Synovitis - Causes, symptoms and treatment. MF.

Synovitis is an inflammation of the synovium, which is limited by its limits and is characterized by an accumulation of inflammatory effusion in the cavity lined with this membrane. As a synovial cavity lined in this inflammatory process, there may be a synovial bag( a small flattened cavity lined with a synovial membrane, delimited from the surrounding tissues by a capsule and filled with synovial fluid), a synovial vagina of the tendon, articular cavities. Most often, the joints( knee, elbow, ankle, and wrist) are affected, while one joint is affected, and more rarely several.

Depending on the nature of the clinical course of the disease, synovitis is divided into acute and chronic.

Acute synovitis is manifested by edema, fullness of the synovial membrane and thickening of it. With the progression of inflammatory changes in the joint cavity or synovial membrane, an effusion occurs, which is an exudate of a yellowish color with fibrin flakes.
Chronic synovitis is accompanied by thickening of the fibrous membrane of the joint capsule and the formation of fibrosis( consolidation of connective tissue with the appearance of cicatricial changes).In some cases, the growth of the synovial villus and the deposition of napiform organized fibrin overlays occur, which like the brushes hang down into the joint cavity( the so-called chronic villous synovitis).With the loosening of the villi, "rice corpuscles" are formed that resemble the grain of rice.

Depending on the nature of the inflammatory process and effusion, there are serous, hemorrhagic, serous-fibrinous and purulent synovitis.

Causes of synovitis

Because of the emergence of the following groups of synovitis:
1) infectious synovitis develops due to the entry of pathogenic microorganisms into the synovial membrane, where they penetrate from the environment, as well as contact, hematogenous( with blood flow) or lymphogenic( with currentlymph) through infectious foci within the body:
b) nonspecific synovitis is caused by pathogenic microorganisms that cause in the synovial membrane non-specific inflammation( withreptokokki, staphylococci, pneumococci and others);
a) Specific synovitis is caused by pathogenic microorganisms that cause specific inflammation in the synovium( for example, tuberculosis mycobacteria or syphilis pathogens - pale treponema);
2) aseptic synovitis occurs in the following conditions:
a) with repeated mechanical injuries of the joint( so-called reactive synovitis);B) with hemophilia;C) for metabolic disorders;D) with endocrine disorders.
3) Allergic synovitis that occurs as a result of the action on the synovial tissue of allergens non-infectious and infectious, provided it is hypersensitive to these allergens.

Symptoms of synovitis

In acute serous nonspecific synovitis, the joint shape changes, its contours smooth out, the body temperature increases, soreness appears when the joint feels, joint effusion starts to accumulate, which is especially noticeable in the knee joint, since it manifests itself by the so-called symptomballotation patella: with a straightened leg pressing on the patella leads to its immersion in the joint cavity until it stops in the bone, but after stopping overpatella infusions like "pops."There is a restriction and painful movements in the joint, as well as general weakness, malaise.

Synovitis of the right knee joint.

In the case of acute purulent synovitis , the symptoms of the disease are much more severe than in the serous synovitis. Purulent synovitis is characterized by the severity of the general condition of the patient, expressed in the form of general weakness, chills, high body temperature, and sometimes - in the appearance of delirium. The smoothness of the contours of the affected joint is determined, the redness of the skin above it, soreness and restriction of movements in it, in some cases - its contracture( restriction of passive movements in the joint).Purulent synovitis may be accompanied by regional lymphadenitis( enlarged lymph nodes due to inflammation).In those cases when acute purulent synovitis is not cured, its relapse is possible.

For the initial period of of chronic serous synovitis , the clinical signs are weak. Patients complain of rapid fatigue, fatigue arising during walking, some restriction of movements in the affected joint, and the appearance of aching pains. There is an accumulation in the joint cavity of an abundant amount of effusion, which leads to the development of hydrarthrosis( dropsy of the joint).In the case of a prolonged existence of hydrocephalus, the ligaments of the joint are stretched, which causes joint loosening, subluxation or, in some cases, dislocation.

Complications of synovitis

Purulent arthritis - develops when the suppurative process caused by acute purulent synovitis spreads to the fibrous membrane of the joint capsule.
Periarthritis and phlegmon of soft tissues - develops when the purulent process spreads from the synovial cavity with an acute purulent synovitis to the surrounding tissue. Purulent arthritis, periarthritis and phlegmon are accompanied by local manifestations: the joint area significantly increases in size, there is edema of the tissues, a sharp redness of the skin over the joint.
Panartrite - develops when bones, cartilage and ligament are involved in the purulent process.

Examination and laboratory diagnostics with synovitis

Diagnosis of synovitis allows for the characteristic localization of the pathological process and the data obtained during clinical investigation, as well as the results of diagnostic puncture.

In addition, in the laboratory examination with acute purulent synovitis in the general blood test( UAC), leukocytosis( white blood cells increase over 9 x 109 / L) is detected with an increase in the percentage of stab neutrophil forms( above 5%), an increase in ESR(erythrocyte sedimentation rate).The pus obtained by puncture is examined by bacterioscopy( laboratory examination of the material under a microscope after its special coloration) and bacteriological( isolation of a pure culture of microorganisms on nutrient media) by methods that not only make it possible to establish the nature of the pathogen, but also to determine its sensitivity to antibacterial drugs.

In cases where the course of acute purulent synovitis is complicated by sepsis( when the pathogen is spread from the purulent focus to the blood stream), the blood is sterilized( seeded), which also makes it possible to establish the nature of the pathogenic microorganism that caused the purulent process and determine its sensitivityto antibacterial drugs.

Cytological examination of the fluid obtained by puncture( examination under a microscope of cells in a liquid under the microscope) is also practiced and specific serological reactions are performed( determination of specific antibodies to a particular pathogen in the patient's blood serum).

In secondary synovitis, the examination is aimed at identifying the underlying disease that caused synovitis.

Treatment of synovitis

Treatment of acute serous synovitis begins with the immobilization of the limb with a gypsum tire. In the initial stage of synovitis, UHF therapy, UV irradiation, Novocain electrophoresis are prescribed, warming compresses with 10-20% dimexide solution are used. In the case of persistent synovitis, electrophoresis is administered with potassium iodide or lidase, as well as phonophoresis with glucocorticosteroids( hydrocortisone).If the synovitis is accompanied by a significant amount of effusion in the synovial cavity, punctures of the corresponding joint are indicated with the possible introduction of antibiotics( selected on the basis of determining the susceptibility of the pathogens) into the joint cavity or intramuscularly.

With , the easy course of the synovitis of is enough to restrict immobilization of the limb and tight bandage of the joint until the effusion in the joint cavity disappears completely and the inflammatory changes in the periarticular soft tissues are eliminated and the physiotherapy procedures are prescribed.

Knee joint puncture

In treatment of acute purulent synovitis , special attention is paid to providing adequate immobilization of the affected limb with a gypsum tire or dressing and carrying out powerful local and general antibiotic therapy. Pus from the joint cavity is removed by means of its puncture, after which antibiotics of a broad spectrum of antimicrobial action, hydrocortisone and novocaine are administered there. Also, a continuous continuous flow-aspiration washing of the joint cavity with non-concentrated solutions of antibiotics through two thin drains is also used. In the case of a severe course of purulent synovitis, they resort to opening and draining the joint cavity.

Treatment of chronic serous or serous-fibrinous synovitis provides resting of the affected limb, performing joint puncture, the appointment of physiotherapeutic procedures( electrification, paraffin applications, mud therapy and others).It is necessary to identify and treat the underlying disease that caused the onset of chronic synovitis. In some neglected cases, it is necessary to resort to surgical treatment - performing synovectomy, which is reduced to complete or partial excision of the synovial membrane of the joint capsule and is performed under endotracheal anesthesia.

Prognosis for synovitis

The prognosis for synovitis largely depends on the nature of the pathogen and the initial state of the patient's body. In addition, the timely and correctly begun treatment is of great importance for the prognosis. Complete recovery, which implies the preservation of movements in the joint, is more often observed with a serous and allergic synovitis. In other forms of the disease, the formation of stiffness or complete immobility in the joint is possible. In severe acute purulent synovitis, the development of sepsis is possible, which often creates a threat to the life of the patient.

Doctor surgeon Kletkin ME