Synovitis - an inflammatory lesion of the synovial membrane of the joint, in which there is an accumulation of synovial fluid in the articular sac.
The disease can be recognized by the deformity of the affected knee, which occurs due to the accumulation of synovial fluid and smoothing of the knee contour. Unlike hemarthrosis, in which it is not synovial fluid that accumulates in the joint, but blood, the increase in the diseased area is fixed insignificant. It is the dimensions of the knee in this case are a kind of differential diagnosis.
However, the diagnosis can only be clarified using joint fluid analysis. Its chemical and physical properties are evaluated, which helps to identify the presence of the pathological process as accurately as possible.
What it is?
Sinovitis of the knee joint - a disease in which the inflammatory process develops in the inner articular membrane. Against this background, the periarticular (synovial) fluid gradually begins to accumulate in the articular sac. Most often the disease occurs after suffering injuries, but may also be the result of osteoarthritis of the knee joint.
In patients of young age, traumatic synovitis is most often diagnosed, and in older people - synovitis resulting from osteoarthritis. The course of the pathological process can be both acute and chronic.
Sinovit is predominantly of a secondary nature, that is, it develops not as an independent disease, but as a complication of other processes. However, it is not harmless. Infectious acute or chronic non-infectious synovitis can aggravate the course of the underlying disease, provoke the formation of hypertrophied villi, sclerotic sites, scarring, thickening, etc.
Such intraarticular changes can have a negative effect on other structures that form the joint.
The gradation of the disease depends on the cause of its development. According to this criterion, synovitis is:
- Primary. It develops against the background of a certain joint disease - arthritis, arthrosis, etc.
- Secondary, the occurrence of which is a specific reaction to a specific pathology. The root cause of such synovitis can be an allergy, an infectious disease, sprain or other damage to the ligaments, meniscuses. To get rid of articular deviations, it is enough to eliminate the disease that provoked it.
- Posttraumatic. This is the most common type of knee joint synovitis. It may occur on the background of bruises or other damage to the patella. As a result of the injury, the production of synovial fluid is activated, which gradually accumulates in the articular sac.
The method of treatment of the inflammatory process depends on which group it belongs to. There are 3 of them:
- Aseptic. This type of synovitis is not caused by the activity of pathogenic microorganisms or viruses, but by autoimmune processes, endocrine, rheumatic and other similar disorders.
- Infectious. This group of synovitis is due to a viral, fungal, or bacterial infection. Most often the provocateur of this pathology becomes an intestinal or tubercle bacillus, pneumococcus, brucella.
- Allergic. The disease manifests itself after contact with a specific allergen.
The exact determination of the affiliation of the pathology to one of the groups described above in each individual case allows the doctor to correctly and correctly assign therapy.
A synovitis of the knee can occur in both acute and chronic, recurrent form. The symptomatology in each of these cases has some differences that you need to be aware of.
Symptoms of acute synovitis
Such inflammation develops within a few hours or days. First of all, swelling of the joint is noted, then - its deflection. The cause of acute synovitis is the accumulation of synovial fluid in the articular cavity. And the more of it, the more pronounced the swelling.
With this disease, the joint is moderately enlarged, and it is for this symptom that it can be distinguished from hemarthrosis. When blood accumulates in the articular cavity, the articulation increases several times, and this process takes from a couple of minutes to several hours.
The second symptom of acute synovitis is a restriction of the mobility of the sore joint. It appears on the background of edema or severe pain.
With moderate synovitis pain syndrome is expressed slightly. Moreover, in many cases it is perceived as discomfort in the knee joint, and not as full pain. The nature of the intensity of pain - weak or medium. The skin color of the affected knee remains normal.
Synovitis may occur in purulent form. In this case, patients will complain of:
- severe pain - pulsating or arching - in the area of the affected knee;
- signs of intoxication (weakness, hyperthermia, nausea, muscle and headache);
- swelling of the diseased joint and restriction of its mobility;
- redness of the skin in the affected area, the acquisition of a shiny or bluish tint;
- feeling of heat in the area of the damaged joint.
Often, only one joint is affected with synovitis. Bilateral inflammatory disease is extremely rare.
Symptoms of chronic synovitis
The chronic form of the disease is rare, and is accompanied by a blurred clinical picture. At the beginning of the pathological process, patients complain of general weakness, discomfort in the knee, fatigue when walking, a slight restriction of movement. Periodically there is aching pain.
In chronic synovitis, effusion begins to accumulate in the articular cavity. The prolonged course of such a process leads to secondary degenerative changes in the joint. So, sprains can develop, instability develops, sprains or joint subluxations form.
The presence of effusion causes the development of sclerotic and hypertrophic processes in the synovial membrane. Against this background, it loses its ability to absorb the secret, which only aggravates the flow of synovitis. As a result, unusual forms of pathology can develop - for example, villous synovitis, which can only be treated surgically.
In addition to examining complaints and physical examination, the doctor must prescribe a patient a number of diagnostic procedures. This is the only way to make a correct diagnosis and determine the exact cause of the ailment.
To confirm or refute the presence of synovitis, the patient must go through:
- Puncture. This is a procedure during which the laboratory technician takes a small amount of effusion accumulated in the articular cavity with the help of a special thin needle. When bacteria are detected in a liquid, they speak of a bacterial etiology of the disease. If in the sample of effusion were found rogic cells (blood cells with rheumatoid factor present in them), then we are talking about rheumatoid synovitis.
- X-ray. With synovitis on the radiograph there is a darkening in the area of the affected joint.
- Ultrasound and MRI. These instrumental diagnostic methods are more informative than WG. As a result, the doctor may notice a thickening of the articular membrane, and see fluid accumulation in the joint.
The risk of developing complications of synovitis depends on the cause of its development, the intensity of manifestation and the timeliness of diagnosis. Adequately prescribed therapy and patient compliance with all medical recommendations significantly reduce the likelihood of adverse effects.
Different types of synovitis can lead to various complications. Usually the serous or allergic form of the pathology has a favorable outcome, which is not the case with the purulent type of the disease. It is dangerous not only a violation of the functioning of the knee, but also the development of sepsis and a state of shock.
Chronic synovitis leads to secondary arthrosis, chronic instability of the affected joint, dislocations and subluxations. Since the risk of such complications in this case is high, the treatment of the disease should be taken as seriously as possible. But the independent use of any drugs is unacceptable, since it can significantly aggravate the situation.
How to treat synovitis?
Whenever possible, synovitis is treated in a conservative manner. In this case, an integrated approach is important, and the patient’s complete rejection of self-treatment.
Thus, therapy for this disease is based on:
- conducting puncture;
- immobilization of the affected joint;
- the use of medications;
- physiotherapy sessions;
- using recipes of traditional medicine.
With the ineffectiveness of conservative treatment, doctors resort to surgery.
Puncture is both a diagnostic and therapeutic method, because it helps to determine the type of synovitis, and find out its cause. In addition, during such manipulation, it is possible to “pump out” the accumulated fluid, thereby significantly improving the condition of the affected joint.
A syringe with a special fine needle is used for puncture. After puncture and pumping out the effusion, an antibacterial solution is injected into the joint cavity. As a rule, this procedure does not require additional anesthesia.
Immobilization - immobilization - of the damaged joint plays a huge role in the treatment of synovitis. But this does not mean that during the entire course of therapy, the patient must abandon any physical activity. To reduce the load on the joint, it is enough to use a special orthosis or compression bandage.
In exceptional cases, plaster or tire may be applied. The maximum term of immobilization of the joint is 1 week.
Pharmacotherapy has several goals:
- relief of the inflammatory process;
- prevention of synovitis complications;
- reducing the frequency of recurrence of pathology.
When synovitis of the knee joint is assigned:
- NSAIDs. Drugs in this group eliminate inflammation and pain. Usually prescribed in the form of gels and ointments. The best options are drugs with diclofenac, ibuprofen, indomethacin. They can and should be combined with tablets and injectable NSAIDs.
- Inhibitors of proteolytic enzymes: Trasilol, Gordox. They are effective in protracted synovitis and its chronic form.
- Corticosteroids. Hormonal drugs are prescribed for neglected or severe pathological lesions of the knee joint. In this case, use Dexamethasone or Kenalog-40 by intraarticular injection.
- Antibiotics. They are prescribed for bacterial synovitis of the knee joint. In parallel with antimicrobial agents, probiotics should be taken to maintain healthy intestinal microflora.
- ATP, vitamin complexes, nicotinic acid help to stimulate the microcirculation of synovial fluid.
For about 3 days after the start of treatment, when the inflammation subsides a bit, physiotherapy sessions can be given to the patient. The following procedures help with synovitis:
- SMT (sinusoidal modulated currents). Such therapy may be prescribed at the very beginning of treatment if intense pain is present. CM-currents block the sensitivity of pain receptors, increase blood circulation, start the process of tissue regeneration. Heat therapy can be applied only at the initial (first) stage of the disease.
- Magnetotherapy. This procedure is based on the impact on the affected area of low-frequency electromagnetic pulses. Manipulation is assigned mainly to elderly patients, as well as patients with chronic synovitis. MT contributes to the restoration of joint mobility, the elimination of pain, tissue regeneration.
- Electrophoresis. This is the most effective method for this disease. Using electric pulses of a certain strength, the medicine is delivered directly to the tissues of the damaged joint. Due to this, puffiness is eliminated, inflammation disappears, pain is relieved, regenerative processes are launched.
You can supplement the main therapy with alternative medicine:
- Ice, made on the basis of salt water. In 1 liter of water dissolve 4 tbsp. l salt, pour liquid into ice forms and freeze. Apply ready ice cubes to the sore area and hold until complete melting. After the procedure, the leg should be wrapped with a warm scarf for 3 - 4 hours.
- Broth on the basis of bay leaf. 10 leaves pour 1.5 cups of water, boil for 5 minutes, insist 3 hours and strain. Take at night for 3 days, then take a week break and drink 3 more days. A second course of therapy can be carried out in a year. All broth needs to be drunk for 1 time, preparing daily a new portion.
- Ointment of comfrey. A glass of crushed comfrey root mixed with the same amount of lard. Soak in a dark, cool place for a week, then apply to rubbing the diseased area. On the basis of the comfrey root is prepared and liquid for rubbing. To do this, 150 g of raw materials need to pour 500 ml of vodka and insist the drug in a dark place for 2 weeks.
Folk remedies are not an independent method of therapy for synovitis, but are excellent as an auxiliary treatment.
Sometimes conservative treatment of synovitis is ineffective. In this case, arthroscopy is performed - a minimally invasive surgical procedure that allows to study the joint tissues and confirm or deny the diagnosis. If necessary, the synovial tissue is taken for further biopsy.
Arthroscopy can also be used for therapeutic purposes. The procedure allows the treatment of the inner part of the articular cavity with necessary medications. Due to this, it is possible to reduce the swelling, which makes it possible to continue to carry out therapy in the usual way.
Synovectomy - total or partial - is performed with chronic, often recurrent synovitis. During the operation, the diseased synovial tissues are removed, followed by a course of antibiotic therapy. In parallel, analgesics and physiotherapy sessions are prescribed.
It is important to ensure the immobilization of the joint for 7 days. But the patient is allowed to get up and walk from 2 days after surgery.Knee arthroscopy
To prevent the development of synovitis and the occurrence of complications it is necessary:
- eat rationally and fully;
- not to avoid physical exertion (but they should be moderate, feasible);
- maintain normal body weight;
- give up bad habits;
- seek medical help in a timely manner after any previous injury to the joints;
- to disinfect wounds in time, especially those that are close to the joints;
- It is necessary to treat tonsillitis, sinusitis, caries and other ENT and dental diseases;
- screen for dangerous infectious pathologies such as pulmonary tuberculosis (FG), syphilis (Wasserman reaction), gonorrhea (venereologist consultation), etc .;
- closely monitor the course of congenital abnormalities (for example, hemophilia);
- avoid allergies.
With the timely start of treatment and a slight course of synovitis, the prognoses for complete recovery are favorable. But with its purulent form, the risk of contractures and sometimes sepsis increases.
It is for this reason that it is categorically unacceptable to allow the development of the disease to a borderline state. When the first disturbing symptoms appear, you should immediately consult an orthopedic surgeon, rheumatologist or trauma surgeon.