Тендиноз — это симптомы дистрофического поражения в области сухожилий крупных мышц.
Тендиноз проявляется сильными болями и нарушением двигательной активности в пораженном суставе, боли выражены при движениях, в покое практически не ощущаются. Тендиноз опасен травмированием, то есть отрывом пораженных сухожилий от места крепления к кости.
Причины
Если нагрузки на мышцы и связки в условиях активных спортивных тренировок настолько сильны, что мышцы и сухожилия не успевают отдохнуть и восстановить микро-повреждения, вызванные нагрузками, то происходит их разрушение – формируется так называемая хроническая (усталостная) травма.
Самой частой из таких травм является тендиноз – прогрессирующая дистрофия, участки дегенерации в области сухожилий.
Самые частые причины тендиноза:
- микротравмы сухожилий,
- чрезмерная, усиленная двигательная нагрузка на сухожилия.
Результатом является образование участков некроза, жирового перерождения сухожилий и хрящей, отложение кальциевых солей. По мере прогрессирования процесса сухожилие окостеневает, теряет эластичность и приводит к дистрофии и воспалению.
Тендиноз – это свидетельство превышения нагрузок на данные мышцы, сильно тяжелые тренировки.
Чаще всего тендинозы бывают посттравматическими, или постнагрузочными, как у профессиональных спортсменов с их высокими нагрузками, так и у работников строек и заводов с тяжелым физическим трудом.
Однако отдельно выделяются тендинозы ревматического происхождения в результате подагры, артритов.
Симптомы тендиноза
К общим симптомам тендиноза относятся:
- боль при совершении движений, проходящая в покое,
- пассивные движения конечности практически безболезненны,
- прощупывание пораженного сухожилия неприятно, болезненно,
- оно уплотнено, видна краснота по поверхности, повышение температуры над пораженным участком,
- при движении слышно похрустывание или треск.
В зависимости от локализации существуют свои характерные особенности тендиноза.
Локоть теннисиста (эпикондиллит латеральный)
– поражение разгибателей запястья. При этом боли возникают в области локтя и отдают вверх, в плечо, по внешней его части и по предплечью. Может возникать слабость в кисти, трудность в поднимании чашек, при рукопожатии или при отжимании белья.
Рука гольфиста, бейсболиста (медиальный эпикондиллит)
– поражение разгибателей и мышц, вращающих предплечье. Проявляется болью во внутренней части локтя, боль при сгибании кисти вниз, надавливании на кисть.
Болезнь Кервена
– тендиноз сухожилий большого пальца руки, проявятся болями при разгибании и отведении большого пальца руки. Боль при прощупывании основания большого пальца, а также боли при соединении подушечки большого пальца с мизинцем.
Тендиноз надколенника (колено прыгуна)
– боли в области коленки, припухлость сухожилия, отек. При нелеченном тендинозе возможен отрыв надколенника.
Тендиноз квадрицепса
напоминает проблему с надколенником, но обычно возникает у более возрастных спортсменов.
Пост-тибиальный тендинит
с поражением большеберцовой мышцы дает боли в сухожилия, боли в пятке, в своде стопы. Может приводить к плоскостопию и пяточным шпорам. Боли усиливаются при беге и ношении тяжестей.
Диагностика
Основа диагностики тендиноза – это жалобы пациента и их связь с чрезмерными и длительными нагрузками, в основном у спортсменов.
Основу диагностики занимает осмотр и тщательное прощупывание сухожилия и мышц, проведение активных и пассивных движений с оценкой их болезненности и степени ограничения движений.
Дополняется осмотр проведением рентгена поврежденного сустава и сухожилия, также данные могут быть дополнены магнитно-резонансным сканированием.
Лечение тендиноза
Лечением тендиноза занимаются травматологи-ортопеды.
Назначается консервативная или оперативная терапия. В ранних стадиях показаны консервативные меры первичного и вторичного характера.
К первичным можно отнести:
- обеспечение полного покоя,
- холод и отдых сухожилию,
- наложение тугих или поддерживающих повязок и придание конечности возвышенного положения.
Вторичные меры консервативной терапии тендиноза включают применение:
- лечебной физкультуры и физиотерапии,
- инъекции препаратов,
- методы реабилитации,
- противовоспалительные препараты.
Все методы терапии на всех этапах назначаются врачом, применяются особые повязки и бандажи исходя из конкретной локализации повреждения и вида травмы. Иногда необходимо применение особого вида фиксирующих повязок.
Противовоспалительные гели и мази применяют в первые трое суток травмы, тогда они будут наиболее эффективны.
При далеко зашедших тендинозах применяют оперативное лечение – иссекают участки с измененными тканями, с последующими пластическими операциями по восстановлению сухожилия.
Прогнозы
Процесс реабилитации занимает до трех и более месяцев, используются методы растяжения и развития силы оперированного сухожилия.
Прогноз для жизни благоприятный, но возможны рецидивы.
Важно! Все материалы носят справочный характер и ни в коей мере не являются альтернативой очной консультации специалиста.
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Когда воспаление колена дает осложнение на сухожилия и распространяется на окружающие ткани, ставят диагноз тендиноз коленного сустава. Недугу преимущественно подвержены спортсмены, однако возникнуть он может у любого человека, вне зависимости от пола, возраста и рода занятий. Отсутствие диагностики и терапевтических мер приводят к ограничению подвижности ноги и влекут развитие инвалидности.
Этиология и патогенез
На появление недуга влияют два фактора: интенсивность физической и двигательной нагрузки на коленные сухожилия и частые микротравмы сустава. Отсутствие должного отдыха ноги, во время которого мелкие травмы успевают зажить, а ткани регенерировать, усугубляет состояние хрящей и суставной сумки в целом, давая толчок развитию дегенеративных процессов. Тендиноз может возникнуть на почве ревматоидного артрита или подагры. А также спровоцировать недуг могут следующие факторы:
- бактериальные и грибковые инфекции;
- ослабленный иммунитет;
- аллергические реакции;
- искривление позвоночника и нарушение осанки;
- деформация стопы, плоскостопие;
- слишком тесная или свободная обувь.
Заболевание возникает при сильных физических нагрузках и травмах.
Особо тяжелые формы болезни приходятся на преклонный возраст. Часто недуг наблюдается у гиперактивных подростков и молодых спортсменов. В группе риска — легкоатлеты, футболисты, гольфисты, теннисисты, баскетболисты и остальные атлеты, чья деятельность связана с интенсивными нагрузками на ноги и руки. Подвержены недугу и работники заводов, строители, грузчики и другие люди, чья работа сопряжена с тяжелым и продолжительным физическим трудом.
Виды тендиноза коленного сустава
В зависимости от причины, спровоцировавшей тендиноз, делят его на два вида:
В зависимости от области, куда приходится нагрузка, выделяют следующие виды болезни:
- болезнь Кервена, при которой поражаются сухожилия большого пальца;
- эпикондилит запястья (локоть теннисиста);
- дегенерация мышц предплечья;
- тендиноз квадрицепса.
Вернуться к оглавлению
Симптомы недуга
Проявления болезни имеют сходства с симптоматикой при растяжении связок, поэтому необходимо точно диагностировать ее для правильного лечения. Первым сигналом служит боль — острая или тянущая, в зависимости от степени и места поражения. Далее возникают остальные симптомы, яркость проявления которых зависит от тяжести перенесенной травмы или обострения хронического дегенеративного процесса. К ним относятся:
- покраснение и отек сочленения;
- ограничение подвижности суставов;
- местное повышение температуры;
- хруст в костях при движении.
Развитие болезни делят на четыре стадии, каждая из которых характеризуется своим набором симптомов. По ним врач и ставит предварительный диагноз. В зависимости от различных обстоятельств (внезапная крупная травма, обострение вялотекущего хронического воспаления), пациент может получить болезнь сразу 2 или 3 ст. Краткое описание проявлений каждой стадии представлено в таблице:
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