Synovitis of the ankle.

Synovitis is an inflammation of the joint capsule, in which a lot of fluid accumulates in its cavity.

All large joints can be affected, but ankle damage is not so common. According to the nature of the inflammation, synovitis can be:

• Serous;
• Serous-fibrinous;
• Hemorrhagic;
• Purulent.

Causes of synovitis of the ankle joint

The causes of synovitis of the ankle joint can be different.

Depending on the nature of the cause of occurrence, inflammation of the joint capsule can be:

• Infectious. Develops when microbes penetrate the synovial sac, especially common with injury and rupture of the joint capsule, as well as with the flow of blood and lymph from the affected tissues located nearby. (specific pathogens - streptococcal, staphylococcal, pneumococcal infection, nonspecific - pale treponema, tuberculosis bacillus, etc.).
• Aseptic. Occurs when:
  • joint trauma (fracture, contusion, damage to the ligament apparatus);
  • damage to the joint capsule due to an avulsion fracture, damage to the ligaments;
  • endocrine pathologies;
  • problems with metabolism;
  • congenital bleeding disorder.
• Allergic. Occurs as an allergic reaction to a specific allergen.

The causes of synovitis of the ankle joint are associated with serious diseases and injuries, and therefore require immediate medical attention and special treatment.

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Symptoms of ankle synovitis

Symptoms of ankle synovitis include:

• Hyperemia and increased temperature at the site of the diseased joint, movements are sharply limited and accompanied by pain;
• The articular joint is enlarged due to accumulated blood, pus, and serous effusion;
• With the purulent form of synovitis, the general body temperature increases.

In non-specific acute synovitis, the joint enlarges, there is a feeling of distension, pain when pressing and moving. When palpating the joint, a fluctuation is felt - a oscillation of fluid in the cavity of the joint capsule.

In acute purulent inflammation, the clinical manifestation is more pronounced - intoxication appears (temperature jump, feeling of weakness, chills). The joint is edematous, hyperemic, mobility is limited. The nearby lymph nodes are enlarged and painful.

In chronic serous or hemorrhagic synovitis, there is no violent clinical manifestation. The disease develops slowly, the pain is aching in nature, manifested by monotonous movement in the joint articulation.

Symptoms of ankle synovitis indicate very serious concomitant diseases that require urgent specialist consultation and qualified treatment. Otherwise, serious life-threatening diseases may develop.

Reactive synovitis of the ankle joint

Reactive synovitis of the ankle joint is an allergic form of inflammation that develops as a result of contact with an allergen and its entry during an injury or concomitant disease. Inflammation can develop without previous injuries and physical exertion; a small cut or release of a toxin in some diseases is enough. Sometimes the reactive form develops with unstable fixation of the joint, so it is better not to postpone a visit to the doctor to clarify the diagnosis.

The reactive form manifests itself quite violently - severe pain is disturbing, movement is limited, muscle activity is reduced, and the ligamentous apparatus weakens due to the passivity of the limb. At this stage, urgent medical intervention and step-by-step treatment with subsequent restoration of the entire range of functions of the joint articulation and limb will be required.

To diagnose and identify the pathogen, a puncture of the joint cavity is performed and a bacteriological analysis of the contents is carried out. Based on the analysis data, antibacterial therapy is prescribed (if necessary).

This disease is often found in athletes involved in football, hockey, and runners. For prevention, it is better not to miss routine medical examinations, and in case of injuries or pain in the joint articulation, immediately seek help from a doctor.

Diagnosis of synovitis of the ankle joint

Diagnosis of ankle synovitis is based on clinical findings and intra-articular puncture results. The main task at this stage is not only to confirm the diagnosis, but also to identify the causes and pathogen. In acute and chronic synovitis, arthroscopy and artropneumography are performed, and in some cases, a biopsy of the joint capsule is performed for cytological examination of tissues.

If concomitant diseases are suspected (probability of hemophilia, endocrine disorders, metabolic pathologies), a series of special tests are prescribed. If allergic etiology is suspected, a test for a hidden allergen is performed.

To identify the pathogen, a puncture of the ankle joint capsule is performed. The obtained contents are sent for bacteriological analysis to identify the nature of the pathogens and their sensitivity to bacterial drugs. Also, such characteristics of the effusion as viscosity, percentage of protein compounds, chondroprotein, hyaluronidase, lysozyme, etc. are of important diagnostic treatment - the presence of these components indicates the destruction of the cartilaginous layer of the articular surface. In the purulent form, not only the purulent contents of the joint capsule are examined, but also a blood sample is taken from a vein for bacteriological examination to exclude the possibility of septicemia.

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Treatment of synovitis of the ankle joint

Treatment of ankle synovitis can be conservative and surgical. In case of synovitis of clarified etiology, treatment can be outpatient. If a case of secondary synovitis is recorded, then an additional consultation with a hematologist and endocrinologist is prescribed. If the effusion in the joint cavity is serous and accumulates quickly, then hospitalization is indicated. If the inflammation is a consequence of injury, then treatment in the traumatology department is indicated; in the acute purulent form, treatment is carried out in the surgical department.

In the treatment of the aseptic form, tight bandaging of the joint articulation and limitation of motor activity are sufficient. If necessary, painkillers and anti-inflammatory drugs, therapeutic lavage of the joint can be prescribed. During the rehabilitation period, UHF, electrophoresis and other physiotherapeutic procedures are prescribed. In the case of a protracted course, electrophoresis is carried out using lidase, potassium iodide. Phonophoresis is also indicated.

The purulent form requires mandatory immobilization of the limb. In mild cases, purulent contents are removed by puncture; in severe cases, opening and drainage of the joint cavity with mandatory washing with antibiotics and administration of antibiotics and painkillers inside is indicated. In the postoperative period, further treatment and rehabilitation are carried out.

In chronic cases, the underlying pathology is treated first, taking into account the severity of the disease and secondary changes in the joint cavity. The course of conservative treatment includes anti-inflammatory drugs, analgesics, glucocorticoids, rumalon, achimotrypsin are indicated, and in severe cases, the use of contrical and trasylol is recommended. Physiotherapeutic procedures are prescribed from day 3-5.

At the rehabilitation stage, you can also use some folk methods, but only after a preliminary consultation with a doctor. Herbal infusion: mistletoe, oregano, St. John's wort, thyme, eucalyptus, bearberry, tansy, valerian, calendula, licorice, marshmallow root, calamus rhizome, is prepared at the rate of 1 teaspoon of each name per 500 ml of boiling water. Drink as tea one or two hours after meals for 2 months.

Prevention of synovitis of the ankle joint

Prevention of synovitis of the ankle joint is carried out in two directions, including proper treatment of inflammation foci in the body and concomitant diseases and mandatory warm-up before competitions, physical activity. It is also worth protecting bones and ligaments from injuries during falls, sprains, torn ligaments, and it is imperative to eat right to strengthen the skeleton and ligaments. The diet must necessarily include food containing gelatin, vitamins C and D, agar-agar, phytoncides.

Prognosis of ankle synovitis

The prognosis for ankle synovitis is favorable with proper treatment, but if doctor's orders and medications are not followed, the following complications are possible:

• Development of a purulent form of arthritis - if purulent inflammation has spread to the fibrous layer of the joint capsule.
• Deforming form of arthrosis – damage to the healic cartilage. It is the most common and develops over a long period of time.
• Development of panarthritis – when not only the cartilage, but also the bones and ligaments become inflamed.
• Development of hydrarthrosis is the accumulation of exudate in the joint cavity.
• Development of Baker's cyst, which is characterized by increased thrombus formation, circulatory disorders, numbness of adjacent tissues, convulsions. Subsequently leads to trophic disorders, gradual necrosis and loss of the limb.
• Ossification and fusion of the joint. Leads to complete immobility in the articular joint.
• Recurrent cases of synovitis after excision of the joint capsule.
• The transition of purulent melting to adjacent tissues manifests itself in the form of phlegmon and periarthritis.
• Penetration of infectious agents into the bloodstream and the development of sepsis – blood poisoning, leading to death.

The prognosis for synovitis of the ankle joint in aseptic and allergic forms is favorable - the restoration of all joint functions occurs in full. In the chronic course, stiffness and limitation of movement in the joint are formed. In the purulent form, contracture is formed, there is a high probability of blood poisoning and severe diffuse purulent lesions of adjacent tissues.