoresis with lidase, and other procedures prescribed by the doctor, depending on the stage of the disease, will also help speed up recovery.

After the inflammation is relieved, physical therapy and massage are prescribed for biceps and triceps tendinitis; these procedures help restore blood circulation in the affected area and normalize the motor activity of the joint. Massage and exercise therapy are especially effective if the patient has chronic biceps tendonitis.

Treatment of biceps brachii tendonitis is not always carried out conservatively; in severe cases, surgery may also be indicated. For purulent tendonitis, the doctor surgically cleans the tendon of pus. The operation is also performed when a tendon ruptures, in which case the surgeon restores it.

Biceps tendonitis must be treated under the supervision of a specialist, otherwise it can become chronic. In complex therapy, it is allowed to use traditional medicine recipes, but before using the product it is recommended to consult a doctor.

For tendonitis, the following folk recipes are used:

Compresses from herbal decoctions are used to relieve inflammation and pain. For tendinitis, comfrey, chamomile, arnica, and sage help well. In the acute stage of the disease, it is recommended to use a cold compress to stop the inflammatory process. During the treatment period, it is recommended to eat turmeric, it has an anti-inflammatory effect for tendonitis. Salt compresses also help well. To prepare such a product, it is best to use sea salt; it is dissolved in hot water and gauze folded 3 times is moistened with the solution. The wet bandage should be placed in a plastic bag and placed in the refrigerator for 20 minutes. Remove the cold gauze from the bag, apply it to the shoulder and secure it on top with a bandage, hold until completely dry.

Pathology of the biceps brachii muscle has been the subject of attention for a long time, but its function has been unclear and treatment methods have varied. Pathological changes in the biceps tendon often accompany other conditions such as impingement, SLAP injuries and ruptures of the supraspinatus and infraspinatus tendons.

Monteggia described instability of the biceps brachii tendon, but the identification of this condition often went unnoticed or was incidental. Treatment methods have developed rapidly, and an understanding of the mechanism of instability and its consequences has emerged.

Biceps tendonitis

Biceps tendonitis can be primary and secondary.

Primary tendinitis– inflammation of the tendon in the intertubercular groove. This condition is rare; Habermayer and Walsh believed that it could only be diagnosed arthroscopically.

Differential diagnosis performed for conditions such as impingement, bone abnormality in the groove area, or biceps subluxation.

Secondary tendonitis– occurs more often and is easily diagnosed.

The first cause of secondary tendonitis – impeachment. Although subacromial impingement affects the anterior rotator cuff, it also compresses the underlying tendon of the long head of the biceps, which leads to the development of concomitant clinically active pathological changes in it. Up to a third of patients with rotator cuff pathology have concomitant biceps tendon injury.
Second cause of secondary tendinitis– bone anomalies of the proximal humerus. Such anomalies appear due to improper consolidation or nonunion of fractures of the proximal end of the humerus. Irritation of the long head of the biceps tendon may occur if the fracture line extends into the intertubercular groove. Anomalies of the groove (its narrowing, formation of osteophytes) are more common at a young age.

Biceps tendon rupture

An acute rupture can occur when falling on a straightened limb or when suddenly braking the arm while throwing. If the force is great enough, either with a single traumatic impact or with repeated stress, it can result in rupture of the long head of the biceps tendon, with or without associated rupture.

The most common cause of this condition is chronic biceps tendinitis. If the cause of the injury is impingement, the tendon ruptures around the rotator cuff interval area rather than at its insertion.

Biceps brachii instability

Biceps instability can manifest as dislocation or subluxation. Habermayer and Walsh divided dislocations into extra-articular and intra-articular.

Extra-articular dislocations- This is the movement of the tendon from the intertubercular beard over/anterior to the intact subscapularis tendon. Such dislocations are rare and occur due to rupture of the coracoid ligament and the supraspinatus tendon.

Intra-articular dislocations– are more common and are accompanied by partial or complete rupture of the subscapularis tendon, which causes displacement behind the biceps tendon.

Signs of biceps tendon subluxation may be difficult to distinguish and often go unrecognized. Walsh called this condition "hidden damage." The most important anatomical components that prevent subluxation of the biceps tendon are the medial retinaculum and the subscapularis tendon. By performing internal or external rotation of the shoulder, you can see how the biceps tendon “breaks” back into the plane of the anterior border of the subscapularis tendon. Normally it should remain anterior to the plane of the subscapularis tendon. The presence of such a phenomenon is a reliable sign of early tendon instability.

Patient complaints

A distinctive sign of pathological changes in the biceps tendon is pain in the anterior part of the shoulder, especially in the area of ​​the intertubercular groove.

For tendinitis: the pain is chronic, aching in nature and intensifies when lifting objects and working above the head, and also radiates in the distal direction to the middle of the limb, rarely in the proximal direction. and tendinitis can have cross-symptoms, appear simultaneously and are difficult to separate.

Biceps instability– manifests itself as a painful click when raising the arm and/or rotating it. The symptoms are similar to those of tendonitis and appear simultaneously.

Rupture of the long head of the biceps tendon– complaints of chronic pain in the anterior shoulder, which is characteristic of tendinitis and/or impingement. Next, they usually describe a painful click in the shoulder, after which the symptoms of impingement decreased or disappeared. Ecchymoses and muscle deformity (“Popeye’s deformity”) may then appear.

Clinical examination

A distinctive sign of pathological changes in the biceps tendon is point pain in the area of ​​the intertubercular groove. The intertubercular groove can best be palpated 3 cm below the acromion process with 10° internal rotation of the limb. With internal and external rotation, pain may follow the movement of the arm. This “pain on movement” is a specific sign of damage to the biceps tendon.

Clinical tests that help identify pathology of the biceps tendon:

• AIDS test(Speed’s test) - the patient, with his elbow straight, bends his shoulder, overcoming the resistance provided by the researcher. It is considered positive if pain appears in the area of ​​the intertubercular groove.
• Yergason test(Yergason test) - the patient tries to supinate his forearms, overcoming resistance. It is considered positive if pain appears in the area of ​​the intertubercular groove.
• Bear hug test– the patient places the open palm of the affected limb on the opposite shoulder. The elbow is located in front of the body. The researcher tries to tear off the patient's hand, while the patient tries to keep his hand on his shoulder. Considered positive for limb weakness and indicates damage to the superior subscapularis tendon and instability of the long head of the biceps.
• Napoleon test– the patient presses the palm of the affected limb on the anterior wall of the abdomen, while trying to keep the hand straight. It is considered positive if the patient is unable to hold the hand straight. This suggests damage to the subscapularis tendon.
• Belly-press test– close to the Napoleon test in terms of execution. The researcher tries to tear his hand away from his stomach. If he succeeds easily, the test is considered positive, which suggests damage to the subscapularis tendon.
• Lift-off test– the patient places the back of the hand on the buttock of the same name. The researcher from behind raises the hand and asks the patient to hold it in this position. If there is weakness or inability to lift the arm from the lower back, the test is considered positive, which suggests damage to the subscapularis tendon.
• Biceps instability test– if the biceps moves over the lesser tubercle when moving the arm into a position of internal rotation, a click is heard or felt under the fingers. This test is performed to confirm tendon subluxation
• Ludington test– the patient is asked to clasp his head from behind with both hands, bending them. Used when damage is not obvious.

Diagnostics

The examination must begin with, which should include examination in the anteroposterior and axillary projections, as well as in the Y-projection.

Before the advent of MRI, arthrography was used and was useful in assessing the biceps tendon. The disadvantage of this method is possible complications when administering a contrast agent.

The effectiveness of ultrasound in determining subluxation of the long head of the biceps tendon is 86%. The advantage of the method is the possibility of dynamic research during shoulder movements.

Diagnosing a biceps tendon injury or dislocation using an MRI is fairly easy, but identifying signs of tendonitis is not easy.

Treatment

Start off tendonitis treatment follows conservative measures: rest, cold, use of NSAIDs. As symptoms decrease, exercises to restore range of motion and strength exercises are performed.

Instability of the biceps tendon – surgical treatment.

Damage to the tendon of the long head of the biceps - surgical treatment is required if a course of conservative measures is not effective.

There are 2 types of operations for pathology of the tendon of the long head of the biceps muscle: tenodesis and tenotomy. In the case of tenotomy, the tendon is cut off from its attachment to the labrum without fixation at another point. This procedure is the operation of choice for patients over 50 years of age with low physical activity and full arms (the cosmetic defect will not be noticeable). The loss of limb strength for flexion at the elbow joint will be no more than 10-15%.

Patients with a high degree of physical activity, young, thin build should undergo tenodesis surgery, i.e. transfer of the point of fixation of the long head of the biceps muscle from an intra-articular position to an extra-articular position. The tendon is cut off from the articular labrum and fixed in the intertubercular area. The methods of fixation are different, as is the level of fixation in relation to the intertubercular groove. But the main goal of the operation is to ensure full function of the tendon with a changed point of its fixation.

After surgery, the patient regains function and notes a significant decrease in pain intensity.

Rehabilitation

In the absence of concomitant pathology, a support bandage is prescribed for 4-5 weeks. Full passive flexion and extension of the elbow joint without load, as well as gentle movements of the shoulder joint, are allowed. From the 4th week, the support bandage is removed, and exercises aimed at restoring the full range of motion in the shoulder and elbow joints are allowed. At the 4th week, they move to external rotation up to 30° in the supine position and anterior flexion in the same position. At the 8th week, cross adduction and slight extension behind the back below the waist begin, and isometric loading is allowed. From weeks 10 to 12, exercises begin to strengthen the rotator cuff and stabilize the scapula. Sports exercises and a gradual return to normal active mode begin at 4-6 months.

You can suspect biceps tendonitis by the appearance of pain in the shoulder. Pathology occurs as a result of inflammation of the biceps tendon caused by injury or degenerative changes in the tissues of the joint. takes a long time and involves the use of drugs that relieve the main symptoms.

The biceps is one of the largest muscles in the upper limb, so inflammation of its tendon causes severe pain and impairment of arm function.

Causes of biceps tendinitis

Tendon inflammation occurs as a result of frequent injury and degenerative changes in the tissues of the shoulder joint. This is often associated with intense sports activities, especially in the case of exercises that involve weight bearing on the arms. The biceps ligaments quickly wear out due to constant injury or insufficient supply of vitamins and microelements to the human body.

Thus, the following factors can lead to inflammation of the long head of the biceps muscle:

• decreased density of fibrous tendon structures, which is associated with destruction or high load on the shoulder;
• frequent microtrauma of tendons;
• rupture of the opposing biceps muscles;
• instability of the humeral head;
• pathological changes in the joint such as dislocation;
• ossification of soft tissues surrounding the joint;
• impaired blood circulation in the shoulder or its innervation.

Symptoms of pathology

With this disease, a person cannot move his arm fully.

Tendonitis of the long head of the biceps has the following characteristic symptoms:

• significant pain in the shoulder area;
• clicking and crunching when moving in the joint;
• incomplete range of limb mobility;
• redness and local increase in temperature of the shoulder;
• spasm of the biceps brachii muscle, which manifests itself in the form of its hardening.

Since the biceps tendons are part of the rotator cuff, the range of motion in the joint after the development of tenosynovitis is significantly reduced. Also characteristic of tendinitis is increased pain after exercise; it is dull and aching in nature. Often the upper part of the shoulder swells, which is caused by the spread of inflammation to nearby tissues. The pain is localized in the upper anterior region of the limb at the site of the projection of the tendon of the long head of the biceps. With a significant spread of the inflammatory process, biceps tenosynovitis develops, since the muscle bursa is involved in the development of pathology.

Diagnostic measures

Symptoms of ligament inflammation can be identified during external examination and palpation of the patient. In this case, the shift in the position of the biceps brachii tendon will be clearly visible to the doctor. To confirm the diagnosis, a laboratory test is performed in the form of a general analysis of urine and blood, where signs of the inflammatory process are noticeable. Biceps tendonitis can be reliably detected using magnetic resonance imaging, and if this is not possible, ultrasound diagnostics and radiography are used. However, with their help, the problem can only be identified indirectly.

What is the treatment?

Glucocorticosteroids are prescribed when NSAIDs are ineffective.

Therapy for tendonitis involves long-term medication. Taking non-steroidal and anti-inflammatory drugs is aimed at eliminating inflammatory manifestations and reducing the severity of pain. If these drugs are ineffective, glucocorticosteroids are used. Treatment with surgical intervention is used very rarely and is indicated only when conservative therapy is ineffective.

The entire period of treatment, the load on the patient’s limb should be limited. In addition, it is useful to additionally take a complex of vitamins and minerals that strengthen the tissues of the musculoskeletal system. After completion of the main treatment of tendinitis and elimination of inflammatory manifestations, a course of physiotherapy with therapeutic massage and gymnastics is indicated. This will restore the functional activity of the limb.

During treatment of tendinitis, stress on the upper limb must be avoided.

Orthopedists and traumatologists often encounter a specific lesion, which is defined as tendon tenosynovitis. The pathology is characterized by a long latent course, which reduces the likelihood of timely consultation with a doctor. The disease causes excessive tendon stiffness, swelling, and pain. Treatment is complicated if the presence of microcrystals of salts in the tendons is confirmed, and they themselves have undergone fiber disintegration.

Causes

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.

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:

• increase in pain after minor physical activity;
• extensive swelling around the knee joint;
• a clear hyperemia of the skin is visible.

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.

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:

Type of treatment, prescribed group of drugs	Purpose and features	Possible side effects
Non-steroidal anti-inflammatory drugs. Diclofenac, Nimesulide (Nise), Ibuprofen	They reduce the spectrum of the inflammatory process and minimize pain. The listed medications are administered once a day for 10 days.	Gastropathy
Painkillers. Ketanov, Ketarol, Dexalgin, Analgin	Analgesics are administered when NSAIDs are insufficiently effective, when pain in the limb persists. The drugs eliminate attacks of pain for 4-5 hours, which allows you to normalize your well-being and helps you cope with post-operative recovery.	Gastropathy, sleep disturbance, arrhythmia
Diuretics Furosemide, Lasix	Therapy, the purpose of which is to reduce swelling. The dosage depends on the patient’s weight, the severity of edema	Lower back pain at the level of the kidneys
Antibiotic therapy Ceftriaxone, Ceftazidime	Broad-spectrum antibiotics are prescribed if there is a proven relationship between tenosynovitis and an existing infection. The goal is to eliminate pathogenic microflora	Intestinal disorder

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.

More details

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 demand for the element 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. Gallstone disease.
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.

Treatment of joints Read more >>

The administration 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.

Conclusion

Tenosynovitis of the tendon can only be cured in a hospital setting, and therefore by the methods of official medicine. It is not safe to rely on alternative options. The most common cause of pathology is chronic damage. Orthopedists and traumatologists are involved in eliminating the disease. If tenosynovitis is of infectious origin, a venereologist is involved in drawing up a treatment plan.

Every person has experienced muscle and ligament sprains. However, few people know that such a harmless injury can develop into nodular tenosynovitis. Athletes are well aware of the dangers of this disease. After all, damage to ligaments and muscles is often accompanied by stretching of the tendons that are nearby. If the injury is not treated properly, an inflammatory process with severe pain may develop - tendon tenosynovitis.

Types and causes of the disease

Doctors divide tenosynovitis into the following types:

1. Stenotic. It is also called tenosynovitis of large joints. Typically, the tendons responsible for flexion and extension of the arm at the elbow, legs at the knee, and abduction of the fingers are affected. When a joint is injured, a person feels pain if he tries to move his limbs. In advanced cases, scars form on the joints and tendons. Interestingly, stenosing tenosynovitis most often occurs in women.
2. Tuberculous. This type of disease is diagnosed in adult patients. If the body is affected by the tuberculosis bacillus, the carpal tendons are the first to be injured. Often no pain is felt, but movement of the hand and fingers is limited, and the arm itself swells in the area below the shoulder.
3. Chronic. Often, inflammatory chronic tenosynovitis leads to rheumatoid arthritis. This disease can only be diagnosed by a specialist after conducting the necessary examinations.

There are many reasons for the occurrence and development of tenosynovitis. First of all, doctors identify various injuries. Minor bruises are not dangerous as they heal quickly. But if the injury leads to injury, then there is a risk of infection. When an infection enters a wound, it causes inflammation. A weakened immune system makes the situation worse. If the body is not able to fight pathogenic microorganisms on its own, then inflammation only intensifies.

Overwork, heavy physical activity and old age can also cause the development of the disease. Usually a person uses a certain muscle group in his everyday activities. Overloading those tendons that are under constant tension often leads to the development of tenosynovitis.

Elderly people are at risk, as their bones and muscles weaken and can no longer withstand the same loads. If timely examination and treatment are not carried out, then any negative factor can provoke the development of the disease. In rare cases, tenosynovitis can be hereditary.

Musculoskeletal tissues are closely related to each other. Damage to one area provokes pathology in other places. Therefore, diseases such as bursitis or rheumatoid arthritis often become the causes of nodular tenosynovitis. In addition, pathogenic organisms spread through the blood due to diseases such as herpes, syphilis, tuberculosis, etc.

Symptoms of the disease

The earlier tenosynovitis is diagnosed, the easier it is to treat. However, this disease often does not cause any discomfort in humans. Only over time does he begin to feel a slight pain when moving his limbs. Then redness of the affected area appears, and when you press on the sore spot, you can feel the swelling. However, the specific symptoms depend on the location of the inflammation. The following localizations are distinguished:

Sometimes, with the same disease, pain sensations are of a different nature. Some people complain of constant aching pain, while others experience discomfort only when moving their limbs.

However, in any case, when the first symptoms appear, you should consult a doctor, since advanced tenosynovitis can lead to disability.

Diagnosis and treatment

For a long time, doctors could not describe the disease. This happened only in the middle of the last century. Nowadays, much is known about the disease, including the fact that tenosynovitis usually affects middle-aged people, and women suffer from it more often than men.

The disease can be diagnosed in several ways. If a tumor is clearly felt upon palpation of the affected area, then this is a reason to immediately go to the hospital. The doctor also examines the patient and prescribes the type of examination. Usually the patient also undergoes a general blood test.

Most often, ultrasound is used to diagnose the disease. With its help, it is possible to examine the size of tumors, their number and location. X-rays are prescribed when tenosynovitis has caused bone deformation. MRI makes it possible to study the type of tumor more thoroughly. A biopsy is performed in cases where it is necessary to distinguish a tumor caused by tenosynovitis from other neoplasms.

Nodular tenosynovitis is treated with medication. However, the lists of medications will be long, since a universal drug that eliminates the disease does not yet exist. The doctor prescribes a group of medications that help relieve inflammation, pain, swelling, swelling and redness. These are painkillers and anti-inflammatory drugs, analgesics, antibiotics, drugs that strengthen the immune system and improve metabolism. The course is selected individually, the duration of treatment depends on the complexity of the disease.

Only a doctor can determine the course of nodular tenosynovitis. He conducts special studies, selects treatment methods, and prescribes medications. Therefore, it is better to refuse treatment with folk remedies without consulting an experienced specialist, otherwise there is a risk of aggravating the situation.

Traditional recipes will not help cope with injury, but they can be used as a preventive measure.

For a speedy recovery, it is better to combine a course of medication with physical therapy. Massage, magnetic therapy, electrophoresis and other physiotherapeutic methods will help restore lost functions of joints and tendons. Only in advanced cases surgical intervention is required. During surgery, the patient has the affected tendon removed. But even surgery does not protect against relapse.

Tenosynovitis may reappear after treatment. Therefore, it is important to follow all doctor’s recommendations during the rehabilitation period.

Treatment of glenohumeral periarthritis is long, but simple

The most common “rheumatic” disease of the shoulder, according to modern research, is considered to be glenohumeral periarthritis. It occurs in approximately 80% of calls related to diseases of the shoulder joint. The reason lies in the fact that the tendons in the shoulder joint are under constant functional tension, which leads to the development of a degenerative process in it.

• Causes of glenohumeral periarthritis
• Symptoms and stages of the disease
• Treatment with traditional methods
• Exercises for illness

Treatment of glenohumeral periarthritis is quite simple, but the main condition for effective treatment is timely initiation of therapy.

Causes of glenohumeral periarthritis

The occurrence of the disease can be triggered by several factors: age after 40 years (women are especially affected by this disease), hypothermia, prolonged exposure to dampness, as well as the presence of diseases - spondylosis, arthrosis, sciatica, neuropsychiatric disorders, congenital defects in the development of the upper shoulder girdle.

The main etymological factor is macro and microtraumas that can occur as a result of professional or sports activities. However, often the occurrence of glenohumeral periarthritis does not have any visible cause.

Symptoms and stages of the disease

In the development of glenohumeral periarthritis, several stages and clinical forms of the disease are observed.

Simple or “simple painful shoulder” is the initial form of the disease and is the most common. It causes isolated inflammation of the tendons of the infraspinatus and supraspinatus muscles, or much less commonly, tendinitis of the long head of the biceps muscle. A symptom of this stage of the disease is the occurrence of painful sensations or their intensification with certain movements of the hand.

In this case, the patient usually cannot lift his arm up or cannot touch the back of his spine. The pain is localized in the anterosuperior part of the shoulder, where the short rotator tendons attach to the greater tuberosity. However, many other movements may not cause pain in the shoulder. X-ray results usually do not reveal pathological abnormalities.

As a result of treatment of glenohumeral periarthritis at the initial stage, there may be recovery within a short period (from several days to a week) or a relapse of the disease with transition to the chronic stage, but without certain restrictions on movements in the shoulder. Also, with the most unfavorable outcome, the disease can progress to the stage of acute glenohumeral periarthritis.

Acute or acute painful shoulder - this stage of the disease can occur independently or be a complication from the first initial stage. When it occurs, inflammation of the tendons and the bursa in which they are located occurs, which leads to calcification (degeneration) of the affected tissues. The pain usually appears suddenly, especially after physical activity on the joint.

It has increasing intensity, radiating to the back of the arm and neck. The pain intensifies at night. Movement of the arm is sharply limited, but forward movement of the arm is almost free. It is more convenient for the patient to hold the sore arm in a physiological position, i.e. in a bent state and brought to the body.

The localization of pain varies. Pain can be on the anterior outer side of the shoulder (the tendons that attach to the short rotators are inflamed), and on the outer area (inflammation in the subdeltoid bursa), and on the anterior surface (the tendon of the long head of the biceps brachii muscle is inflamed).

At this stage, the disease may be accompanied by elevated body temperature and increased ESR. X-ray results reveal tissue degeneration in the subacromial region of the shoulder, supraspinatus tendon or subscapularis muscle.

Treatment for acute painful shoulder may take several days or several weeks. Chronic ankylosing or blocked shoulder is most often the result of an acute form of the disease. This stage of the disease is characterized by dull pain that intensifies when moving the shoulder. The main symptom is progressive stiffness in the shoulder joint. The patient cannot perform lateral abduction of the shoulder, because when the scapula is fixed, the scapulothoracic joint does not function.

The blocked shoulder condition does not lead to increased body temperature or changes in laboratory tests. X-rays may reveal salt deposits (calcifications) in the affected tendons.

Palpation determines pain in front and under the acromion, along the groove of the biceps muscle of the head of the shoulder joint, as well as at the point of attachment of the deltoid muscle to the joint.

Treatment with traditional methods

The answer to the question: “How to treat glenohumeral periarthritis?” You can start by saying that the most important thing in the process of treating this disease is persistence and duration. Because During all periarthritis, there is a slow resorption of calcifications and foci of degeneration, while the process of microtraumatization of the tendons continues.

The main methods of treating periarthritis include:

• unloading of affected tendons;
• use of anti-inflammatory and analgesic medications;
• physical and balneological methods;
• less often - surgical intervention.

Rest of the affected limb is created by immobilizing the diseased tendon. For example, in mild cases, this is done using a support bandage, a simple wooden or wire splint, which limits the mobility of the affected limb. In the first stage of the disease, recovery may occur after several days of immobilization. In more severe cases, a removable plaster splint is used.

Only after the pain has been relieved do they gradually begin to perform careful movements: first more active, then passive. At the same time, the use of analgesics is used - acetylsalicylic acid, analgin, brufen, indocide, butadiene, reopirin, etc. in normal doses.

Painful sensations of increased intensity are relieved by infiltrating the affected tendon with a combination of novocaine and hydrocortisone. It is injected into the subdeltoid or subacromyl region with a dose of 50-100 mg.

The injection is repeated after five to ten days until the pain decreases. Acute pain can also be relieved by oral corticosteroids. For example, triamcinolone or prednisolone, 3 tablets per day, gradually reducing the dose to ¼ tablet. in 5 days.

However, it should be remembered that glucocorticosteroids, while quickly reducing pain and exudative phenomena in the affected tissues, are not able to prevent the development of joint stiffness and therefore their use is advisable only as part of a complex treatment of glenohumeral periarthritis.

Complex treatment of the disease also involves the use of physical methods. Ultrasound, sinusoidal currents and hydrocortisone phonophoresis help improve blood circulation and provide good pain relief. Also, in the case of persistent pain syndrome, doctors recommend the use of x-ray therapy, and in case of chronic, protracted development of the disease, general hydrogen sulfide or radon baths.

For glenohumeral periarthritis, massage is contraindicated. However, the best way to prevent shoulder blockade during chronic glenohumeral periarthritis is therapeutic exercises, which should be performed systematically over several months.

Only if traditional methods of conservative treatment are ineffective, surgical intervention is used.

Treatment of the disease with folk remedies

Competent treatment with folk remedies for glenohumeral periarthritis can produce a positive effect. For example, the widely used method of hirudotherapy (treatment with leeches) can improve microcirculation in tissues and promote a rapid recovery of the patient.

Also, in the treatment of glenohumeral periarthritis, various decoctions and infusions of herbs that have an anti-inflammatory effect are used. They are used either internally or as a compress on the affected area.

1. 1 tbsp. a spoonful of crushed St. John's wort is poured into a glass of boiling water. The decoction is infused for half an hour. Take it 1 tbsp. spoon 4 r. per day.
2. Dried nettles are poured with boiling water and kept in a water bath for 15 minutes. Take 1 tbsp. spoon 3-4 r. per day.
3. 5 gr. crushed black currant berries are poured with a glass of boiling water and left for twenty minutes. Take half a glass 3 times. per day.
4. Horseradish is grated, heated, wrapped in gauze and applied warm as a compress to the affected area.
5. 50 gr. Calendula flowers are diluted with half a liter of vodka and left for 15 days. Then it is used as a rub in the glenohumeral region of the affected joint.
6. Take equal quantities of mint leaves, birch buds, dandelion root and coriander and pour boiling water over them. After infusion, use 3 rubles for rubbing. per day.

The folk methods listed above help relieve pain and inflammation.

Exercises for illness

Active exercises will help to achieve rapid complete restoration of joint function. There are quite a lot of them, so the choice depends on the doctor’s recommendations and the patient’s own capabilities.

1. I.P. (starting position) - Hands on the waist. We make circular movements with the shoulder.
2. I.P. - Hands on the waist. We move the shoulder forward and backward.
3. I.P. - A sore arm on a healthy shoulder. With your healthy hand, gently pull your other elbow up with a smooth movement.
4. I.P. - hands clasped behind your back. With a careful movement, we pull the sore hand towards the buttocks.

Regular exercise helps prevent the disease from becoming chronic. The prognosis for glenohumeral periarthritis is favorable. During treatment, foci of degeneration and calcifications gradually resolve, pain disappears and limb mobility is restored. The basic rule of effective treatment is: in order to prevent serious complications, treatment must begin at the moment the first symptoms appear.

Useful articles:

The humeral joint in the structure of the shoulder includes the biceps ligament, which performs a kind of stabilizing function. The inflammatory process in the tendon of the long head of the biceps brachii muscle and in the biceps brachii muscle connecting to it is designated by the term tendonitis, and with the functional location of the tendon and muscles, the developing inflammatory process is biceps tendinitis. Inflammatory processes are activated by the unstable position of the head of the humerus during movement, which disrupts the overall function of the shoulder joint.

Causes of development of the inflammatory process caused by biceps tendinitis

The causes of the development of the inflammatory process may be:
- constant excessive loads on the tendon cause degenerative disorders in its tissues, which leads to a decrease and loss of the strong properties of the continuous fibrous structures of the tendon and can lead to its rupture;
— chronic overstrains, causing permanent microtraumas of the tendon;
- the torn transverse humeral ligament does not perform the restraining function of the biceps tendon, and it comes out of the bicipital recess, causing its irritation;
- repeated movements of the head of the humerus lead to instability of the shoulder and unstable position of the head of the humerus due to the load on the soft tissues;
- a change in the anatomical position of the shoulder joint (dislocation) causes damage to the tendon or compression in the subacromial space;
- damage to the rotator cuff causes weakening of the biceps tendon;
— reactive and degenerative calcification of tendons;
- pinching of the soft tissues located between the head of the humerus and the upper part of the scapula.

The inflammatory process (bicipital tendinitis) can also occur if
other pathologies present in the shoulder joint and its structures involved in connecting muscle to bone.
The inflammatory process of the biceps brachii tendon may involve the joint capsule and surrounding tissues.
The development of inflammation can occur gradually, during the aging process, or appear suddenly, as a result of injuries and stress factors. Often combined with disorders of the rotator functions of the shoulder joint. It can appear with equal frequency in both men and women during adolescence and to a greater extent in the period from 25 to 40 years.

Risk groups include

Risk groups include people involved in:
sports and professions that involve frequently repeated pushing and rotational movements that place stress on the attachment points of the muscles to the bones in the shoulder girdle.

Description of pain: Pain can be in the form of mild or severe manifestations, quite long-lasting. Increased pain is observed as the inflammatory process develops, which at the beginning of the process may not have any manifestations and the pain may be short-lived. As the process moves to the next stage, pain will appear after physical activity and will be more pronounced. With prolonged attacks of pain, even at rest for 6-8 hours, a severe course of the process begins.
Lolizatiya pain: The pain runs along the upper surface of the shoulder, along the lower anterior region of the biceps muscle, with increasing intensity at night, during loads associated with lifting heavy objects, performing pulling, rotating movements, while lying on the sore side of the shoulder joint. Tenderness may be felt at the junction of the biceps and biceps muscles. Activation of the inflammatory process can cause local redness of the skin. There may be a clicking sound in the joint. The hand may be in a forced position, with limited movement.
The upper part of the biceps, which is in a constrained position, may indicate possible damage to its transverse ligament. If one of the biceps tendons ruptures, swelling may occur.

Diagnostic definition

Diagnostic definition accessible by palpation of painful points of the inflamed tendon. A positive Ergason sign may indicate a displaced position of the biceps tendon. X-ray will rule out other pathologies of the shoulder joint. Detection of shoulder ligament rupture is possible using computer visualization of changes in magnetic waves.

Treatment of biceps inflammation

Treatment of biceps inflammation- long-term (several months).
Providing rest to the shoulder joint reduces pain. The use of anti-inflammatory drugs acts to reduce the inflammation process. Pain relief is achieved by administering glucocorticoids. It is produced into the tendon from the protrusion of the supraglenoid tubercle of the long head of the biceps brachii muscle. Subsequently, complex exercises are performed for the shoulder joint, with a gradual increase in the range of motion.
In rare cases, when a satisfactory therapeutic effect is not achieved with conservative treatment methods, surgical intervention is recommended.

Complications: appear during the chronic course of the disease - atrophy of the biceps and deltoid muscles.