Synovitis

Synovitis is an inflammation of the synovial membrane, which is limited to its boundaries and is characterized by the accumulation of inflammatory effusion in the cavity lined by this membrane.

The synovial bursa (a small flattened cavity lined with synovial membrane, separated from surrounding tissues by a capsule and filled with synovial fluid), synovial sheath of the tendon, and joint cavities may act as synovial-lined cavities involved in this inflammatory process. It often occurs (knee, elbow, ankle, wrist). These processes are characterized by damage to one joint, less often - several at the same time.

ICD 10 code

Excluded here: chronic crepitant inflammation of hand and wrist (M70.0) current injury - ligament or tendon injuries by body region soft tissue disorders related to strain, overuse and pressure (M70.0)

• M65.0 This is the abbreviation for tendon sheath abscess. If necessary, an additional code (B95-B96) is used to identify the bacterial agent.
• M65.1 Means other infectious (teno) inflammations. M65.2 Calcifying tendinitis. In this case, the following are completely excluded: shoulder tendinitis (M75.3) and specified tendinitis (M75-M77).
• M65.3 Trigger finger Nodular tendon disease M65.4 Tenosynovitis of radial styloid process [de Quervain's syndrome]
• M65.8 Other inflammations and tenosynovitis. M65.9 Synovitis and tenosynovitis, unspecified. All these codes show the location of the disease and its types. Synovitis is a serious disease that requires a full investigation. Thanks to the localization code, you can understand the seriousness of the phenomenon and prescribe high-quality treatment.

Causes of synovitis

The causes of synovitis may depend on other diseases or directly on the trauma of diarthrosis. Most often, it manifests itself in diseases of a metabolic nature or associated with an autoimmune nature. If it occurs against the background of other diseases of the knee joint, then it is secondary. In this case, it can be defined as reactive suppuration.

Inflammation of the joint during synovitis is usually not accompanied by infection. Simply put, it is aseptic in nature. If the synovial bag is infected with various harmful agents, the fluid changes its composition. In this case, pathogenic microorganisms actively predominate at the site of the lesion, causing inflammation of a different kind, which leads to complications.

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Synovitis after surgery

Synovitis after surgery "behaves" normally. But it is advisable to monitor the patient's condition. After all, serious complications in the form of arthritis are not excluded. A decrease in the range of motion is possible due to irreversible changes in the synovial membrane or articular surfaces. The process also spreads to adjacent areas of the ligamentous apparatus.

The most severe complication of the infectious form of inflammation is sepsis, which is life-threatening. Sepsis (the appearance of the pathogen in the blood) in infectious synovitis can develop in people with a weakened immune system (for example, with HIV infection) or in the case of a long-term absence of treatment.

In any case, a person should be under the supervision of a specialist for a long time. Because relapses occur quite often and in many cases it is not so easy to avoid them.

Infectious synovitis

Infectious synovitis is usually provoked by pathogenic microorganisms that cause non-specific inflammation. These can be the following pathogens: staphylococci, strepto- and pneumococci. There is a specific type. These include tuberculosis mycobacteria.

Pathogenic microorganisms can penetrate into the joint during trauma and wounds (contact route), or be carried with lymph and blood from internal foci of infection (lymphogenous and hematogenous routes). This mechanism of disease occurrence is often found in people who suffer from arthritis and allergic diseases, as well as hemophilia.

It is worth noting right away that it is not so easy to get rid of this type of disease. After all, it occurs against the background of infection in the inflamed area. This process is easier to prevent by seeking help from a doctor in time. It is eliminated with medication, but it requires high-quality treatment. After all, repeated forms of the disease are not excluded.

Tuberculous synovitis

It is a bag form of the disease. It occurs hematogenously in the form of a rash of tubercles on the synovial membrane. Clinically, such primary arthritis, despite its duration, proceeds in most cases benignly. In most cases, effusion with thickening of the capsule is formed. But together they do not lead to caseous degeneration, do not cause destructive changes in either cartilage or bones and often end with the usual sanatorium-orthopedic treatment with the restoration of the joint function with full mobility. During the period of occurrence and initial development, primary synovial lesions on the knee joint in their manifestations are very similar to those observed in primary ostitis. As for non-specific reactive changes, they differ from them mainly in their constancy. In this respect, they are closer to the early manifestations of secondary synovitis, characterized by a triad of pain, muscle atrophy, and some limitation of function, but with more pronounced effusion and thickening of the capsule in the absence of contractures and with significant preservation of movement.

Allergic synovitis

Allergic synovitis is a type of reactive disease. Many patients are completely perplexed when diagnosed with this disease. After all, not many understand why they have developed this type of inflammation.

This form of pathology develops as a result of toxic or mechanical impact. This type of inflammation is characterized by the appearance of various allergic reactions.

Without specific morphological changes, this type is characterized by a milder, usually cyclical course. It is observed more often post-infectiously, during the recovery period from a usually mild acute infection. The impetus may be tonsillitis or the cessation of the acute period in dysentery. This type of inflammation is of particular interest to infectious disease specialists. After all, in its manifestations, it resembles a rare form. To date, there are no exact causes for the occurrence of the disease.

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Traumatic synovitis

Traumatic synovitis is quite common, especially in athletes. In acute manifestations of the disease, an increase in the volume of the joint is observed within a few hours. This type of disease is characterized by a change in the shape of the diarthrosis, smoothing of its contours, and an increase in temperature. Pain during palpation is possible. In addition, an effusion forms in the joint cavity, which is especially well detected in the knee joint by balloting the patella. Movements in the joint are limited and painful. Weakness, malaise, moderate increase in body temperature, and acceleration of ESR are noted.

In the purulent form of the disease, the symptoms are expressed more sharply than in the serous form. A severe general condition of the patient is characteristic. The contours of the diarthrosis are significantly smoothed out, reddening of the skin in the joint area, pain, limitation of movement, and contracture are observed. Often, regional lymphadenitis is detected during diagnostics. In some cases, the process spreads to the fibrous membrane of the joint capsule with the development of purulent arthritis and to the tissues surrounding the joint. The diarthrosis area is significantly enlarged, the tissues are pasty, the skin on the joints is sharply hyperemic and shiny. If the bones, cartilages, and ligamentous apparatus of the joint are involved in the inflammatory process, panarthritis develops. Untreated ailment can recur. Often, recurrent suppurations are accompanied by chronic forms of dropsy. They are characterized by further development of hypotrophy and its fibrosis. A vicious circle is formed, aggravating the phenomenon and development of degenerative-dystrophic processes in the diarthrosis.

Post-traumatic synovitis

Posttraumatic synovitis is the most common. This is the body's reaction to the destruction of diarthrosis tissue or its damage. In this case, the synovial membrane forms an effusion into the joint. It can also occur without visible damage outside the joint. This occurs in the case of irritation of the membrane as a result of movements of the articular body, damage to the cartilage or meniscus.

The diagnosis of the disease is carried out as follows. To determine the exact problem and the cause of the inflammatory process of the synovial membrane, it is necessary to find out from the patient whether the inflammation was preceded by trauma or any inflammatory disease. After all, this will allow us to distinguish rheumatoid arthritis from post-traumatic.

The acute form of the disease is characterized by an increase in the diarthrosis in volume lasting from several hours to several days. There is a change in shape, swelling of the knee, smoothing of the contours of the damaged and an increase in temperature in the area of the joint, painful sensations during palpation. The mobility of the joint is significantly limited, and the slightest movement causes acute pain. In this case, general weakness, increased body temperature, malaise are observed, and a blood test shows an acceleration of ESR.

Symptoms of synovitis

Symptoms of synovitis depend on the type of disease. In the acute serous non-specific form, a change in the shape of the joint is observed, its contours are smoothed out. An increase in body temperature is noted, pain is possible when palpating the joint, effusion begins to accumulate in the joint cavity. This phenomenon is especially clearly visible in knee diarthrosis, as it manifests itself as the so-called symptom of balloting of the patella. It is characterized by the following: with a straightened leg, pressing on the patella leads to its immersion in the joint cavity until it rests on the bone, but after stopping the pressure, the patella seems to "float up". Limited and painful movements in the joint, as well as general weakness and malaise are possible.

Acute purulent inflammation is characterized by significantly greater severity of the symptoms of the disease than the serous form. The purulent form is characterized by a severe condition of the patient. It is expressed in sharp general weakness, chills, high body temperature, and sometimes in the appearance of delirium. Often, smoothing of the contours of the affected diarthrosis, reddening of the skin above it, pain and limitation of movement in it are determined. Sometimes its contracture is encountered. Purulent inflammation can be accompanied by regional lymphadenitis. If this ailment is not cured, a relapse is possible.

The initial period of chronic serous suppuration is characterized by weak symptoms. Patients complain of rapid fatigue, fatigue that occurs when walking. All this can be accompanied by limited movement in the affected joint, the appearance of aching pain. Gradually, an abundant amount of effusion accumulates in the joint cavity. This phenomenon leads to the development of hydrarthrosis (dropsy of the joint). If dropsy on the diarthrosis exists for a long period, then its loosening is possible.

Synovitis of the knee joint

Synovitis of the knee joint can be varied. The reasons for this phenomenon are hidden in many ways. Inflammation of the synovial membrane develops against the background of metabolic and autoimmune diseases, such as arthritis, bursitis, hemophilia. Also, inflammation of the knee joint can "form" without visible external damage as a result of cartilage injuries, meniscus or insufficiency of the connective fluid of the knee joint.

Synovitis, the symptoms of which usually appear gradually, is protracted. Often, symptoms appear 2-3 days after infection. The fluid accumulated in the diarthrosis leads to deformation of the joint and limitation of movement. The skin around the knee joint does not become inflamed, the temperature is normal. The victim experiences pain, not very strong, but mainly nagging and prolonged.

In case of inflammation of the knee diarthrosis, it is very important to make a correct diagnosis, and not only to determine the disorder itself, but also to find out the reason why it happened. After all, in case of any mistake, a relapse is possible. For an accurate diagnosis, a puncture of the knee joint is performed. The surgeon slowly inserts a special needle into the cavity of the joint and carefully collects a little fluid, which is then sent for analysis. In the obtained "raw material", the level of blood cells, the amount of protein and the presence of harmful microorganisms are determined. In most cases, magnetic resonance imaging and arthroscopy are used, which allow you to determine the appearance of diarthrosis, as well as the condition of the cartilage and diagnose synovitis.

Synovitis of the hip joint

Synovitis of the hip joint is an inflammation of its synovial membrane with the formation of the so-called effusion. It should be noted that inflammation can develop in several joints. The disorder in this case is called gonitis, and is much more common.

The non-specific form often causes lameness in children, most often boys from 3 to 10 years old suffer from it. The malaise may appear after an acute respiratory viral infection or some injuries, but the exact cause-and-effect relationship has not yet been proven. If the cause of development was an infection from internal foci, then this indicates the presence of infectious suppuration, if due to injury - traumatic. Most often, the disease manifests itself spontaneously and develops quite quickly. Inflammation of the synovial membrane leads to the accumulation of fluid, resulting in a tumor of the joint.

Symptoms of inflammation may resemble those of tuberculosis. This is manifested in limited mobility of the diarthrosis, muscle spasm and pain. Fever is observed in rare cases, as is an increase in temperature. X-ray examination may show nothing in the early stages of the disease. The only thing that attracts attention is the widening of the joint space.

Gradually, night pains become an indicator that the joint pathology has begun an active phase of development. The danger of this disease is that it causes mild pain that can be safely tolerated for quite a long time, especially since it decreases in a state of rest. Ultimately, patients seek help late, and treatment in this case is difficult, because the disease is not so easy to eliminate.

Synovitis of the ankle joint

Synovitis of the ankle joint can be aseptic or infectious in its form. The infectious variation develops as a result of penetration of an infectious agent of any type into the synovial sac. The main causes of the aseptic type include: injuries, hormonal disorders, allergic conditions, neurogenic factors,

Inflammation of the ankle, accompanied by increased pain during palpation in the joint projection. If a pathological process begins to develop in the affected area, swelling and effusion immediately appear, and as a result, hyperemia is observed. Patients mainly complain of impaired joint function, they have an increase in body temperature, and the range of motion is limited.

It should be emphasized that synovitis of this type, as a rule, develops only in one diarthrosis and does not spread to several at the same time. Bilateral damage is very rare in clinical practice. However, such cases have occurred.

Synovitis of the shoulder joint

Synovitis of the shoulder joint is an inflammatory process that forms in the synovial membrane of the joint. It is also characterized by fluid accumulation. The disease, the symptoms of which are described in this article, in most cases occurs due to mechanical injury, infection or arthritis.

Symptoms of the disease. They mainly depend on the type of disease. During the acute traumatic form, the volume of the joint and its shape increase. The victim may also experience an increase in body temperature, limited movement of the diarthrosis, and general weakness. Purulent inflammation often has the following symptoms: severe weakness, chills, delirium, high body temperature. In some cases, redness of the skin in the area of the diseased joint, limited movement are observed. Recurrent suppuration is characterized by the occurrence of chronic dropsy.

To determine the type of disease, it is necessary to immediately seek help from a doctor when any symptoms appear. In more advanced cases, the disease is not so easy to cure.

Synovitis of the wrist joint

Wrist synovitis is not very common. However, it should be diagnosed immediately. The first step is to perform an MRI. It evaluates the structure of the distal radioulnar joint, midcarpal, intercarpal and carpometacarpal joints. All these joints are functionally interconnected and form a single wrist diarthrosis. Optimal diagnostics of structural changes in the bones that form these joints is achieved by performing magnetic resonance imaging.

Magnetic resonance imaging of the wrist area is generally indicated for all patients with trauma, pain in the diarthrosis, dysfunction and limited mobility. MRI results can provide the doctor with the most complete information about the condition of the bones that form the wrist joint, ligaments, tendons, articular disc and ligaments that make up the triangular fibrocartilaginous complex, as well as the ulnar nerve.

Magnetic resonance imaging helps to detect suppuration of the wrist joint and hand joints, as well as to fully assess the condition of the synovial membrane and the presence of pannus in suspected arthritis of various etiologies. The main cause of chronic pain and dysfunction in the wrist diarthrosis are paraarticular ganglion cysts and tendon tenosynovitis. They occur as a result of chronic stress in people whose activities are associated with fine manual labor. When conducting MRI, it is possible to reliably determine the localization, size of the cyst, assess its contents, the connection of the cyst with the joint or synovial membrane of the tendon, which is important in planning synovitis therapy.

Synovitis of the hand

Synovitis of the wrist is characterized by a gradual onset and slow progression. The disorder begins to manifest itself with periodically occurring swelling in the joint. As a rule, this is caused by the accumulation of hemorrhagic exudate in its cavity. During loads on the affected diarthrosis, pain may occur due to the pinching of the synovial membrane growths. Over time, swelling in the joint and arthralgia become permanent.

Movements in the joint are maintained in full for a long period, then stiffness gradually arises and increases. In special cases, periodic "blockades" of diarthrosis are observed, indicating the presence of a "joint mouse". A person cannot move his hand freely.

The involvement of the synovium of the mucous bags has the symptoms of bursitis and is most often found in the ankle joint. Involvement of the synovial membrane of the tendon sheaths leads to the development of severe tendovaginitis and is usually observed in the flexor and extensor tendons of the hand. The general condition of patients is usually not affected. Body temperature is normal.

Reactive synovitis

Reactive synovitis can be caused by allergies. Doctors try their best to eliminate the impaired functions of the affected joint. For this purpose, special general strengthening therapy is actively used, as well as therapeutic exercise and physiotherapy. The actions of doctors are mainly aimed not only at eliminating the cause, but also at relieving the symptoms of the disease. After all, dysfunction and pain mainly manifest themselves.

To relieve severe pain, various medications are used. Sometimes, to cope with this serious disease, the patient has to undergo surgery on the affected joint. It should be noted that surgical intervention remains an extreme measure. It is resorted to only in the absence of the effect of conservative treatment methods or a threat to the patient's health (development of sepsis).

If a person notices any signs of the disease. It is necessary to immediately seek help from a specialist. The symptoms are as follows: pain, sharp limitations of mobility, fever, and a change in the form of diarthrosis. The approach to treating patients is usually complex, and it is determined by the causes that provoked this ailment and the mechanism of development of the pathological process.

Acute synovitis

Acute synovitis occurs quite often. The disease is characterized by excessive accumulation of fluid in the joint. In children, inflammation often develops due to injuries. The disease can also occur against the background of inflammatory and infectious diseases, such as rheumatism, tuberculosis, syphilis and others.

With a genetic predisposition, as well as against the background of existing neuroendocrine disorders, inflammation can develop with any toxic effect on the body. This can even be a common flu. In this case, we are talking about the so-called reactive inflammation.

Acute suppuration often develops with infectious or traumatic damage to the joint. When injured, the integrity of the joint cavity is violated, resulting in an inflammatory process. Often the cause of such inflammation is the insufficiency of the ligamentous apparatus.

As a rule, one diarthrosis suffers when affected, but there are cases when the disease spreads to several joints at once. Most often, inflammation of the knee joint occurs, since it is subject to great loads and injuries.

A characteristic symptom of the acute form is severe pain in the affected diarthrosis. The pain increases significantly upon palpation. This form of inflammation is characterized by an increase in the joint volume over several hours or days. An effusion forms in its cavity, which can be easily determined by balloting the patella. The shape of the joint changes, and its contours are smoothed out. The movement of the diarthrosis is significantly limited. The patient may also have general symptoms: malaise, weakness, increased body temperature, and high ESR.

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Chronic synovitis

Chronic synovitis is relatively rare. At the initial stage, clinical manifestations are weakly expressed. Patients complain of rapid fatigue, fatigue when walking. A slight limitation of movement in the diseased joint and the presence of aching pain are possible. Exudate begins to accumulate abundantly in the joint cavity, resulting in dropsy. With prolonged existence of which, the ligaments of the joint are stretched. This process leads to its looseness, subluxation and even dislocation. In many cases, mixed types are observed: chronic serous-fibrinoid, chronic vilous and vilous-hemorrhagic.

In chronic serous-fibrinoid putrefaction or serous-fibrous suppuration, a large amount of fibrin is observed in the abundant effusion, which has fallen out in the form of individual threads and clots. They actively compact and thus form free intra-articular bodies.

Chronic villous synovitis is characterized by the presence of hypertrophied and sclerosed villi. They are capable of being pinched off with the formation of so-called rice bodies and chondromous bodies. In the chronic form of synovitis, the growth of pathological changes and clinical manifestations of the disease is caused not so much by the duration of the inflammatory process, but by the disruption of blood and lymph circulation in the diarthrosis capsule as a result of its fibrous degeneration.

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Minimal synovitis

Minimal synovitis is characterized by intense discomfort and swelling of the affected area. This form is characterized by changes in the joint due to the accumulation of serous fluid in its cavity. The mobility of the organ is significantly reduced, the ligamentous apparatus weakens and cartilage instability is observed. If minimal synovitis is diagnosed based on the examination, then it is sufficient to use a pressure bandage or a special patella.

In the infectious nature of the disease, local symptoms of inflammation are observed. This is an increase in the size of the affected tissues and an increase in local body temperature. In the acute form, serous fluid accumulates. If treatment is not started for a long time, purulent bodies may appear in it. In this case, the ends of the bones will also be involved in the process. Over time, signs of general intoxication will appear: high temperature, chills, pain, weakness.

Connective tissue with a purulent nature of inflammation significantly wrinkles, and scars form on it. Later, as a result of changes, there is a violation of the mobility of the joint. In children aged 3-8 years, transient putrefaction of the femoral diarthrosis is usually diagnosed. Such inflammation of the cartilage passes quickly, and occurs due to a viral infection, being the most common cause of obvious lameness in children of this age.

Moderate synovitis

Mild synovitis often accompanies OA, especially in the later stages, and may contribute to increased pain. This mechanism is supported by the reduction in pain in OA in response to NSAID treatment.

Pain caused by inflammation has long been the subject of serious attention, and currently the mechanisms of pain associated with inflammation are actively studied. The fact is that any peripheral pain is associated with an increase in the sensitivity of specialized neurons - nociceptors. They are able to create a signal recognized as pain. Increased sensitivity of the primary nociceptor in the affected peripheral tissue can lead to an increase in the activity of neurons that send a signal to the spinal cord and the central nervous system, but it should be emphasized that spontaneous electrical activity can be generated in the inflammation site, causing persistent pain syndrome.

The following pro-inflammatory components are powerful inducers of pain sensitivity: bradykinins, histamine, neurokinins, complement, nitric oxide, which are usually found in the inflammation focus. Particular attention is paid to prostaglandins, the accumulation of which correlates with the intensity of inflammation and hyperalgesia.

Violation of biomechanics in the affected joint can lead to the development of secondary periarticular syndromes - bursitis, tenosynovitis, etc. When collecting anamnesis and examining a patient with OA, it is necessary to determine what causes the pain - directly damage to the joint or inflammation localized in the joint bags and synovial sheaths. Based on this, it is decided how to eliminate synovitis.

Severe synovitis

Severe synovitis manifests itself with more severe symptoms. A person suffering from this type of inflammation is bothered by heaviness and pain in the diarthrosis area. With minor damage, the pain syndrome is weakly expressed and appears mainly during movements. With a severe form, the patient complains of pain and a feeling of distension even at rest. Movements are significantly limited. During examination, mild swelling of soft tissues, smoothing of contours and an increase in the size of the joint are revealed. Minor redness and an increase in local temperature may appear. Fluctuation is determined during palpation.

To confirm the diagnosis and clarify the cause of inflammation, a puncture of the joint is performed with subsequent cytological and microscopic examination of the synovial fluid. According to the indications, the patient is often referred for consultations to various specialists. Basically, these are: a rheumatologist, a phthisiologist, an endocrinologist and an allergist. If necessary, additional studies are prescribed: X-ray of the ankle diarthrosis, ultrasound, CT of the joint and MRI of the ankle joint, allergy tests, blood tests for immunoglobulins and C-reactive protein, etc.

Villonodular synovitis

Villonodular synovitis is a non-malignant disorder. It is characterized by synovial proliferation, hemosiderin pigmentation, formation of nodular masses, villi, and pannus. The disorder is rare and occurs more frequently in young adults.

Symptoms. PVS can be suspected in the presence of a chronic disease. Mostly the knee joint becomes inflamed, other joints - extremely rarely. Over the course of several years, the swelling of the diarthrosis gradually increases, moderate pain is observed (severe pain is usually associated with trauma). Defiguration of the joint appears, during the period of exacerbation - effusion, soreness, local hyperthermia, limitation of mobility. X-ray often does not detect changes. In extremely rare cases, degenerative changes with osteoporosis are detected, which resemble superficial erosions.

During laboratory examination during the period of exacerbation of the disease, an increase in ESR is possible. Synovial fluid is xanthochromic with an admixture of blood. The diagnosis of PVS can be made on the basis of a biopsy of the synovial membrane: nodular proliferation, hemosiderosis, and infiltration by mononuclear cells are characteristic.

Treatment. Synovectomy is indicated only in cases of severe joint damage, as relapse occurs in 30% of cases. In general, synovitis is treated with medication.

Suprapatellar synovitis

Suprapatellar synovitis occurs against the background of advanced bursitis. Symptoms begin to manifest themselves on the first or second day after the injury. This occurs when fluid accumulates in the tissues in sufficient quantities and deforms it. This entails difficulties in making movements. If measures are not taken in time, the inflammation will leave behind unpleasant consequences. Therefore, with certain symptoms, it is necessary to make a correct diagnosis.

For injured people, the signs of the disease are very insidious. This can lead to unpleasant consequences in the form of an incorrect diagnosis. Detection is complicated by the fact that the disease of knee diarthrosis has symptoms similar to similar injuries. With the disease, there is no inflammation of the skin, nor local elevated temperature. However, in order to be completely sure of the diagnosis, a puncture of the joint can be performed. A needle is inserted into the cavity of the joint to collect fluid and it is checked for the presence of certain blood cells.

Transient synovitis

Transient synovitis of the hip diarthrosis (TS KD) is a disease that often occurs in children aged 2 to 15 years. TS has recently taken an important place among other diseases of the musculoskeletal system, its frequency is 5.2 per 10 thousand children, so it is very important to start taking medications from an early age.

The causes of inflammation, unfortunately, have not been precisely established. There are contradictory views on the etiology and pathogenesis of TS KS in children, strategic directions for the prevention and therapy of this disease have not been determined. Most likely, inflammation of the synovial capsule of the joint has a toxic-allergic origin. In order to exclude this disease, it is necessary to take special means for prevention.

The disorder may have an acute, subacute and sometimes gradual onset. The lesion of the joint is also manifested by pain in the groin area, knee diarthrosis, along the hip, lameness is characteristic, limitation and pain in movements in the hip joint. In 5% of cases, damage to both joints is noted.

The provoking factor for the development of TS is often any infection, usually a respiratory infection, which the child suffered from 2-4 weeks before.

Exudative synovitis

Exudative synovitis develops most often with prolonged microtraumatization, in people whose work is associated with prolonged pressure on the elbow: engravers, draftsmen, miners. The fact is that the elbow joint is very reactive - even with minor trauma, it responds with excessive formation of scar tissue and ossifications. Prevention of bursitis is reduced to reducing pressure on the olecranon.

During the development of the pathological process, it may be accompanied by serous, hemorrhagic or purulent effusion, cellular proliferation, fibrosis, and sometimes calcification of necrotic tissues. The disease is extremely rare on its own; more often, it is combined with damage to other soft tissue structures. In most cases, there is simultaneous or sequential involvement of tendons in the pathological process that touch the inflamed joint bags - tendobursitis.

The inflammation is localized superficially. Mainly between bone protrusions and skin. Synovitis of this type belongs to the first group, as it is located between the skin and the olecranon.

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Serous synovitis

Serous synovitis is an inflammation of the synovial membrane of the joint capsule. It often occurs as a result of trauma, overwork of the animal due to early exploitation, acute rheumatism, brucellosis and other diseases.

Main clinical signs. The inflammatory process develops rapidly. This leads to severe hyperemia and swelling of the synovial membrane. The synovial villi, especially near the articular margin, are sharply hyperemic and swollen. The fibrous membrane of the diarthrosis capsule is significantly saturated with serous effusion. The effusion begins to accumulate in the joint cavity itself, sometimes cloudy, containing small-molecular proteins. The number of leukocytes in the synovial fluid increases, and the content of erythrocytes increases significantly. Subsequently, exfoliating endothelial cells of the synovial membrane are mixed with the effusion.

If the process is significantly delayed, fibrin exudation is observed. As for infiltration, it is initially significantly limited, then becomes diffuse. Paraarticular tissues become edematous.

Villous synovitis

Villous synovitis is a specific type of fibrohistiocytic proliferation. In this case, there is a formation with the formation of numerous villonodular structures. All of them have locally destructive growth. Women suffer from this inflammation twice as often as men. In 80% of cases, the knee joint suffers, other, mainly large, joints are affected less often. Rarely, a multiple process develops. About a quarter of affected patients have multiple cysts in the bone tissue around the diseased diarthrosis.

The cyst contains myxoid material or fluid. Sometimes, small zones of apparently unchanged synovial membrane are found in the affected joint. Villous outgrowths of this membrane vary in both size and shape. In addition, there may be massive nodules without or with villi. Erosions of the articular cartilage are also found. Under the microscope, the villi are covered with synoviocytes, abundantly containing hemosideric. The rods of the villi are densely penetrated by inflammatory infiltrate.

Hemosiderin may be found in the cytoplasm of macrophages and outside the cells. In some cases, macrophages with foamy cytoplasm and giant multinucleated cells are found. There are usually few lymphocytes. Mitotic figures can be found both in synoviocytes and in the cells of the inflammatory infiltrate. A certain part of the villi may be sclerosed, and occasionally entire foci of fibrosis are formed. Pigmented villous-nodular synovitis should be differentiated from traumatic or rheumatic lesions, hemarthrosis, and synovial sarcoma.

Secondary synovitis

Secondary synovitis occurs in patients suffering from osteoarthrosis. It is characterized by a light yellow effusion, transparent, of normal viscosity, with a dense mucin clot. The content of protein, glucose and lactic acid in the effusion is within normal limits, and the number of cells does not exceed 5000 in 1 mm3, with mononuclear cells prevailing over polymorphonuclear leukocytes.

Inflammation occurs periodically. It is characterized by slight swelling, fever, and pain. All these symptoms persist for 3-4 days, in some cases they last for 10-15. In some patients, depending on the nature of the lesion and working conditions, inflammatory changes in the joint (secondary suppuration) can recur every 2-3 months. All this leads to the development of sclerotic changes in the synovial membrane. This process has a negative effect on the functional state of the synovial fluid and cartilage tissue. Over time, fibrous changes occur in the periarticular tissues. At the last stage of the process, individual fragments of coarse osteophytes can break off and be free in the joint cavity. When they get into the joint space, the formations cause sharp pain, and the patient loses the ability to move.

Positive pains in the affected diarthrosis recur secondary suppuration. This condition is characterized by displacement of the limb axis, limitation of active and passive movement in the joints. This leads to hypotrophy of regional muscles, which, along with thickening of periarticular tissues, displacement of the patella, contributes to the deformation of the joint. The most pronounced violations of the specified parameters of muscle function are characteristic of relapse, at a later stage of the disease.

Purulent synovitis

Purulent synovitis often occurs after injuries, bruises and other damage to the diarthrosis. It can develop when the process moves from paraarticular tissues, tendon sheaths, synovial bursae communicating with the joint. Metastatic purulent inflammations are observed in sepsis, postpartum infection, myitis, paratyphoid fever, omphalophlebitis, etc.

The diagnosis is made solely on the basis of clinical signs and anamnestic data. The correctness of its establishment, if necessary, is confirmed by puncturing the joint and examining the punctate. At the initial stage of the lesion, when macroscopic changes in the synovium are difficult to establish, a qualitative test with trichloroacetic acid is used. For this, 3-5 ml of a 5 or 10% solution of the said acid are poured into a test tube and 2-3 drops of the punctate are added there, which, under the action of the acid, coagulates and disintegrates into small lumps that quickly settle to the bottom of the test tube. The upper part of the solution in the test tube remains almost transparent. Drops of synovium that were removed from a healthy diarthrosis also coagulate when added to the said solution, but the resulting loose clot does not disintegrate into lumps and does not settle to the bottom of the test tube.

Proliferative synovitis

Proliferative synovitis is the most common form of the disease. It occurs as a result of serious injuries. The membrane begins to produce a large amount of effusion. It is cloudy and contains a lot of protein. Pathological fluid most often accumulates in the hip joint. Synovitis is usually accompanied by increased pressure in the joint cavity. All this indicates that it is necessary to begin treatment as early as possible to prevent a violation of motor function in a person.

There are only 4 degrees of the proliferative process: thickening of the synovium without significant villous proliferation, the appearance of focal accumulations of villi against the background of thickened synovium, the villi cover most of the synovium of the lateral sections of the joint, leaving the upper section free, diffuse villous proliferation, which covers all sections of the diarthrosis.

In secondary knee inflammation in patients with osteoarthritis, a light yellow effusion of normal viscosity, transparent, with a dense mucin clot is observed.

Recurrent synovitis

Recurrent synovitis occurs when the acute form of the disease is poorly treated. It is accompanied by chronic forms of dropsy. At the same time, due to constant pressure on the synovial membrane, its hypotrophy and fibrosis develop. All this leads to a violation of the outflow and absorption capacity. A vicious circle arises, aggravating the course of suppuration and the development of degenerative-dystrophic changes in the joint.

As the inflammation progresses, the size of the pathological focus increases. With active treatment, this leads to a change in the ratio between the amount of the drug introduced into the joint and the mass of the affected tissue. On the other hand, this significantly worsens the circulation of fluid in the diarthrosis and makes it difficult for the drug to enter the inflammation zone. It is not so easy to eliminate this type of lesion. Because if it occurs once, then subsequent cases of repeated inflammation are not excluded.

Nodular synovitis

Nodular synovitis is mainly expressed in a tumor-like intra-articular node with a diameter of 1-8 cm, varying in shape and color. Men suffer from inflammation twice as often as women. As for the node, it consists of a large number of fibroblasts. Myofibroblasts, primitive mesenchymal cells and histiocytes, some of which contain hemosilerin or have foamy cytoplasm.

The number of lymphocytes may vary from insignificant to enormous. Giant multinucleated cells may be encountered. In addition, there are fields of collagenized, locally hyalinized fibrous tissue, in which foci of necrosis are sometimes encountered.

Localized nodular synovitis must be distinguished from synovial sarcoma. Rare diseases such as synovial chondromatosis, synovial chondrosarcoma, and intra-articular synovial sarcoma can also develop in the synovial membrane.

Villous synovitis

Villous synovitis is considered a slowly progressing disease. Villous and nodular growths gradually appear in the area of synovial membranes of joint bags and tendon sheaths at a young age. Large diarthroses are mainly affected, especially the knee. In addition to the synovial membranes, the process can spread to adjacent tissues, including the adjacent bone.

According to histological studies, PVNS can manifest itself in two types of cells: polyhedral mononuclear cells and giant multinuclear cells. Intracellular and extracellular deposits of hemosiderin and lipids are found in the lesion.

In some cases, lymphocytic infiltration fields are found. Monocellular cells have the appearance of histiocytes. There is no specific data on the origin of this type of disease.

Hypertrophic synovitis

Hypertrophic synovitis is a chronic type of disease. This diagnosis is made based on the morphological examination of the synovial membrane. As a result of prolonged irritation of the synovial membrane, there is a pronounced proliferation (hypertrophy) of its villi. This leads to numerous unpleasant symptoms.

In case of severe hypertrophic inflammation, when the thickness of the synovium reaches 1 cm or more, the use of this method before chemical synovectomy significantly facilitates the tolerability of the course, and the use as preoperative preparation significantly facilitates the performance of the surgical operation indicated in some cases. The treatment was carried out according to the following protocol: the drug was injected into the cavity of the diarthrosis twice a week in the amount of 5 ml of glucose solution into small joints (elbow, shoulder, ankle) and 10 ml into the knee joint. It is important to start treatment on time, or rather, to maintain the affected diarthrosis. Synovitis in this form gives a person a lot of inconvenience.

Synovitis in a child

Synovitis in a child is extremely rarely characterized by severe pain in the hip joint during movement, causing understandable anxiety and concern in parents. However, this ailment goes away on its own, usually within a week, without any serious consequences. It is necessary to exclude other possible causes of pain in the joint beforehand. In many cases, the exact cause of transient inflammation of the hip joint remains unknown. Presumably, the disorder is the result of activation of the immune system due to infection. There is an opinion that this is not a true joint infection, but joint inflammation. The cause of which is an upper respiratory tract infection. At the time when the immune system reacts to the infection. Whether it is flu or inflammation of the respiratory tract, the child experiences pain caused by temporary inflammation of the diarthrosis. This is a typical reaction of the immune system to viral infections. It is not possible to prevent it even with vaccination.

True transient synovitis usually does not lead to any serious complications. It is generally a short-term condition. It usually lasts no more than a week. Ultrasound or magnetic resonance imaging may reveal excess fluid in the hip joint, called effusion. It is important to confirm the diagnosis by examination as soon as possible. With inflammation, limping, pain, and discomfort usually go away after about a week. Most of them last for three to four days, but symptoms lasting up to seven days should not worry a person. If symptoms persist for longer than a week, further examination is necessary.

Why is synovitis dangerous?

Do you know why synovitis is dangerous? It is difficult to answer this question unequivocally. Because much depends on the location of the disease. Thus, suppuration of the knee joint is dangerous because of its location. The fact is that when moving, a person takes all the load on the knee.

When an injury of any kind occurs, inflammation may occur. It is easy to detect that it is the knee joint that is inflamed. The first symptoms appear on the second day. Initially, pain syndrome occurs. It is not sharp at all, but similar to aching and prolonged. When diagnosing, the main thing is not to make a mistake and not to confuse it with another disorder.

Unpleasant sensations may be accompanied by elevated body temperature and redness in the area of inflammation. The diagnosis is made exclusively by the attending physician. In general, the disease is not dangerous if it is treated immediately. Therefore, the main danger lies in the neglect of the disease. If it is diagnosed in time and treatment begins, no problems will arise.

Diagnosis of synovitis

Diagnosis of synovitis includes a specific algorithm.

The first step is an examination. The specialist identifies changes in the size of the joint, its deformation, redness of the skin, increased temperature, pain during palpation and movement, as well as limited mobility of the diarthrosis and other changes.

Then laboratory tests are carried out. In case of intensively developing infectious processes, it is possible to detect inflammatory changes in general and biochemical blood tests. In case of allergic manifestations, it is easy to detect an increase in eosinophils in the blood, immunological shifts (increase in immunoglobulins of class E). If the process has developed against the background of rheumatoid arthritis, then the corresponding biochemical markers are determined.

The X-ray method is included in a number of diagnostic measures to identify the disease. Computer and magnetic resonance imaging, ultrasound examination reveal the expansion of the joint cavity, in some cases it can be found in it.

Puncture of the junction is the final stage of diagnostics. Moreover, it is the main diagnostic method for detecting inflammation. Depending on the obtained fluid, it is possible to determine the nature of the exudate, identify the infectious agent and determine its sensitivity to antibacterial drugs. In many cases, puncture is also used for therapeutic purposes. Arthroscopy can be performed simultaneously with puncture. Arthrography, artropneumography, and biopsy are used as additional research methods.

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Echo signs of synovitis

Echo signs of synovitis completely depend on the location of the inflammation. Thus, first of all, the diarthrosis itself suffers. Inflammation and damage to healthy tissue can occur there. Moreover, the formation of effusion is not excluded. As a rule, it contains a lot of protein.

In general, it is difficult to say for sure about echo signs. After all, as was said above, they completely depend on the location of the inflammation and its predecessor. Because the damage can develop against the background of an existing disease and become a sign of a complication. In other cases, the problem arises due to a serious injury, especially in athletes.

Only the attending physician can conduct diagnostics and view certain changes. Based on the data obtained, all "deformations" are noted and the correct diagnosis is made.

Treatment of synovitis

Treatment of synovitis in patients should be comprehensive. First, the disturbed anatomical relationships are eliminated and then the metabolic shifts in the joint are corrected. As for the question of conservative or surgical treatment, in each individual case it is necessary to decide individually depending on the severity of the damage, the nature of secondary intra-articular changes and other reasons. If the indications for surgery have been confirmed, then it is necessary to proceed to the consideration of the first stage of inflammation elimination. Naturally, a full course of drug correction of metabolic disorders of the internal environment of the joint, as well as effective restorative treatment.

Primary indications include early joint puncture with synovial evacuation and joint immobilization with a pressure bandage or patella. In some cases, more rigid joint stabilization with rest splints is required for 5-7 days with the use of hypothermia (cold) for the first few days. As for long-term immobilization, it is undesirable without indications, as complications may arise.

Prevention of synovitis

Prevention of synovitis consists of timely treatment of inflammatory diseases that may cause it.

You should be careful during sports training, avoid falls and injuries, and eat a balanced diet to strengthen the ligamentous apparatus.

If you receive any herbs, you must immediately go to the hospital. The fact is that inflammation in an advanced form easily leads to the development of this disease. This must be understood.

In most cases, everything depends on the people themselves. If a person does not monitor their health and does not eliminate the consequences of injuries, then the disease can easily overtake. Moreover, not all people pay attention to the first signs of the disease. This only aggravates the situation and leads to a chronic form. Therefore, at the slightest injury, it is necessary to immediately contact a medical center.

Synovitis prognosis

The prognosis of synovitis depends entirely on the type of disease. In acute forms, with correct and timely treatment, the symptoms of the disease are completely reversible.

If synovitis is recurrent or chronic, then with prolonged existence of hydrarthrosis, the joint ligaments are stretched, it becomes loose. All these changes can lead to subluxation or even dislocation. Due to the destruction of the covering cartilage, deforming arthrosis and joint contracture may develop.

Severe infectious forms threaten human life. They require urgent medical attention and treatment. As a result of purulent parasynovitis and panarthritis, wrinkling and scarring of the surrounding tissues develops, disrupting the functions of the joint. Relapses of the process and diarthrosis contractures are possible even after surgical intervention. In general, in most cases the prognosis is favorable. But for this to really happen, it is necessary to start treatment on time.