Stenozuojantis tenosinovitas: rizikos veiksniai, diagnostika, gydymas
Apžvalga / Review
Stenozuojantis tenosinovitas, dar vadinamas spragsinčiu pirštu, yra pirštų sausgyslių arba jų dangalų uždegimas, kuris dažniausiai atsiranda ilgą laiką reguliariai atliekant tam tikrus plaštakos judesius: griebiant, gniaužiant, dirbant kompiuteriu, rašant, grojant klavišiniais instrumentais [2]. Svarbūs ir kiti rizikos veiksniai: reumatoidinis artritas, mikrotraumos, infekcija, cukrinis diabetas, podagra [3]. Veikiant rizikos veiksniams, sustorėja skaidulinis A1 žiedas, progresuoja sausgyslės trauma ir uždegimas, kol pacientai pradeda skųstis skausmu, atliekant tam tikrus judesius, judesių ribotumu, piršto strigimu [2]. Ligos diagnostikai dažnai pakanka anamnezės bei klinikinių simptomų įvertinimo. Priklausomai nuo būklės, liga gali būti gydoma konservatyviu arba chirurginiu būdu [6]. Šio darbo tikslas – išanalizuoti ir aptarti stenozuojančio tenosinovito rizikos veiksnius, diagnostikos ypatybes bei gydymo principus.
Hand diseases account for a large part of all occupational diseases in Lithuania [1]. Stenosing tenosynovitis, also called a trigger finger, usually occurs over a long period of time with regular hand movements: grasping, clenching, working on a computer, typing, playing keyboard instruments [2]. It is not surprising that this disease usually occurs among representatives of professions that often perform these hand movements: teachers, writers, pianists, production workers [1]. In addition to regular movements of the hand, other risk factors are also important for the development of the disease: rheumatoid arthritis, microtraumas, infection, diabetes, gout [3]. Under the influence of risk factors, the fibrous A1 ring thickens, which no longer allows the tendon to move freely through the canal. As a result of the friction, tendon injury and inflammation progress, until finally patients begin to complain of pain during certain movements, limitation of movements, finger jamming [2]. The diagnosis of the disease is often sufficient to evaluate the anamnesis and clinical symptoms. Depending on how advanced the condition is, the disease can be treated conservatively or surgically [6]. Conclusions: 1. The main risk factors for stenosing tenosynovitis are rheumatoid arthritis, regular hand work, hand injuries, wound infection, diabetes, gout. 2. To confirm the diagnosis of stenosing tenosynovitis, anamnesis and evaluation of clinical symptoms are usually sufficient. Blood and imaging tests can be performed in unclear cases of the disease and to find out the causes of the disease. 3. Stenosing tenosynovitis is treated with analgesia, immobilization, exercise and corticosteroid injections. As the disease progresses, the disease is treated surgically.