Overuse or trauma can lead to inflammatory reactions in the periosteum, tendons, muscles, and bursae.
Conservative treatment options for traumatic inflammation include rest and immobilisation. During the acute phase, a pressure bandage and pharmacological therapy (antiphlogistics, analgesics, local injection of corticosteroids) may be used. During later stages, remedial therapy can be considered.
The following types of traumatic inflammatory reactions are suitable for “surgical” treatment by a general practitioner.
Bursitis
Inflammation of a bursa. Common types caused by trauma include bursitis olecrani and bursitis praepatellaris.
Therapy [Decision Tree 2]: If you detect this problem in an early stage, a reasonable initial approach is watchful waiting. If the swelling has persisted for more than one week without improving, you may puncture it to rule out secondary infection (pus). If a diagnosis of traumatic inflammation without secondary infection is made (this is the case when a clear, yellow liquid is aspirated), then the bursa can be completely aspirated followed by hydrocortisone injection. Injection of hydrocortisone is contra-indicated when blood and/or pus are aspirated. Infectious bursitis should be treated by incision and drainage.
Puncturing, even when performed well, can also cause secondary infection.
Decision Tree 2
Epicondylitis Lateralis
“Tennis Elbow” – micro-trauma occurring in the attachments of tendons of the extensor muscles due to stress.
Therapy:
- Rest.
- Physiotherapy. The physiotherapist preferably uses a combined therapy approach with ultrasound and cross friction (Cyriax method). Both methods promote hyperaemia and ameliorate pain by generating vibrations.
- Hydrocortisone injection.
- Tenotomy by a surgeon.
Tendovaginitis Stenosans
Inflammation of the tendon sheath, whereby the tendon thickens or the tendon sheath narrows, which limits mobility. When the tendons of the m. abductor pollicis longus and the m. extensor pollicis brevis are affected, it is referred to as De Quervain syndrome. If a tendon sheath of the flexors of the hand is affected, it is called “trigger finger.” This name is derived from the snapping noise heard during passive finger extension. With this disorder, the flexor tendon thickens at the meta-carpophalangeal joint; the thickening is often palpable at this location.
Therapy:
- Hydrocortisone with lidocaine injection in the tendon sheath.
- Recurrence cleavage of the tendon sheath by a surgeon.