Orthopedics - Oleksa A.P. 2006

Occupational diseases of the musculoskeletal system
Stenosing ligamentitis

Conditions leading to tendon stenosis and entrapment within tendon sheaths typically occur in individuals whose work involves heavy strain on the upper extremities and repetitive movements associated with microtrauma to Muscles and ligaments.

Based on their anatomical localization, the most common types of stenosing tenosynovitis (ligamentitis) are:

1. Stenosing tenosynovitis of the dorsal carpal ligament at the first compartment (De Quervain's Disease).

Clinical Features: The disease has an insidious onset, beginning with pain in the distal forearm on the radial side. The point of maximum tenderness is the radial styloid process. Patients may experience Sleep disturbances and increased excitability. Pain may radiate to the neck. This is followed by restricted mobility of the thumb, particularly abduction.

Objective findings:

— Swelling in the region of the radial styloid process;

— sharp tenderness upon Palpation;

— limited abduction of the thumb;

— inability to approximate the tips of the I-V fingers (Elkin's sign).

Radiological examination reveals soft tissue thickening around the radial styloid process, as well as hyperostosis and deformity of the process.

Treatment: Immobilization of the hand for at least two weeks is required, along with physical therapy (paraffin baths, mud therapy, ozokerite) and hydrocortisone injections. If conservative therapy fails, surgical intervention is indicated, which involves releasing the dorsal carpal ligament along the affected compartment.

Treatment lasts up to six weeks, after which the patient is reassigned to alternative work. Dispensary follow-up is maintained for six months.

2. Stenosing tenosynovitis of the dorsal carpal ligament at the sixth compartment.

This condition occurs more frequently in working-age men As a result of compression of the extensor carpi ulnaris tendon and the branch of the ulnar nerve. Work capacity remains unimpaired.

3. Stenosing tenosynovitis of the transverse carpal ligament — the flexor retinaculum (“Carpal tunnel syndrome”).

Clinical picture: Aching pain (typically worse at night) In the second and third fingers, paresthesias, finger numbness, and pain upon finger extension.

Objective findings: Forced posture of the hand with semi-flexed fingers; the hand is cold and the fingers are cyanotic. Hypoalgesia of the II-III fingers and decreased grip strength are observed. Percussion over the transverse ligament elicits pain (Tinel's sign).

Treatment is generally conservative, consisting of hydrocortisone or Kenalog-40 injections with novocaine into the carpal tunnel, physical therapy, and two weeks of rest (immobilization). If conservative treatment is ineffective, surgical release of the transverse ligament (flexor retinaculum) is performed. Work capacity is restored within two months.

4. Stenosing tenosynovitis of the annular (pulley) ligaments of the digits, particularly the first digit (trigger finger or Notta's disease).

This condition develops in individuals whose work requires significant pressure on the PALMAR ASPECT OF the finger. A characteristic and constant sign is the “locking and unlocking” phenomenon of the finger during flexion and extension, which can be felt upon palpation. Pressure over the metacarpophalangeal joint elicits pain, and localized swelling is visible in this area.

Treatment involves avoiding work associated with palmar trauma, immobilization of the affected finger or the entire hand, physical therapy (UHF therapy, UV radiation, paraffin, mud Applications), and hydrocortisone injections beneath the annular ligament. If conservative therapy fails, Surgical treatment — release of the annular ligament — is performed. Patients are incapacitated for a period of two months.