Evolution of structural and functional changes in stenosing ligamentitis

Abstract

The aim — to determine sonographic criteria for the pathological changes formation in stenosing ligamentitis depending on the stage of the process.Materials and methods. An ultrasonography of the tendon‑ligament complex of the metacarpophalangeal joint was performed in 57 patients at different stages of the pathological process. Scanning was performed in the sagittal and frontal planes at rest and during movement in the interphalangeal joints. The annular ligament A1, the flexor tendon and the surrounding soft tissues (tendon sheath, volar plateau) was evaluated. The thickness of the annular ligament was measured over the upper part of the tendon (volar surface). The conditional norm was similar indicators of the contralateral limb in the absence of clinical manifestations of any pathology in this segment. The distribution of patients according to the degree of the pathological process was as follows: stage 1 — 4 (7.1 %), stage 2 — 24 (42.1 %), stage 3 — 29 (50.8 %).Results and discussion. At the first stage of the disease, the use of ultrasound can exclude the presence of other pathological conditions with similar clinical manifestations. The ratio of the thickness of the ligament A1 and flexor tendons is from 0.09 to 0.12. Ultrasonic signs of the second stage of stenosing ligamentitis are a thickening of the annular ligament and flexor tendon and thinning of the tendon in the critical zone with preserved tendon mobility during the performance of the functional test. The ratio of the thickness of the annular ligament A1 and the flexor tendon is from 0.21 to 0.35. The third stage of stenosing ligamentitis is characterized by a thickening of the annular ligament and flexor tendon , as well as a thinning of the tendon in the critical zone in the absence of tendon mobility during the performance of the functional test. The ratio of the thickness of the annular ligament A1 and the flexor tendon is from 0.39 to 0.67.Conclusions. Ultrasound study in patients with stenosing ligamentitis of the fingers along with a clinical study are the main methods of diagnosis and verification of the process stage. The study allows to assess changes in annular ligament A1 and flexor tendons both in the area of the ligament itself (thinning of the tendons, hourglass‑shaped deformation) and in adjacent areas (thickening of the tendons), objectively determine the parameters of the tendon‑ligament complex. The main criterion for establishing the stage of the process is the index of the ratio of the annular ligament A1 thickness and the tendons in the critical zone, which can be calculated by the proposed formula.