Synovitis - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Musculoskeletal System.

Synovitis - inflammation of the synovial membrane, which is limited to its borders, and is characterized by the accumulation of inflammatory exudate in the lining of the cavity shell.As the synovium lining cavities, involved in the inflammatory process, may act bursa (small flattened form a cavity lined with synovial membrane, demarcated from the surrounding tissue capsule and filled with synovial fluid), synovial sheath tendon, joint cavity.Most often there is a defeat of the joints (knee, elbow, ankle, wrist), the characteristic lesion of the joint, at least - at the same time a few.

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

acute synovitis manifested edema, congestion and thickening of the synovial membrane of her.With the progression of inflammatory changes in the joint cavity or the formation of the synovial membrane effusion, which is a yellowish exudate with flakes of fibrin.
Chronic synovitis accompanied by a thickening of the j

oint capsule of fibrous membranes and the formation of fibrosis (connective tissue seal with the appearance of scarring).In some cases there is a proliferation of synovial villi and deposition of fibrin vorsinopodobnyh organized overlays that like brushes hang in the joint cavity (called villous chronic synovitis).When the villi are formed otshnurovyvanii "rice bodies", resembling grains of rice.
Depending on the nature of the inflammatory process and effusion distinguish serous, hemorrhagic, seroplastic and purulent synovitis.

Causes synovitis

Due to the occurrence of the following groups of synovitis:
1) infectious synovitis develop due to ingress of pathogens into the synovium, where they penetrate from the environment, as well as contact, hematogenous (through the blood) or lymphogenous (with shock lymph) by means of infectious foci in the organism:
b) non-specific synovitis caused by pathogenic microorganisms that cause in the synovium nonspecific inflammation (streptococci, staphylococci, pneumococci, and others);
a) specific synovitis caused by pathogenic microorganisms that cause specific inflammation in the synovium (eg, tuberculous mycobacteria or syphilis - treponema pale);
2) aseptic synovitis occur under the following conditions:
a) with repeated mechanical joint injuries (the so-called reactive synovitis);
b) in hemophilia;
c) in metabolic disorders;
g), endocrine disorders.
3) Allergic synovitis, which result from actions on synovial tissue allergens and infectious non-infectious nature, provided it increased sensitivity to these allergens.

symptoms of synovitis

Acute serous nonspecific synovitis is a change of joint shape the contours of its smoothed, there is an increase in body temperature, there is pain when the joint palpation, in the joint cavity begins to accumulate effusion, which is especially noticeable in the knee joint, as shown socalled a symptom of balloting the patella: the straightened leg pressure on the kneecap causes it to dive into the joint cavity completely into the bone, but after the termination of pressing the kneecap as it "floats".There restriction and pain in the joint movements, as well as general weakness, malaise.

Synovitis right knee.

If acute purulent synovitis noted significantly greater severity of symptoms than in serous synovitis.For purulent synovitis is characterized by the severity of the patient's general condition, expressed in Razka general weakness, chills, high body temperature, sometimes - in the emergence of delirium.Determined smoothed contours of the affected joint, redness of the skin over him, tenderness and limitation of movement in it, in some cases - it's contracture (the restriction of passive joint movement).Purulent synovitis may be accompanied by regional lymphadenitis (swollen lymph nodes due to inflammation).In cases where acute purulent synovitis nedolechen, it is possible relapse.

For the initial period chronic serous synovitis characterized by a weak severity of clinical manifestations.Patients complain of fatigue that occurs when walking fatigue, some restriction of movement in the affected joint, the appearance of aching pain.There is accumulation in the joint cavity copious amounts of exudate, leading to the development hydrarthrosis (joint dropsy).In the case of long-term existence of dropsy of the joint ligaments are stretched, which causes joint laxity, subluxation, or, in some cases, dislocation.

Complications synovitis

purulent arthritis - razvmvaetsya the propagation of purulent process caused by acute purulent synovitis, fibrous membrane in the joint capsule.
Periarthritis and soft tissue abscess - developing the propagation of purulent process of the synovial cavity in acute purulent synovitis of the surrounding tissue joint.Purulent arthritis, periarthritis and abscess accompanied by local symptoms: joint region significantly increases in size, there is swelling of the tissue, the sharp reddening of the skin over the joint.
panarthritis - developed with the involvement in the process of purulent bone, cartilage and ligaments.

survey and laboratory diagnostics in synovitis

diagnose synovitis characteristic allows localization of the pathological process and the data obtained in the clinical trial and the results of diagnostic puncture.

Furthermore, in laboratory testing for acute purulent synovitis in the general analysis of blood (UAC) is determined by leukocytosis (increased white blood cells (WBCs) of more than 9 x 109 / l) with the increase of percentage of band forms of neutrophils (over 5%), increasedESR (erythrocyte sedimentation rate).The resulting puncture pus investigated smear microscopy (laboratory research material under the microscope after a special color) and bacteriological (isolation of pure cultures of microorganisms on nutrient media) methods, which not only makes it possible to establish the nature of the pathogen, but also to determine its sensitivity to antibacterial prparatam.

Where for acute purulent synovitis complicated by sepsis (in the propagation of the infectious agent of purulent focus in the bloodstream), produced a study (culture) of blood for sterility, which also makes it possible to establish the nature of the pathogen that caused the purulent process and determine itssensitivity to antibiotics.

also practiced cytology obtained by puncture liquid (microscopic examination of cells in a liquid) and carrying out specific serological tests (determination of specific antibodies in the serum of the patient's blood to a particular pathogen).

In secondary synovitis survey aims to identify the underlying disease, which was the cause of synovitis.

Treatment of synovitis

Treatment of acute serous synovitis begins with limb immobilization using plaster tires.In the initial stage of synovitis assigned UHF therapy, ultraviolet irradiation, electrophoresis with novocaine, apply a hot compress to 10-20% solution Dimexidum.In the case of persistent synovitis flow assigned electrophoresis with potassium iodide or Lydasum and phonophoresis with corticosteroids (hydrocortisone).If synovitis accompanied by a significant volume of exudate in the synovial cavity, showing the respective joint puncture with the possible introduction of antibiotics (selected on the basis of susceptibility to pathogens of them) into the joint cavity, or intramuscularly.

When lung during synovitis sufficient to limit the immobilization of a limb and tight bandaging of the joint up to the complete disappearance of effusion in the joint cavity and elimination of inflammatory changes in the periarticular soft tissues, as well as the purpose of physiotherapy.

puncture knee joint

in the treatment of acute suppurative synovitis special attention is paid to ensuring adequate immobilization of the affected limb using a bandage or plaster tires and holding a strong local and systemic antibiotic therapy.Pus from the articular cavity is removed by puncture it, and then to introduce broad-spectrum antibiotics antimicrobial action, hydrocortisone and procaine.Also used long, continuous flow-suction flushing joint cavity of dilute solutions of antibiotics through the two thin drainage.In the case of heavy flow of purulent synovitis resort to incision and drainage of the joint cavity.

Treatment of chronic serous or seroplastic synovitis provides for the rest of the affected limb, joint implementation of punctures, the appointment of physiotherapy (electrification, paraffin baths, mud, etc.).It is necessary to identify and treat the underlying disease that caused the occurrence of chronic synovitis.In some severe cases have to resort to surgical treatment - implementation of synovectomy, which is reduced to a total or partial excision of the synovial membrane of the joint capsule and is performed under endotracheal anesthesia.

prognosis of synovitis

prognosis of synovitis in many respects depends on the nature of the pathogen and the initial state of the patient's body.In addition, of great importance for the forecast is a timely and proper treatment initiated.Full recovery, implying the conservation movement in the joint, most often observed in serous and allergic synovitis.In other forms of the disease, the formation of stiffness or total immobility of the joint.In severe course of acute purulent synovitis may develop sepsis, which often poses a threat to the life of the patient.

Surgeon Kletkin ME