Synovitis is an inflammatory process in the synovial membrane, accompanied by an accumulation of fluid (effusion) in the joint cavity. Pathology can develop as a result of trauma, infection, allergies, certain blood diseases, endocrine diseases and metabolic disorders. It is manifested by pain, an increase in the volume of the joint, weakness and malaise. When a purulent infection is attached, the pain increases, symptoms of general intoxication occur. The diagnosis is made on the basis of symptoms, examination of synovial fluid and other examinations. Treatment – immobilization, punctures, if necessary, drainage or surgery.
ICD 10
M65 Synovites and tenosynovites
Meaning
Synovitis is an inflammatory disease of the synovial membrane of the joint, accompanied by an accumulation of effusion. Occurs in some diseases and metabolic disorders. In some cases, it develops with injuries. The knee joint is more often affected, other joints (shoulder, ankle) are less likely to suffer. With injuries, the inflammatory process usually develops in one (injured) joint. In diseases and metabolic disorders, in some cases, several joints may be affected.
Causes
This pathology is a polyethological condition that occurs with injuries (including in the long-term period), deforming arthrosis and arthritis of various etiologies. It can be detected with the development of an allergic reaction, metabolic and endocrine disorders, hemophilia.
Classification
Taking into account the course in traumatology and orthopedics, there are:
- Acute synovitis – accompanied by thickening, fullness and swelling of the synovial membrane. The effusion is a translucent liquid, sometimes with flakes of fibrin visible to the naked eye.
- Chronic synovitis is manifested by the development of fibrous changes in the joint capsule. In some cases, the villi of the synovial membrane grow, fibrinous overlays appear on the shell, hanging from the joint cavity (villous synovitis). During separation, the overlays transform into so-called “rice corpuscles”, which move freely in the articular fluid and additionally injure the synovial membrane.
Taking into account the type of inflammation and the nature of the effusion, there are:
- Serous synovitis.
- Serous fibrinous synovitis.
- Hemorrhagic synovitis.
- Purulent synovitis.
Taking into account the cause of occurrence , there are:
1. Infectious synovitis. It occurs as a result of pathogenic microorganisms entering the joint cavity. The causative agent of infection can penetrate into the synovial membrane from the external environment (with penetrating wounds of the joint), from surrounding tissues (with purulent wounds and ulcers located near the joint), as well as from distant foci of infection. In the latter case, microorganisms enter the joint through lymphatic or blood vessels.
- Nonspecific infectious synovitis. It is caused by non-specific pathogens: pneumococci, staphylococci, streptococci, etc.
- Specific infectious synovitis. It is caused by pathogens of specific infections: pale treponema (with syphilis), tuberculosis bacillus (with tuberculosis), etc.
2. Aseptic synovitis. There are no pathogenic microorganisms in the joint cavity, the inflammation is reactive. The reason for the development may be:
- Mechanical injury (intra-articular fractures, joint bruises, ligament tears, meniscus injuries, etc.).
- Irritation of the synovial membrane by freely lying articular bodies or a structure damaged as a result of a previous injury (torn meniscus, damaged cartilage, etc.).
- Endocrine diseases.
- Metabolic disorders.
- Hemophilia.
3. Allergic synovitis. The cause of the occurrence is the patient’s contact with the allergen.
Symptoms
Nonspecific acute serous process is accompanied by an increase in the joint volume. The contours of the joint are smoothed out, in some cases there is a feeling of bursting. Sometimes there is a mild pain syndrome. Possible malaise, slight increase in general and local temperature. Movements are limited, the feeling of the joint is weak or moderately painful. During palpation, fluctuation is determined. The test is carried out as follows: the surgeon puts his fingers on opposite surfaces of the joint and then gently presses on one side; if there is a push under the fingers of the other hand, then there is fluid in the joint. When examining the knee joint, balloting of the patella is also detected: when pressed, the patella “sinks” all the way into the bone, and when the pressure stops, it “pops up”.
Acute purulent synovitis is accompanied by vivid clinical manifestations. The patient’s condition worsens, there are signs of acute intoxication: fever, chills, sharp weakness. In severe cases, delirium is possible. There is a pronounced pain syndrome. The joint is swollen, enlarged in volume, the skin above it is hyperemic. Movements are painful, joint contracture may develop. In some cases, regional lymphadenitis (enlargement of nearby lymph nodes) is detected.
Chronic synovitis can be serous, but more often refers to one of the mixed forms: serous fibrinoid, vileznohemorrhagic, etc. The disease is usually accompanied by poor clinical symptoms, especially in the early stages. The patient is concerned about minor aching pains, with repeated movements there is a rapid occurrence of “fatigue”, “fatigue” of the joint on the sick side.
Complications
In acute and chronic aseptic synovitis, infection of the effusion with the development of more severe infectious synovitis is possible. If the infectious process spreads beyond the synovial membrane and passes to the fibrous membrane, purulent arthritis occurs. With the further spread of the process to the surrounding tissues, phlegmon of soft tissues or periarthritis may develop. A serious complication of infectious synovitis is panarthritis, in which all structures involved in the formation of the joint are involved in the purulent process: bones, cartilage and ligaments. In some cases, sepsis may develop as a result of the purulent process.
Long-term chronic aseptic synovitis is also fraught with unpleasant complications. The joint gradually increases in volume, since excess fluid does not have time to be absorbed back into the synovial membrane. In the absence of treatment in such cases, hydrarthrosis (dropsy of the joint) develops. The prolonged existence of hydrarthrosis causes looseness of the joint. His ligaments gradually weaken, subluxation or even dislocation may occur.
Diagnostics
The diagnosis is made on the basis of clinical signs, diagnostic puncture data and other studies. At the same time, it is important not only to confirm the presence of synovitis, but also to identify the cause of its occurrence, which in some cases is quite a difficult task. Arthroscopy and arthropneumography may be prescribed to clarify the diagnosis of the underlying disease in acute and chronic aseptic synovitis. Synovial membrane biopsy and cytological examination may also be required. If hemophilia, endocrine or metabolic disorders are suspected, appropriate tests are prescribed. If the allergic nature of the disease is suspected, allergic tests are carried out.
One of the most informative studies is the study of punctate (fluid obtained as a result of diagnostic puncture). The study of effusion in the acute aseptic traumatic form of the disease indicates a large amount of protein, which confirms the high permeability of blood vessels. Due to the decrease in the amount of hyaluronic acid, the viscosity of such an effusion is lower than that of a normal synovial fluid. In chronic inflammatory processes, increased activity of enzymes (chondroproteins, hyaluronidase, lysozyme, etc.) is detected. D.), which leads to disorganization and accelerated destruction of cartilage.
With purulent synovitis, pus is detected in the punctate, which is examined by bacteriological or bacterioscopic methods. This makes it possible not only to determine the type of pathogenic microorganisms that caused inflammation, but also to choose the most effective antibiotics. In addition, patients with this form of the disease must be prescribed a blood test. According to the results of the analysis, an increase in ESR, an increase in the number of rod-shaped neutrophils and leukocytosis are revealed. If sepsis is suspected, blood is additionally seeded for sterility.
Treatment
If the cause of the disease is established and there is a small amount of fluid in the joint, outpatient treatment. If the effusion in the joint appeared as a result of injury, the patient is referred to a trauma specialist for outpatient treatment. Secondary symptomatic synovitis is treated by doctors of the appropriate profile: hematologists, endocrinologists, etc. Acute aseptic synovitis of unclear etiology, as well as synovitis with a large amount of effusion is an indication for hospitalization in a hospital. Patients with traumatic synovitis are hospitalized in the trauma department, patients with purulent synovitis – in the surgical department, the rest – in the departments corresponding to the profile of the underlying disease.
With aseptic synovitis with a small amount of effusion, tight bandaging of the joint, immobilization and elevated position of the limb are prescribed. The patient is referred for UV irradiation, UHF or electrophoresis with novocaine. With a large amount of effusion, in addition to the listed therapeutic measures, therapeutic joint punctures are performed. With persistent flow, phonophoresis with hydrocortisone and electrophoresis with hyaluronidase or potassium iodide are prescribed.
Treatment of acute purulent synovitis provides for mandatory immobilization with the provision of an elevated position of the limb. With a mild course, the pus from the joint cavity is removed by puncture. With a purulent process of moderate severity, continuous long-term flow-aspiration washing of the joint cavity with a solution of antibiotics may be required. In severe cases, an autopsy and drainage of the joint cavity is performed.
In chronic aseptic synovitis, therapy of the underlying disease is carried out. The tactics of treatment of synovitis is determined individually, taking into account the severity of the disease, the presence or absence of secondary changes in the joint, etc. Punctures are performed, provide rest of the limb. Nonsteroidal anti-inflammatory drugs, salicylates, glucocorticoids, calf cartilage extract and chymotrypsin are prescribed. On day 3-4, the patient is referred for ozokerite, paraffin, magnetotherapy, phonophoresis, UHF and other physiotherapy procedures. With significant infiltration and frequent relapses, aprotinin is injected into the joint cavity.
With chronic synovitis, accompanied by irreversible changes in the synovial membrane, as well as with prolonged and persistently recurrent forms of synovitis, surgical intervention is indicated – complete or partial excision of the synovial membrane. In the postoperative period, rehabilitation therapy is carried out, which includes immobilization, the appointment of anti-inflammatory drugs and antibiotics, as well as physiotherapy.
Prognosis and prevention
In acute aseptic and allergic synovitis, the prognosis is usually favorable. After adequate therapy, the inflammatory phenomena are completely eliminated, the effusion in the joint disappears, the movements are preserved in full. With a purulent form of the disease, contractures may form in some cases, in severe cases, the development of dangerous complications that threaten the patient’s life is not excluded. With chronic aseptic synovitis, stiffness may develop. After synovectomy, relapses and the development of contractures are observed in a number of cases. Prevention consists in the prevention of injuries, timely treatment of diseases that can cause synovitis.