Ray George, Sandean Darren P., Tall Michael A.
UTHSCSA
University Hospitals of Leicester
Tenosynovitis is a broad term describing the inflammation of the fluid-filled synovium within the tendon sheath. It commonly manifests as pain, swelling, and contractures, depending on the etiology. The condition can affect any tendon in the body surrounded by a sheath but has a predilection for the hand, wrist, and foot. A basic understanding of the tendon anatomy allows the clinician to appreciate the pathophysiology, treatment, and complications. The tendon anatomy and relationship to the tendon sheath are well illustrated in the hand. The tendons' intricate arrangement in the hand permits the gripping, grasping, and precise motor function of the hand. Shortly after exiting the carpal tunnel at the wrist, the tendons of flexor digitorium superficialis and profundus muscles cross the palm and enter tunnels formed by the fibrous sheaths on the palmar aspect of each digit. Within each tunnel, the tendons are surrounded by a synovial sheath or bursa. Together, the fibrous tunnel and synovial covering form the tendon sheath. The tendon sheath has the following functions: 1. The synovial fluid nourishes the tendon and provides a low-friction environment, allowing the smooth gliding of the tendon and reducing wear and tear of the tendons from excessive friction. 2. The fibrous sheath provides anchor points for the tendon to prevent 'bowstringing.' For example, in the hand, they help anchor the tendons to the bony plane of the phalanges and interphalangeal joints to prevent the tendons from bowing when the digits are flexed.
腱鞘炎是一个广义术语，用于描述腱鞘内充满液体的滑膜的炎症。根据病因不同，其通常表现为疼痛、肿胀和挛缩。这种病症可影响身体任何有腱鞘包裹的肌腱，但在手、腕和足部更为常见。对肌腱解剖结构的基本了解有助于临床医生理解其病理生理学、治疗方法及并发症。手部很好地展示了肌腱的解剖结构及其与腱鞘的关系。手部肌腱的复杂排列使手具备抓握、握持和精确的运动功能。指浅屈肌和指深屈肌的肌腱在腕部穿出腕管后不久，便穿过手掌，进入由每个手指掌侧纤维鞘形成的隧道。在每个隧道内，肌腱被滑膜鞘或滑囊所包裹。纤维隧道和滑膜覆盖物共同构成腱鞘。腱鞘具有以下功能：1. 滑液滋养肌腱并提供低摩擦环境，使肌腱能顺畅滑动，减少因过度摩擦导致的肌腱磨损。2. 纤维鞘为肌腱提供固定点，防止“弓弦样畸形”。例如，在手部，它们有助于将肌腱固定于指骨和指间关节的骨平面，以防止手指弯曲时肌腱出现弓弦样畸形。
