Synovitis is an inflammation of the synovial membranes that line the inside of the cavity of one or more large joints. When the disease in the synovial membrane accumulates fluid. It is expressed by malaise, an increase in the volume of the joint, pain and weakness. When infection appears signs of intoxication. For exemption from military service in case of synovitis, impaired function of the large joint should be noted.
Our task is to explain to you what the disease is, what causes the development of synovitis and what to do to quickly restore the body.
What is synovitis?
Synovitis is an inflammatory disease of the synovial membrane (cavity) of a joint, characterized by excessive accumulation of effusion in it. The border of the inflammatory process in synovitis is limited to the synovial membrane.
As the cavities lined by the synovial membrane, involved in this inflammatory process, a synovial sac (small flattened cavity, lined with synovial membrane, separated from the surrounding tissues by the capsule and filled with synovial fluid), synovial vagina of the tendon, articular cavities can act.
With synovitis in 65–70% of cases, the knee joint suffers, and the shoulder, elbow, ankle, and hip joints are much less frequently affected. The disease is widespread, has many options for the course, occurs equally often in children and adults of all age groups.
Given the flow emit:
- Acute synovitis – accompanied by thickening, plethora and swelling of the synovial membrane. An effusion is a translucent fluid, sometimes with fibrin flakes visible to the naked eye.
- Chronic synovitis – manifested by the development of fibrotic changes in the joint capsule. In some cases, the villi of the synovial membrane grow, fibrinous overlays appear on the membrane, hanging down from the joint cavity (villous synovitis). When separating, the overlays are transformed into so-called “rice bodies”, which move freely in the joint fluid and additionally injure the synovial membrane.
According to localization, synovitis is isolated:
- shoulder joint (shoulder);
- elbow (elbow);
- hip (hip);
- knee joint (knee);
- ankle (ankle);
- wrist joint (wrist).
By the nature of the exudate:
- Serous fibrous;
In addition, depending on the nature of the causative factor, all synovitis is divided into infectious and aseptic. Accordingly, infectious synovitis is triggered by the entry of pathogenic microbes into the joint, and aseptic can be caused by all other causal factors, with the exception of infectious.
Most often synovitis occurs in men, mostly up to 35-45 years of age, which is due to vigorous physical activity and age for professional sports, as well as heavy physical work. Also, synovitis can haunt people with reduced immunity, who often suffer from infectious diseases.
There are the following reasons for the development of synovitis of the joints:
- infection in the joint cavity;
- accompanying illnesses;
- allergic reactions;
- joint instability;
- increased body weight.
Non-infectious or aseptic synovitis, depending on the causes, develops in different ways. With traumatic injuries in athletes, people engaged in physical labor, the mechanical factor comes to the fore.
Immunological disorders in rheumatism, rheumatoid arthritis lead to the fact that antibodies produced by the body infect their own synovial membrane.
And with some metabolic disorders, an accumulation of toxins or uric acid salts (with gout) in the joint cavity leads to synovitis.
Symptoms of synovitis + photo
Synovitis is characterized by damage to one joint or ligament, in rare cases the disease is multiple.
Common signs of synovitis:
- swelling and smoothing of the joints
- pain under load, reduced volume of movement in the affected area
- general increase in body temperature or local increase in skin temperature in the affected area
- general weakness, feeling unwell.
Some of these symptoms may be more pronounced than others, but with infectious synovitis, the signs will always be more pronounced than with non-infectious.
- With this form of disease, the inflamed area becomes larger in the first 2–3 hours. This is due to the accumulation in it of a large amount of synovial fluid.
- As a rule, unpleasant sensations appear only when touching the affected area, and in the normal state a person does not experience any discomfort.
- Over time, the inflamed area becomes warm, and the patient begins to experience general malaise;
- The most characteristic symptom of this form of the disease is stiffness in the affected joint.
- Also, when performing movements in the affected joint, pain appears.
- Long movements in the affected joint are not possible due to fatigue.
- Ultimately, this form of synovitis can lead to hydrarthrosis of the joint (dropsy), which leads to subluxation and dislocation of the joint (due to sprains).
Possible complications of synovitis:
- reduced movement due to irreversible changes in the synovial membrane or articular surfaces,
- the spread of the process to the adjacent areas of the ligament apparatus.
The most dangerous complication of infectious synovitis is sepsis, which is life threatening. Sepsis (the appearance of the causative agent of the disease in the blood) in case of an infectious synovitis can develop in people with a weakened immune system (for example, in case of HIV infection) or in the case of a prolonged absence of treatment.
Objective examination of the patient with joint synovitis:
- On examination, there is observed: an increase in the joint size, swelling, smoothing of the surface, hyperemia, stiffness of articular movements.
- On palpation (palpation) one feels: local temperature increase, soreness, swelling, fluctuation (the presence of fluid oscillations in the joint during movement). In some cases, an increase in regional lymph nodes is felt.
For accurate diagnosis, the doctor examines the affected joint using the following methods:
- X-ray examination;
- punctures during which they receive intraarticular fluid and send it to an extended laboratory test;
- CT or MRI.
Currently, arthroscopy, a type of endoscopy, is used for this. Through a small hole in the skin in the area of the inflamed joint, a special optical device, an arthroscope, is inserted into the articular cavity.
Arthroscopy allows not only to visually assess the state of the articular cavity, but also to carry out some therapeutic procedures, in particular, to remove the inflammatory fluid.
Laboratory research methods:
- In the general analysis of the blood, there is an increased erythrocyte sedimentation rate (ESR), an increased number of white blood cells, a C-reactive protein is detected.
- In the study of punctate determine the physico-chemical properties, conduct microscopic, bacterioscopic and bacteriological analysis.
Treatment of synovitis
As soon as a person has noticed any symptoms of an illness, he should immediately consult a doctor. The specialist will conduct an examination, examine the results of examinations, establish an accurate diagnosis and prescribe competent treatment of synovitis.
Treatment of acute serous synovitis should be carried out with the initial immobilization of the limb with a plaster splint. How to treat synovitis at the initial stage:
- UV irradiation
- electrophoresis with novocaine,
- warming compresses with Dimexidum solution.
If synovitis is severe, the doctor prescribes:
- Lidaza electrophoresis
- potassium iodide electrophoresis,
- phonophoresis with glucocorticosteroids.
If the symptoms of synovitis are only a large amount of effusion in the synovial cavity and general weakness, then joint punctures with possible addition of antibiotics are necessary.
It should be noted that medical puncture is performed only in the case when the infectious nature of synovitis is excluded.
There are the following contraindications to perform therapeutic puncture of the joint:
- bleeding disorders;
- infection of the skin in the area of the needle;
- the presence at the site of the needle wound.
Treatment of chronic serous or serofibrinous synovitis involves ensuring the rest of the affected limb, performing joint punctures, prescribing physiotherapy procedures (electrification, paraffin application, mud therapy, etc.). Necessary to identify and treat the underlying disease, which was the cause of chronic synovitis.
In some advanced cases, it is necessary to resort to surgical treatment – the implementation of synovectomy, which is reduced to complete or partial excision of the synovial membrane of the articular capsule and performed under endotracheal anesthesia.
In any type of disease, immobilization is shown, that is, the joint is immobilized with a kneecap or bandage, they must be worn for at least a week. The elevated position of the limb is also sometimes recommended.
Drugs for synovitis
The appointment of drug therapy is carried out in several directions:
- After puncture of the joint, intra-articular administration of broad-spectrum antibiotics is prescribed. This is necessary for the prevention of the accession of an infection or for its elimination with the established bacterial nature of the disease.
- Practically all patients with such a diagnosis are prescribed NSAIDs (diclofenac, voltaren, ibuprofen, indomethacin) in the form of ointments, injections or oral medications.
- Intra-articular administration of corticosteroids is also possible in combination with physiotherapy (magnetic therapy, ultraviolet irradiation, ozokerite, UHF, paraffin, phonophoresis).
- To restore the microcirculation, the administration of Thiotriazoline, Trental, and Nicotinic acid is indicated.
In the absence of a positive effect after a course of drug treatment, as well as with increased symptoms of synovitis, surgical treatment is prescribed. The patient under local or general anesthesia is performed by opening the joint, cleansing its internal cavity, and washing with antibacterial and drying solutions.
In the presence of "foreign" structures – bone and / or cartilage formations, as well as bone fragments after a joint injury – the surgeon performs a kind of plastic, restoring the uniformity and uniformity of its inner surface.
Full restoration of the affected joint with synovitis is possible no earlier than in 2-3 months. Even if the condition of the patient allows you to start a normal way of life earlier, it is better to withstand a gentle regimen during this period of time. This will completely eliminate the inflammatory process, prevent its recurrence and the transition to the chronic form.
Timely diagnosis of the disease and the conduct of medical or surgical treatment can significantly increase the patient’s chances of complete or partial recovery and restoration of joint mobility.